Background: The lateral femoral notch sign is associated with roughly 25% of acute ACL tears with increasing incidence in younger athletes with high impact or pivot injuries. It is described as a deeper vertex than the normal terminal sulcus or exaggerated posterior extension of the terminal sulcus.

Case report: A 13 year old male athlete presented to clinic 7 days following a knee injury at football practice. His physical exam wasequivocal, notable for a mild effusion and a trace lachman maneuver. Radiographs revealed a lateral notch sign, increasing suspicion for an ACL tear. Complete ACL tear was confirmed by MRI and the patient proceeded with reconstruction.

Conclusion: Radiographs should be performed on young athletes with an acute knee injury and should be scrutinized for a lateral notch sign. The presence of a pathological lateral notch should increase the clinical suspicion for an ACL tear as well as warrant further evaluation with an MRI. Distinguishing a pathological lateral notch from a normal terminal sulcus is an important skill for every clinician. In cases with an unclear physical exam and borderline measurements of the lateral notch, clinicians should consider obtaining radiographs of the contra lateral side for comparison.

Hepatitis B is a potentially life threatening liver infection caused by the Hepatitis B Virus (HBV). It is a major global health problem. It is not possible, on clinical grounds, to differentiate HBV from hepatitis caused by other viral agents and, hence, laboratory confirmation of the diagnosis is essential. Sonographically, gallbladder f indings of increased wall thickness and pericholecystic edema are very common. It can be used as auxiliary f indings in case of acute viral hepatitis; especially when serological testing facility is not available it can back up in the diagnosis. A twelve year old Sudanese male, developed classic symptoms of acute HBV. In the emergency department, he presents with nausea for 9 days accompanied by vomiting, anorexia, fatigue, mild upper abdominal pain, loss of appetite, jaundice with pale stool, and dark urine. Laboratory investigation revealed an increased level of White Blood Cells (WBC), Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), and total serum bilirubin. Serological testing was positive for the Hepatitis B (HB) Surface Antigen (HBsAg), HB e Antigen (HBeAg), and anti-HBc (both IgM and IgG). Abdominal ultrasound revealed marked edematous gallbladder wall thickening. Also, gallbladder hyperemia was detected by Doppler ultrasonography. The patient received his initial HB vaccinations and was discharged with considerable improvement in biochemical tests. Gall bladder findings on ultrasound can be used to diagnose acute HBV when serological tests are not available.