Discussion Author: Jason Rexroad
The WES triad consists of visualization of the gallbladder wall, the echo of a gallstone within the gallbladder, and the posterior acoustic shadow caused by the stone. This sign indicates the presence of gallstones within a contracted bladder and is helpful in differentiating an otherwise difficult to locate gallbladder with stones from a loop of bowel containing gas (1). The presence of the sign may also represent a single large gallstone or multiple smaller stones filling the gallbladder lumen, which is incompletely visualized. Also called the double-arc-shadow-sign, the gallbladder wall appears as a curvilinear echogenic line in the near field of the transducer while the edge of the gallstones form a farfield echogenic line (2,3). The hypoechoic space separating these two echogenic lines represents passive interspersed bile. In some instances, only one echogenic line is seen. This may be due to calcification within the gallbladder wall (porcelain gallbladder). Poor axial resolution may also cause this appearance of a single line (3). Another mimic of the WES sign is nonvisualization of a contracted gallbladder with visualization of echoes from the duodenal wall in which the duodenal wall and the air within the duodenal lumen are echogenic and result in acoustic shadowing. In this case, the patient can drink a glass of water while the sonographer scans so that echogenic bowel can distinguished from a true WES sign (3).
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