72-year-old male with chronic viral hepatitis C, confusion and ascites on physical exam. Exam is somewhat limited by the patient's inability to cooperate.LIVER:Liver is small, echogenic and nodular in contour consistent with cirrhosis. No gross, focal hepatic abnormality although the patient was unable to fully cooperate. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: Gallbladder contains a stone in the region of the neck, minimally mobile, but without significant gallbladder distention or wall thickening. The visualized biliary tract is normal in caliber.PANCREAS: Limited due to bowel gas.SPLEEN: Enlarged, measuring 18.3 cm in length.KIDNEYS: The right kidney measures approximately 12.3 cm in length. Kidney appears mildly echogenic as noted on the prior exam consistent with parenchymal disease. In the extreme lower pole of the right kidney, there is a small cystic area that may have a focus of calcification. This is unchanged from the prior exam.The left kidney demonstrates significant parenchymal loss and associated caliectasis, particularly in the lower pole. There are likely small cortical cysts as well. Renal length is difficult to assess. No obvious dilatation of the upper pole collecting system or renal pelvis. Patient has a history of significant, obstructive left nephrolithiasis and this is likely chronic. Previously noted calcification in the extreme lower pole not visualized on today's exam.ABDOMINAL AORTA: Normal in caliber without aneurysm.INFERIOR VENA CAVA: Visualized inferior vena cava is patent by color Doppler.OTHER: No ascites. Bladder decompressed with Foley catheter in place. Right pleural effusion.
Cirrhotic appearing liver with patent main portal vein.. There is associated splenomegaly.Renal parenchymal disease with renal cysts as well as chronic caliectasis involving the lower pole of the left kidney.Gallstone in the gallbladder neck without wall thickening or pericholecystic fluid.Right pleural effusion.