60-year-old male with SIRS. There is clinical concern for acute cholecystitis. LIVER:The liver measures approximately 14.2 cm. Hepatic parenchyma has normal echotexture. There is a hyperechoic lobulated well-defined focus in the left liver that respects the anterior aspect liver capsule measuring approximately 5.7 x 1.7 x 2.3 cm. No calcifications or internal vascularity. No intrahepatic biliary dilation or ascites. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended. No stone or sludge. Negative sonographic Murphy's sign. No pericholecystic fluid. Gallbladder wall measures 4.5 mm. The common bile duct measures approximately 3.7 mm.PANCREAS: Pancreas is obscured by overlying bowel gas.SPLEEN: The spleen measures approximately 8.6 cm without specific radiographic abnormality.KIDNEYS: The right kidney measures approximately 12.8 cm. The left kidney measures approximately 11.8 cm. There is a shadowing hyperechoic focus in the pelvis of the left kidney measuring approximately 1.1 x 0.9 x 1.3 cm, consistent with a renal stone. It is nonobstructing. Mild hydronephrosis on the right without shadowing calculi. OTHER: No significant abnormality noted.
1. No evidence of acute cholecystitis.2. Echogenic focus in the left lobe of the liver may represent a hemangioma however dedicated CT or MRI would be helpful for better characterization of this lesion.3. Mild hydronephrosis of the right kidney.4. Nonobstructive nephrolithiasis of the left kidney. No hydronephrosis.