Wall Echo Shadow (WES): Amy Cameron and Christina Cheng PA-C | Boston, MA

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A middle-aged F presents with epigastric abdominal pain radiating to her back. Symptoms for a month, but getting worse. Nausea, but no fevers or emesis. Noted to have epigastric discomfort, but an equivocal Murphy's sign.

POCUS Biliary shows 2 hyper-echogenic (white) crescent lines representing the surface of the gallbladder and a large gallstone, with a small strip of hypo-echoic (black) bile in between the two white crescents (the wall-echo-shadow, WES sign). A big gallstone is casting a large acoustic shadow.

SONO Pearls: The WES sign (stone filled gallbladder) could be confused with a loop of bowel.