Presentation
Pain in right upper quadrant with fever
Patient Data
Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.
Echogenic area in gallbladder fossa represents gall bladder with multiple small gallstones. Posterior acoustic shadowing is present beneath the gallstones. Thin rim of hypoechoic area between two echogenic lining could represent bile between gall bladder wall and calculi.
Case Discussion
Wall-echo-shadow (WES) sign represents a well-defined echogenic gall bladder wall (W), echoes (E) from gallstones beneath the gall bladder wall, and prominent posterior acoustic shadowing (S). The hypoechoic area beneath the echogenic gall bladder wall and calculi represents interpostioned bile. This sign is sufficient for the diagnosis of cholelithiasis.
This sign suggests a large gallstone or multiple small stones filling the entire gall bladder lumen. If the WES sign is not recognized, and gall bladder may be misinterpreted as a bowel loop.
Pitfalls are:
calcification of gall bladder wall as in porcelain gallbladder
collapsed gallbladder
portion of duodenum appears echogenic with posterior shadowing.