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This most commonly occurs at the diaphragm but the most problematic is the mirroring of the gallbladder into the thorax, especially when it’s a partial mirror image. In this case, the gallbladder can mimic pleural and pericardial effusion to the hasty sonographer.

Other places for mirror image, where generally a strong air–soft tissue interface exists, are on the far side of the heart when aerated lung is in direct opposition to the pericardium, and the urinary bladder against the colon or thin body wall. See Chapter 3 for more explanation and examples.