Reason: 14 y/o M with mixed phenotype ALL; concerns for cholecystitis; liver toxicity; VOD; please comment on presence of ascites History: RUQ and RLQ abdominal tenderness and guarding LIMITED ABDOMENLIVER: The liver is mildly echogenic with a slightly coarsened echotexture, measuring 16.2 cm in length. No focal liver masses are identified. There is no significant intrahepatic biliary ductal dilatation. BILIARY TRACT: The gallbladder is nondistended and filled with debris, as seen previously. Mild echogenicity in the gallbladder fossa may reflect focal fat deposition. The gallbladder wall is upper limits of normal in thickness, measuring 3 mm. No definite pericholecystic fluid is identified. The common bile duct is 4 mm in diameter, within normal limits.PANCREAS: The pancreatic head is visualized and appears normal. The distal pancreas is obscured.SPLEEN: No significant abnormalities noted. KIDNEYS: The right kidney is normal in size and echogenicity without hydronephrosis or nephrolithiasis. The left kidney is also normal in appearance, without hydronephrosis or nephrolithiasis. OTHER: No free fluid.
1.Echogenic and coarsened texture of the liver, compatible with an infiltrative process, as can be seen in hepatic steatosis among other etiologies.2.Mild gallbladder distention and gallbladder debris/sludge without definite evidence of acute cholecystitis. No biliary ductal dilatation.3.No free fluid.