47-year-old male with elevated bilirubin. Evaluate for right upper quadrant abnormality. LIVER: Measures 18.2 cm in length. Increased hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: There is gallbladder wall thickening up to 0.6 cm. A punctate echogenic focus is noted in the gallbladder lumen which may possibly represent a small stone, however this is equivocal. There is no pericholecystic fluid or biliary ductal dilation.PANCREAS: The pancreas is incompletely imaged due to bowel gas. The imaged portions of the pancreas appear unremarkable. SPLEEN: Mildly enlarged spleen measures 14.7 cm, without discrete focal lesion.KIDNEY: Increased renal echogenicity without hydronephrosis, nephrolithiasis, or solid mass.OTHER: No significant abnormalities noted.
1. Marked gallbladder wall thickening raises suspicion of acute cholecystitis in this clinical setting. There is an equivocal small gallstone, and acalculous cholecystitis is also a differential consideration. 2. Increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease.3. Increased renal echogenicity consistent with medical renal disease, without hydronephrosis.4. Mild splenomegaly. 