58 years old, Female, Reason: RUQ US exam to evaluate biliary tree History: Abdominal distention in patient with HCV/EtOH cirrhosis, HIV LIVER: The liver measures 19 cm in length. The liver has a nodular contour with widened fissures. No definite focal liver lesion. The liver parenchyma is diffusely echogenic. Echogenic material consistent with a thrombus is again noted at the confluence of the splenic vein and SMV. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.2 m/s. There is trace ascites present.BILIARY TRACT: The gallbladder is hydropic, there is increased distention of the gallbladder since the prior study, now measuring 5 cm. There is sludge within the gallbladder and small cholelithiasis. The gallbladder wall is mildly diffusely thickened measuring 5 mm, which is nonspecific in the setting of cirrhosis and ascites. Per the ultrasound technologist, the sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 6 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 11 cm in length. RIGHT KIDNEY: Kidney measures 12 cm in length. Normal echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 13 cm in length. Normal echotexture. No hydronephrosis.
1.Cirrhotic liver without definite focal hepatic lesion.2.Hydropic gallbladder with circumferential wall thickening as above, nonspecific in setting of chronic liver disease and ascites. Correlation with patient's clinical history/physical exam recommended and if there is continued clinical concern, a HIDA scan may be considered for further evaluation.3.Thrombus at the confluence of the splenic vein and SMV is similar in appearance to prior study.