53-year-old male with a history of altered mental status and elevated bilirubin. LIVER: The liver echotexture is mildly coarsened. No focal hepatic lesion or biliary ductal dilatation. Normal hepatic size, measuring 18.8 cm in craniocaudal dimension. Perihepatic ascites. Pulsatile normally oriented portal venous blood flow up to 40 cm/sec. BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common duct measuring 4 mm. The gallbladder appears contracted and full of shadowing gallstones and sludge. No pericholecystic fluid. Evaluation for focal tenderness is limited by the patient's mental status.PANCREAS: Limited evaluation of the pancreatic head is unremarkable.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 10.9 cm in length without hydronephrosis, shadowing nephrolithiasis or focal lesion identified. OTHER: The spleen is normal in size measure 11.4 cm. It is partially obscured. The left kidney is partially obscured, measuring 10.2 cm without gross hydronephrosis.The urinary bladder is collapsed with a Foley. Pelvic ascites. Bilateral pleural effusions.
1. The gallbladder appears partially contracted with gallstones/sludge. No significant gallbladder wall thickening or pericholecystic fluid to suggest acute inflammation. Evaluation for focal tenderness is limited by the patient's mental state. 2. Pulsatile portal venous blood flow is unchanged.3. Ascites and pleural effusions.