42 year-old female with new onset right upper quadrant pain with history of acute hepatic failure secondary to Tylenol overdose. LIVER: The liver parenchyma is coarse. There is a focal hyperechogenic geographic region measuring 5.7 cm without mass effect, compatible with focal fatty infiltration. The remainder of the liver is coarse. The liver is normal in size, measuring 16.8 cm in the craniocaudal dimension. The liver capsule is smooth. There is normal hepatopetal portal venous blood flow at 20 cm/sec.BILIARY TRACT: No extrahepatic biliary ductal dilatation with common bile duct measuring 4 mm at the level of the pancreatic head. A normally distended gallbladder is present with sludge. There is mild diffuse wall thickening up to 5 mm markedly improved from the prior study. There may be a small amount of pericholecystic fluid, but no focal tenderness.PANCREAS: The visualized pancreatic head and body are normal.SPLEEN: The spleen measures 10.8 cm without a focal abnormality evident.RIGHT KIDNEY: The right kidney measures 14-cm in length with no hydronephrosis, shadowing calculus or discrete lesion evident. Echogenic cortex. OTHER: The left kidney measures 12.7 cm in length without hydronephrosis, shadowing calculus or discrete lesion. Echogenic cortex.There is a trace amount of ascites. Small left pleural effusion.
1. Gallbladder sludge, moderate yet improved diffuse gallbladder wall thickening without focal tenderness; overall, these findings are not specific for acute cholecystitis. 2. Coarse hepatic parenchyma with suspected focus of focal fatty infiltration is compatible with diffuse parenchymal dysfunction. 3. Trace ascites. Small left pleural effusion. 4. Echogenic renal cortices compatible with medical renal disease. 