A 40 y/o G10P10 presents with RUQ pain worse with fatty foods.
- When evaluating for acute cholecystitis, what 5 sonographic findings do you look for?
- What is the Mickey Mouse sign?
- 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. 
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.
- 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]