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.