The POCUS Kingdom

Ultrasonography is a visual discipline and metaphors relating to familiar analogous items such as animals make recognition of normal and abnormal images easier. They also serve as teaching aids, enhancing memory retention of the learners. Some authors use the term “ultrasound pareidolia” to describe this concept. The ‘POCUS Kingdom’ section is dedicated to such interesting comparisons.

Kidney and Bladder

Another Dromedary hump
Twin kidney appearance: perinephric hematoma
ACKD = acquired cystic kidney disease
Kidney on Fire appearance: Normal Power Doppler
Hydronephrosis appearing like a scary face

Other abdominal organs

Gall bladder and portal vein appearing like an exclamation mark!
Another example of Banana peel
Another example looking more like a goat head
Another bunny head
Another Double-barrel shotgun sign (IVC and aorta from lateral aspect)
Triple barrel view (dilated hepatic vein in addition to Ao and IVC)
Liver and IVC long axis appearing like a fish head or snake head
IVC ‘smoke’ seen in heart failure due to stasis/rouleaux formation (also seen in healthy thin individuals when using high-resolution US machines)
Snake thrombus in the IVC secondary to renal cell carcinoma
Screaming face liver: Mouth = plethoric IVC, eyes = hepatic veins, cheek spot = portal
Sun and the bird (RUQ transverse)
2 moons in the sky (liver): Plethoric IVC and liver cyst

Heart

2 fish mouths
“Swinging heart” in pericardial effusion: echo equivalent of electrical alternans
Parachute MV (short axis)
Large septated pericardial effusion in subcostal view: heart in web appearance
Arrows point to pulmonary veins
Subcostal bicaval (Snail) view
Note spade-shaped left ventricular cavity in diastole
Retroaortic anomalous coronary (RAC) sign or tram track sign (pay attention to the LVOT area)
Arrow points to mitral annular calcification (popcorn sign). Also note pericardial effusion.

Lung

Another whale tail + spine sign
Pac-Man shaped lung
Rt. pleural effusion from subxiphoid view: Dinosaur head sign (effusion = mouth, collapsed lung = tongue, IVC = eye, liver = face)
Curtain sign: Normally aerated supradiaphragmatic lung (A-lines) moving over the diaphragm and liver/spleen. Usually lost in pleural effusion/basal consolidation.
‘Light beam’ sign: a thick hyperechoic band of confluent B-lines arising from a portion of the pleural line that is relatively smooth. Typically seen in COVID19

Vascular and others

IJ vein wine bottle appearance: the neck is used to estimate the RAP (column height)
IJ vein paint brush appearance (a wariant of wine bottle)
Appearance of pedal edema is similar to that of cellulitis
Police siren sign: alternating red-blue pattern (only D-wave below the baseline) indicating severe hepatic vein congestion
Another Hepatic police siren
Portal vein police siren sign
Thyroid transverse