74-year-old male patient with history of myeloproliferative disorder, CHF, with acutely elevated INR. Evaluate portal flow, signs of embolic obstruction. LIVER: The liver measures 17.3 cm in length and has a coarsened echotexture. Main portal vein flow is hepatopetal and measures 0.2 m/s. The hepatic veins are dilated.GALLBLADDER, BILIARY TRACT: Numerous gallstones are noted within the neck of the gallbladder. There is no gallbladder wall thickening or pericholecystic fluid. No intra- or extrahepatic biliary ductal dilatation is identified. The common bile duct measures 3 mm in diameter.PANCREAS: The pancreas is not visualized.RIGHT KIDNEY: The right kidney measures 9.8 cm in length. Renal cortical echogenicity is increased. No evidence of hydronephrosis.OTHER: Left kidney measures 9.9 cm in length and contains a 2.9 x 3.2 cyst, similar to the prior study. Renal cortical echogenicity is increased. No evidence of hydronephrosis.The spleen is enlarged measuring 20.1 cm in length.A right pleural effusion is seen.
1. Cholelithiasis without sonographic evidence of acute cholecystitis.2. Patent portal vein with hepatopetal flow. Coarsened hepatic echotexture suggestive of hepatic parenchymal dysfunction.3. Splenomegaly.4. Medical renal disease. 5. Small right pleural effusion.