Reason: Evaluate for cirrhosis vs hcc, eval for renal disease worsening Cr History: hcv cirrhosis, acute renal failure Examination mildly limited by constraints positioning patient.LIVER: The liver measures 14.3 cm in length. The liver parenchymal echotexture is coarse. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.17 m/s.BILIARY TRACT: Sludge/debris is present within the gallbladder. No significant gallbladder wall thickening. Common tail artifact associated with the gallbladder wall suggesting adenomyomatosis. The sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 2 mm in diameter.PANCREAS: Pancreas poorly visualized.SPLEEN: No significant abnormalities noted. The spleen measures 8.5 cm in length. RIGHT KIDNEY: Kidney measures 7.3 cm in length. Increased parenchymal echogenicity. No frank hydronephrosis.LEFT KIDNEY: Left kidney is not well-visualized.ABDOMINAL AORTA: The proximal aorta measures 1.0 cm AP x 0.7 cm transverse. The middle aorta measures 1.1 cm in AP dimension. The distal aorta is not well-visualized.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: Large amount of ascites, increased from prior. Foley catheter in collapsed bladder.
1.Limited exam.2.Cirrhotic liver morphology without focal lesions identified. Large amount of ascites, increased.3.Increased echogenicity of right kidney compatible with medical renal disease. Left kidney not well visualized. No frank hydronephrosis on the right.