Ultrasound: Signs

Aortic ultrasound

• Seagull Sign
  • Take-off of the celiac trunk and bifurcation to hepatic and splenic arteries

Bladder ultrasound

• Twinkle Sign
  • Rapid alternation of color immediately behind a stationary echogenic object, acquiring a false appearance of movement
  • Can indicate stone in the UVJ

Cardiac ultrasound

• McConnell's Sign
  • Right apical hyperkinesis in acute right heart strain with relative akinesis of the RV free wall, as seen in the apical 4 chamber view
  • Typically in the setting of large PE

• D- Sign
  • Noted when the left ventricle forms a "D" rather than its typical round shape, in the parasternal short axis view
  • Represents right ventricular strain

Biliary ultrasound

• Playboy Bunny Sign
  • Confluence of the middle and right hepatic veins into the inferior vena cava
• Exclamation Point Sign
  • Portal vein and Main Lobar Fissure (MLF)
• Mickey Mouse Sign
  • Portal Vein (face), CBD (right ear), and hepatic artery (left ear)
• SIN Sign
  • Stone-in-neck
• Double Barrel Shotgun Sign
  • CBD is markedly dilated to same size as the portal vein, giving “double barrel shotgun” appearance
• WES (Wall-Echo-Shadow) Sign
  • A contracted gallbladder filled with stones

Ultrasound: Lungs and Thoracic

• Spine Sign
  • Anechoic or hypoechoic fluid is present in the pleural space allowing continued visualization of the spine superior to the diaphragm

• Seashore Sign
  • Using M-Mode over the pleura, this sign represents normal lung sliding, demonstrating a clear transition point between the sea (the immobile chest wall) and the shore (mobile pleura)

• Bar code Sign
  • Using M-Mode over the pleura, this sign represents absent lung sliding, including pneumothorax, showing no transition in movement from the immobile chest wall to the immobile pleura creating a bar code effect

Ultrasound: MSK

• Swirling
  • Probe pressure creates turbulence in abscess air/fluid level

Other

• Donut Sign
  • Thicker outer ring is made up of the thickened wall of the returning limb of the intussusceptum and the thinner outer wall of the intussuscipiens

Ultrasound: Pelvic

• Donut Sign (Bagel Sign in OB literature)
  • Ectopic pregnancy
• Cheerio Sign
  • TVUS finding of thin walled cystic structure measuring ~6 mm; double decidual sign; + pregnancy (IUP vs NIUP)

Renal ultrasound

• Twinkle Sign
  • Rapid alternation of color immediately behind a stationary echogenic object, acquiring a false appearance of movement
  • Can indicate stone in the UVJ

Testicular ultrasound

• Buddy View
  • Both testicles in view for landmarking

Vasculature

• Target Sign
  • Needle tip in the middle of the vessel
• Swinging Bell
  • Needle tip back and forth within vessel
• Bubbles
  • Saline flush with probe over heart for vessel placement confirmation

See Also

• Ultrasound (Main)