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

  • Another Portal triad
  • 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)
  • 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

Heart

  • “Swinging heart” in pericardial effusion: echo equivalent of electrical alternans
  • Arrows point to pulmonary veins
  • Subcostal bicaval view appearing like a snail
  • Note spade-shaped left ventricular cavity in diastole

Lung

  • Another whale tail + spine sign
  • 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

  • Another Mickey
  • 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
  • Police siren sign: portal vein