74-year-old male with history of myeloproliferative disease and ascites. LIVER: Enlarged liver measures 21.1 cm in length. Increased hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow measuring 0.2 m/s, with an abnormal pulsatile waveform.BILIARY TRACT: Cholelithiasis. Mild gallbladder wall thickening but no sonographic Murphy sign. No biliary duct dilation.PANCREAS: Portions of the pancreas are not clearly visualized due to bowel gas. The visualized portions of the pancreas are unremarkable.SPLEEN: Enlarged spleen measures 20.1 cm in length. No focal lesions.KIDNEY: Increased renal echogenicity without hydronephrosis. Mildly complex left renal cyst measures 3.5 x 2.7 x 2.6 cm.OTHER: Mild ascites.
1.Hepatosplenomegaly with increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease.2.Patent portal vein with abnormal pulsatile waveform suggestive of elevated right-sided pressures.3.Cholelithiasis and mild gallbladder wall thickening favored to be secondary to liver disease or elevated right sided pressures. No additional specific findings to suggest acute cholecystitis. 4.Mildly complex left renal cyst, for which further evaluation with dedicated MRI or CT is suggested. Medical renal disease. 5.Mild ascites.