This is a 16 y/o F w/ RUQ pain and scleral icterus. This week’s image shows the WES sign which stands for Wall-Echo-Shadow. As you can see, sometimes the gallbladder is contracted around a large gallstone and all you see is the gallbladder wall, hyperechoic gallstone followed by shadowing behind the stone, preventing you from seeing the posterior wall of the gallbladder. In the second image, you can see a thin hypo echoic space between the gallbladder wall and the stone representing a small amount of bile.

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