History of cholangiocarcinoma status post colostomy and bariatric surgery. Abdominal pain and nausea. LIVER: Coarse liver parenchyma. Large right hepatic lobe mass is better evaluated on recent CT. It measures approximately 8.9 x 9.1 cm. There is perihepatic ascites with septations and internal echogenicity. Multiple small vessels are noted in the region of the portal vein with hepatopedal portal venous blood flow.BILIARY TRACT: No extra hepatic biliary ductal dilatation with the common duct measuring 6 mm. Partially distended gallbladder with probable sludge. Nonspecific wall thickening in the setting of ascites. No shadowing gallstones.PANCREAS: The visualized pancreatic body and head is unremarkable.SPLEEN: The spleen measures 16.4 cm in length without a focal lesion. RIGHT KIDNEY: The right kidney measures 12.2 cm in length with a lobular contour. No hydronephrosis or shadowing nephrolithiasis. Color Doppler demonstrates hilar blood flow. OTHER: The left kidney measures 11.8 cm without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow.
1. Coarse liver parenchyma with large right hepatic lobe mass better evaluated on recent CT. Complex perihepatic ascites. Portal vein thrombosis with collateral vessel formation was better characterized on CT.2. Partially distended gallbladder with probable sludge and nonspecific wall thickening. Correlate clinically and with HIDA scan results for chronic cholecystitis.