WES sign
Background
The "wall echo shadow" (WES) sign is observed in patients with a contracted gallbladder around a large gallstone. There are two parallel hyperechoenic lines (Wall) separated by a hypoechoic space (Echo), and distal shadowing (Shadow) from the gallstone. Patients with multiple gallstones can also produce the finding if the gallbladder is contracted around them. The sign can distinguish a gallstone from a loop of bowel when the entirety of the gallbladder is not visible due to the large shadowing. [1][2]
Images
Instructions
Perform a Gallbladder Ultrasound