77-year-old male with cholangiocarcinoma and prior removal of cholecystostomy tube. Now with sepsis. Evaluate for biliary dilatation or fluid collection. LIVER: Liver is normal in size but highly echogenic due to parenchymal disease. There are scattered masses present within the liver which have a "target" appearance with an echogenic center and hypoechoic rim. Although not specific, findings should be worrisome for metastatic disease. Infection is considered unlikely. Main portal vein is taking by color and spectral Doppler with appropriate flow direction.BILIARY TRACT: No biliary dilatation. The gallbladder is significantly thick-walled with a small amount of pericholecystic fluid. This could be related to prior cholecystostomy tube but certainly cholecystitis cannot be excluded. No shadowing gallstones are identified, and the wall does not appear hypervascular.PANCREAS: Limited by bowel gas.SPLEEN: Limited but normal in size.RIGHT KIDNEY: 14.5 cm in length including a 4 cm cyst in the upper pole. Kidney is echogenic consistent with parenchymal disease. No hydronephrosis. OTHER: Left kidney measures approximately 12.3 cm in length. Kidney is echogenic consistent with parenchymal disease with at least one cyst in the midportion.Trace of perihepatic fluid.
1. Trace of perihepatic fluid. Thick gallbladder wall. This could be related to prior drainage tube but cannot exclude acalculus cholecystitis.2. Presumed metastatic disease involving the liver.3. Echogenic kidneys with cysts.4. Echogenic liver