65-year-old male with gram-negative rod sepsis. Evaluate for biliary cause. LIVER: The liver is mildly coarse in echogenicity. It is normal in size measuring 15.8 cm in the craniocaudal dimension. No intrahepatic biliary ductal dilatation or focal hepatic lesion is evident. Normal hepatopetal portal venous blood flow at 31 cm/sec.BILIARY TRACT: A normally distended gallbladder is present without wall thickening, or pericholecystic fluid. Evaluation for focal tenderness is limited by the patient's mental status.Minimal sludge and possible non-shadowing gallstone.No extrahepatic biliary ductal dilatation, measuring 4 mm.PANCREAS: The visualized pancreatic body and head are unremarkable. There is mild dilatation of the pancreatic duct, measuring 3 mm. There may be a small amount of peripancreatic fluid posteriorly, correlate with lipase.SPLEEN: The spleen measures 10.2 cm in length without a discrete abnormality.RIGHT KIDNEY: The right kidney measures 11.6 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident.OTHER: The left kidney measures 11.5 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident. Color Doppler demonstrates hilar blood flow.Bilateral pleural effusions are noted.
1. Biliary sludge and possible gallstone without other specific findings of acute cholecystitis, given the limited evaluation for focal tenderness in the patient's current state.2. Mild pancreatic ductal dilatation and possible peripancreatic fluid. Correlate with lipase.3. No biliary ductal dilatation.4. Bilateral pleural effusions. 