Mickey Mouse Sign

Real-time free-hand ultrasound scanning is one of the current indispensable imaging tools. Training radiology residents and technologists (ultrasonog-raphers) how to do ultrasound examinations can be a challenge. Royal Bartrum and Harte Crow are two of the best teachers of this craft. Their book, Real-Time Ultrasound, is an excellent introductory text. One of the practical points they illustrated in the book is the Mickey Mouse sign (Figure 1). They used this sign to help residents and others find the common bile duct more easily. Prior to their description, longitudinal scanning with attempts to trace the hepatic vascular and biliary ductal structures was the norm, but this was often confusing. The Mickey Mouse sign, seen in transverse scans, was more easily reproducible (Bartrum, personal communication). ‘The portal vein is Mickey Mouse’s face, the main bile duct is his right ear, and the hepatic artery his left ear. Once you have this relationship in mind, it is no trick to find the duct [main bile duct] quickly in nearly every patient.’ ¹ Figure 1 (A) A cross-section of the porta hepatis resembles Mickey Mouse (PV, portal vein; HA hepatic artery; BD, main bile duct). (B) The transverse or ‘Mickey Mouse’ view is the easiest way to identify the main bile duct (arrow). Reprinted from Bartrum and Crow<xref ref-type="bibr" rid="ref54_1"> ¹ </xref>. Inflammatory diseases of the biliary system. <italic>Semin. in USD,</italic> 1980, 1, 102–8, with the permission of the author and W.B. Saunders Company https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9781003076568/34c29fd5-5662-4e8f-b58c-badd7fa5d724/content/fig54_1_B.jpg"/>