Ultrasound: Signs

Ultrasound: Appendix

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

DVT ultrasound

FAST exam

Foreign Body

Biliary ultrasound

  • Playboy Bunny Sign
    • Confluence of the middle and right hepatic veins into the inferior vena cava
  • Exclamation Point Sign
    • Portal vein and medial longitudinal fasciculus (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: In Shock and Hypotension & IVC ultrasound

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

Ultrasound: Nerves

Ocular ultrasound

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