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.

[2,3]

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

[4,5]

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Sources:

  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