The “eccentric ripple sign” is a newly identified diagnostic indicator for venous pseudoaneurysms, specifically in patients with a history of bariatric surgery (BAARISh). This sign refers to the unique ripple-like appearance seen on ultrasound imaging of pseudoaneurysms, which may help in differentiating these from other vascular abnormalities. Recognizing this sign can enhance diagnostic accuracy and improve clinical management of patients with venous complications following bariatric procedures.