Abstract
Abstract Background The wall echo shadow (WES) triad, also known as the double-arc-shadow sign consists of a well-defined near wall, echos from stones immediately beneath the wall, and posterior shadowing caused by strong echoes from stones in the gallbladder fossa. It has been used for over 20 years as a nonspecific finding suggestive of a gallbladder lumen filled with either multiple stones or one large stone (Miller et al. J Emerg Med 30(1):69–74, 2006; Blaivas et al. Acad Emerg Med 10(6):1020–1023, 1999; Raptopoulos et al. AJR Am J Roentgenol 138(2):275–278, 1982). In the past, the WES triad has been correlated with underlying chronic cholecystitis. However, there are no studies that compare clinical findings to a gold standard such as surgical pathology. Case reports Three cases of the WES triad were reviewed at New York Medical Hospital of Queens over a 16-month period.
Highlights
Background The wall echo shadow (WES) triad, known as the double-arc-shadow sign consists of a welldefined near wall, echos from stones immediately beneath the wall, and posterior shadowing caused by strong echoes from stones in the gallbladder fossa
Initial vital signs were significant for tachycardia of 112 beats/min
Laboratory results were significant for elevated white blood cell count of 20.1 K/lL
Summary
The wall echo shadow (WES) triad, known as the double-arc-shadow sign consists of a welldefined near wall, echos from stones immediately beneath the wall, and posterior shadowing caused by strong echoes from stones in the gallbladder fossa. The WES triad has been correlated with underlying chronic cholecystitis. Case reports Three cases of the WES triad were reviewed at New York Medical Hospital of Queens over a 16-month period. Keywords WES Á Wall-echo-shadow Á Emergency ultrasound Á Cholelithiasis Á Cholecysititis Á Gallstones A 79-year-old female presented to the Emergency Department (ED) with right upper quadrant (RUQ) abdominal pain radiating to the right flank for 2 weeks.
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