Increasing LFTs. Generalized abdominal pain. LIVER: The liver is normal in morphology. It is mildly coarse in echotexture suggesting parenchymal dysfunction. It is normal in size measuring 16.1 cm in length. No focal lesion is evident. Normal hepatopedal portal venous blood flow at 15 cm/s. The hepatic veins are prominent suggesting increased right-sided heart pressure.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation with the common duct measuring approximately 4 mm.Partially distended gallbladder with laminated wall thickening up to 5 mm. Shadowing gallstones are present. Minimal pericholecystic fluid. No focal tenderness was present, however the patient was medicated.PANCREAS: The visualized portions of the pancreatic head are unremarkable. Otherwise it is obscured by overlying bowel gas shadowing.SPLEEN: The spleen is normal in size measuring 6 cm in length.RIGHT KIDNEY: The right kidney measures 9.9 cm in length without hydronephrosis or shadowing nephrolithiasis. OTHER: The left kidney measures 9.8 cm in length without hydronephrosis or shadowing nephrolithiasis.Small right pleural effusion.
Cholelithiasis, gallbladder wall thickening and pericholecystic fluid may be seen in the setting of acute cholecystitis versus liver disease. Lack of focal tenderness may be due to patient's pain medication. If further imaging is clinically warranted a HIDA scan should be considered.Small right pleural effusion.Coarse liver echotexture suggestive of parenchymal dysfunction. Prominent hepatic veins may represent elevated right-sided heart pressure.