Liver failure. Known spontaneous left renal hemorrhage at outside hospital. LIVER: Cirrhotic liver morphology. Coarsened parenchymal echogenicity. No focal hepatic lesions. GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. The gallbladder is not well-visualized.PANCREAS: No sonographic abnormality evident in the visualized pancreatic head and neck. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney is 13.3 cm in length. The renal parenchyma is markedly echogenic. No suspicious renal lesions or hydronephrosis.The left kidney is 13.1 cm in length. No suspicious renal lesions. Mild hydronephrosis. A 12.5 x 8.3 x 5.4 cm hypoechoic collection extends from the inferior pole of the left kidney and is incompletely visualized.BLADDER: Collapsed with Foley catheter in place.SPLEEN: 12.6 cm in length, without focal lesions evident.ABDOMINAL AORTA: Patent. 2.2 cm in maximal diameter, without aneurysm. The distal most aorta is obscured by overlying bowel gas.INFERIOR VENA CAVA: Patent.OTHER: Moderate amount of ascites noted. Complex appearing right pleural effusion is partially imaged.DOPPLER
1. Cirrhosis with minimal detectable portal venous flow.2. 12 cm retroperitoneal collection at the inferior pole of the left kidney, compatible with hemorrhage given the clinical history. This is incompletely visualized by ultrasound and CT is recommended if more complete evaluation is warranted.3. Echogenic kidneys compatible with medical renal disease. Mild left-sided hydronephrosis.4. Moderate amount of ascites. Right pleural effusion.