November 2013 Case of the Month- Courtesy of Jenny Beck-Esmay

A 33yo male presents with 2 weeks of intermittent mid epigastric/RUQ pain which acutely worsened the night prior to presentation. No other complaints. He denied any PMH. Social history was significant for tobacco use. Patient was originally from Ecuador. His presenting VS were as follows:

BP 160/88 HR 84 RR 18 O2 98% T 97.2

On exam patient had RUQ TTP but no other abnormal findings. Bedside US was performed which revealed the following:

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WES3

The above images demonstrate the “WES” sign, or “Wall-Echo-Shadow” sign, which is seen when the gallbladder is contracted while full of stones.  The sign consists of a clearly defined near wall, echoes from stones within the gallbladder and strong echoes from the stones. The WES sign is diagnostic of cholelithiasis and can be suggestive of cholecystitis, however often the gallbladder wall is within normal limits.  In our patient’s case, the gallbladder wall was normal, there was no visible pericholecystic fluid and his CBD was within normal limits.  He was evaluated by surgery, given dietary precautions, analgesia and scheduled for outpatient follow up.

Traveling internationally to spread some ultrasound knowledge, skills and research!

NYU/Bellevue made an appearance at the INDUS-EM conference in Kerala, India, spreading the word on some ongoing research as well as teaching during the Ultrasound course!
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Next stop was Kigali, Rwanda, reunited with our own Joe Novik and recent graduate Nicole with a dedicated Ultrasound Workshop for the pediatric residents and the Ultrasound applications for the Trauma Symposium for the Emergency Medicine residents.
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