Reason: cholecystitis History: critically ill, persistent reflux of bile LIVER: The liver measures 18.3 cm in length, enlarged. Diffusely heterogeneous hepatic parenchyma. The portal vein is patent with normal directional hepatopetal portal venous blood flow, peak velocity 25.8 cm/s with a pulsatile waveform. No focal mass.GALLBLADDER, BILIARY TRACT: The gallbladder is collapsed with shadowing stones. No evidence of pericholecystic fluid or inflammation. The gallbladder wall measures 0.2 cm. The common bile duct measures 0.4 cm. Negative sonographic Murphy's sign. No biliary ductal dilatation.PANCREAS: Obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 11.3 cm. Echogenic renal parenchyma. No shadowing stones or hydronephrosis. Small 1.0 x 0.9 x 1.0 cm lower pole cyst. No injury isLEFT KIDNEY: The left kidney measures 11.3 cm. Echogenic renal parenchyma. No shadowing stones or hydronephrosis.OTHER: Status post splenectomy with multiple rounded hypoechoic lesions in the left upper quadrant, representing accessory splenules. No ascites. Left pleural effusion.
1. Heterogeneous hepatic parenchyma with a pulsatile portal venous waveform, consistent with hepatic venous congestion.2. Cholelithiasis without evidence of acute cholecystitis.3. Echogenic renal parenchyma, consistent with medical renal disease.4. Left pleural effusion.