Introduction

‘Walking man’ sign EUS from D1

This image depicts an endoscopic ultrasound (EUS) view from the duodenal bulb, showing several key anatomical structures labeled:

            •          CBD: Common bile duct

            •          HOP: Head of pancreas

            •          MPD: Main pancreatic duct

            •          SMV: Superior mesenteric vein

            •          PORTAL V: Portal vein

            •          SPLENIC V: Splenic vein

Fig 1

The “walking man” sign refers to the unique appearance created by the convergence of the splenic vein, superior mesenteric vein, and portal vein. In this EUS image, these vessels can be seen coming together, forming a characteristic shape that resembles a walking figure. The legs being SMV and the Splenic veins and Portal vein being trunk. This is a common landmark when performing EUS from the duodenal bulb to assess the portal venous system, biliary tree, and pancreas.

This anatomical view is important for orienting during procedures and for identifying pathology in the pancreaticobiliary region. This peculiar appearance is a common sight on scanning from the Duodenal bulb but the terminology has not been attributed.

Reference

1.  Endosonography Text Book, Fourth Edition; 2019; Robert H. Hawes, Paul Fockens and Shyam Varadarajulu

2.  Radiology Key - EUS of the Normal Pancreas

3.  SpringerLink - Standard Scanning Techniques for EUS Examination- New Challenges in Gastrointestinal Endoscopy.