Interesting ultrasound of the RUQ…

February 24, 2013

Abdomen/Pelvis, Non-Trauma, Ultrasound

This is a right upper quadrant (RUQ) ultrasound in a middle-aged female presenting with upper abdominal pain:

West Sign GB

What the heck is going on here?

In this image there is an example of a “Wes” sign.  Wes sign is when you see two echogenic lines separated by a hypoechoic space at the expected wall of the gallbladder (1).  This sign is often found with a large calculi occupying the entire lumen of the gallbladder (or when the gallbladder is contracted around a large calculi).  This case, however, is somewhat interesting in that there isn’t an acoustic shadow beyond the majority of the hyperechoic mass inside the gallbladder.  You can the typical expected acoustic shadow near the neck of the gallbladder in this image.  Our thoughts as well as radiology’s thoughts were that this image represents a large calculus at the neck with dense sludge or a bunch of very small calculi filling the rest of the gallbladder (thus allowing sound waves to penetrate beyond).  Fortunately for the patient her pain got much better, she was discharged and is expected to get an elective cholecystectomy in the near future.  Here is a link to an article discussing the “Wes” sign from the Radiology Society of North America:

Wes Sign

Author:  Russell Jones, MD


1.  Rybicki F.  The Wes Sign.  Radiology 2000; 214: 881-882.

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EMREMS: Radiology in Emergency Medicine

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