Ultrasound: Signs

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

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

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

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)

Authors

Aaron Snyder, Neil Young, Daniel Ostermayer