55-year-old male patient with altered mental status on admission, widespread amyloid. Assess for cirrhosis. The patient has abdominal situs inversus.LIVER: The liver measures 21.3 cm in length and has a coarsened echotexture. Small amount of perihepatic fluid is noted. Main portal vein flow is hepatopetal and measures 0.1 m/s.GALLBLADDER, BILIARY TRACT: The gallbladder contains sludge. The gallbladder wall measures 4 mm in diameter, which is borderline thickened though nonspecific in the setting of ascites. Sonographic Murphy's sign is negative. The common hepatic duct measures 4 mm in diameter.PANCREAS: The head of pancreas appears normal. The tail is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 12.9 cm in length and has increased renal cortical echogenicity. No evidence of hydronephrosis.OTHER: The left kidney measures 10.2 cm in length and has increased cortical echogenicity. No evidence of hydronephrosis.The spleen measures 13.8 cm in length. A cystic area in the spleen measures 7.2 x 3.2 x 6.8 cm.
1. Abdominal situs inversus.2. Biliary sludge and borderline gallbladder wall thickening, which is non-specific in the setting of ascites.3. Hepatomegaly and perihepatic ascites.4. Cystic area in spleen may represent an old hematoma.5. Medical renal disease. 