63-year-old male with elevated bilirubin. Evaluate for gallstones common ascites. LIVER: Increased echogenicity of the liver measuring 18.0 cm in length. No hepatic lesions. Portal vein is patent with appropriate directional flow; peak velocity measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: Gallbladder is contracted containing stones. Gallbladder wall is mildly thickened measuring 4 mm in thickness. No pericholecystic fluid. Sonographic Murphy's sign is negative. Common bile duct is normal in caliber measuring 4 mm. No intra-extrahepatic biliary ductal dilatation.PANCREAS: Visualized portions of the pancreas are normal in echogenicity.RIGHT KIDNEY: Increased echogenicity of the right kidney measuring 11.5 cm in length. Focal echogenic focus in the lower pole is noted.OTHER: Normal echogenicity of the spleen measuring 13.9 cm in length. Increased echogenicity of the left kidney measuring 12.2 cm in length. Non obstructing 5-mm calculus is noted in the mid to upper pole.Abdominal ascites.Bilateral pleural effusions.
1. Increased echogenicity of the liver compatible with fatty infiltration.2. Contracted gallbladder with cholelithiasis. Mild thickening of the gallbladder wall is nonspecific in the setting of ascites. No pericholecystic fluid. Sonographic Murphy's sign is negative.3. Increased echogenicity of the kidneys suggestive of parenchymal dysfunction. Nonspecific echogenic focus in the lower pole of the right kidney may be a small AML or non shadowing stone. Nonobstructing calculus in the left kidney.4. Abdominal ascites and bilateral pleural effusions. 