71-year-old male with CT scan nodule liver, increased INR. Evaluate for liver changes in architecture, cause for increased INR. LIVER: Nodular contour of the liver with coarse echotexture. No focal hepatic lesions. Portal vein is patent with appropriate directional flow; peak velocity measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: Sludge noted within the gallbladder. No gallbladder wall thickening. No pericholecystic fluid. Sonographic Murphy's sign is negative. Common bile duct measures 3 mm in caliber. No intra or extrahepatic biliary ductal dilatation. PANCREAS: Visualized portions of the pancreas are unremarkable.RIGHT KIDNEY: Increased echogenicity of the right kidney measuring 13.2 cm. No hydronephrosis or shadowing calculus are noted. Right renal cyst measures 3.9 cm x 3.7 cm x 3.0 cm.OTHER: Increased echogenicity of the right kidney measuring 12.6 cm. no hydronephrosis or shadowing calculus are noted. Renal cyst measures 1.9 cm x 2.3 cm x 3.5 cm.Spleen is large measuring 18.6 m in length.Perihepatic ascites and bilateral pleural effusions.
1. Findings compatible chronic liver disease and cirrhotic liver morphology.2. Splenomegaly. 3. Increased renal echogenicity suggestive of parenchymal dysfunction. Bilateral renal cysts. 4. Perihepatic ascites and bilateral pleural effusions. 