A 40 y/o G10P10 presents with RUQ pain worse with fatty foods.

  1. When evaluating for acute cholecystitis, what 5 sonographic findings do you look for?
  2. What is the Mickey Mouse sign?
  3. What is the mantle clock sign?

1. Gallstones/sludge, peri-cholecystic fluid, ant wall thickening, sonographic Murphy’s, enlarged CBD diameter.

One recently published prospective cross-sectional study (Villar et al., 2015) suggested simplifying the definition of a positive POCUS test to be presence of gallstones alone. With the simplified definition in evaluating for acute cholecystitis, POCUS had a sensitivity of 100% and NPV 100%. In other words, absence of gallstones alone rules out acute cholecystitis. [1]

2. Mickey Mouse sign refers to a short axis visualization of the portal triad.


3. Mantle clock sign refers to the appearance of the SMA in short axis view shortly after branching off the aorta.




  1. Villar J, Summers SM, Menchine MD, Fox JC, Wang R. The absence of gallstones on point-of-care ultrasound rules out acute cholecystitis. J Emerg Med. 2015 Jul. [Epub ahead of print]
  2. http://www.em.emory.edu/ultrasound/ImageWeek/Abdominal/mickey_mouse.html
  3. http://images.clipartpanda.com/mickey-mouse-clip-art-MICKEYD-600×600.jpg
  4. http://www.fpnotebook.com/mobile/surgery/Rad/UltrsndInAbdmnlArtcAnrysm.htm
  5. http://www.portablefireplace.com/images/P/Remington.png