UMEM Educational Pearls


A 41 year old female presenting with intermittent RUQ abdominal pain for 1 week. An ultrasound of the right upper quadrant was performed. What is the diagnosis ?


Answer: WES sign

WES sign stands for Wall Echo Shadow sign. It is a triad of:

1- Thick echogenic gall bladder wall (W)

2- Echoes filling the gallbladder (E)

3- A posterior acoustic shadow (S)

  • It is suggestive of either one big stone or multiple stones filling the gallbladder.
  • This sign can be mistaken for either a bowel loop or an empty and contracted gallbladder.
  • To differentiate between WES and a bowel loop, look for visible bowel peristalsis.

Rybicki, F. J. (2000). The WES Sign 1. Radiology, 214(3), 881-882.