History of pancreatic cancer status post ERCP presenting with fever. LIVER: The liver is heterogeneously coarse and echogenic limiting evaluation for a focal lesion. No intrahepatic biliary ductal dilatation. Several punctate probable calcifications. Attenuated portal vein with intact hepatopedal portal venous blood flow at ~20 cm/second. Mild perihepatic ascites.BILIARY TRACT: Partially distended gallbladder with sludge wall thickening and mild pericholecystic fluid. Evaluation for focal tenderness is limited by patient's altered mental state. No extrahepatic biliary ductal dilatation.PANCREAS: The pancreas is obscured by overlying bowel gas.SPLEEN: The spleen is normal in size measuring 11 cm without a focal abnormality.RIGHT KIDNEY: The right kidney measures 10.5 cm. It is mildly echogenic without hydronephrosis or shadowing nephrolithiasis. OTHER: The left kidney measures 11.3 cm. It is mildly echogenic without hydronephrosis or shadowing nephrolithiasis.
1. Partially distended gallbladder with sludge wall thickening and mild pericholecystic fluid. Evaluation for focal tenderness is limited by patient's altered mental status. Findings raise the possibly of acute cholecystitis.2. Heterogeneously coarse and echogenic liver parenchyma suggests parenchymal dysfunction/infiltrative disease, however limits evaluation for a focal lesion. Attenuated portal vein with intact hepatopedal portal venous blood flow. No biliary ductal dilatation. If further evaluation is clinically warranted a CT and/or MR should be considered.3. Echogenic kidneys suggesting medical renal disease.