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At the end of VUS and bladder emptying there can still be a “layer” of UCA lining the mucosa of the empty bladder. The configuration of the bladder in transverse section in combination with the remaining echogenic UCA resembles the mouth part of a “smile sign”. This sign indicates that there is still sufficient UCA in the bladder and if considered necessary a second filling with normal saline only would suffice to carry out cyclical VUS
