Female 65 years old; Reason: c/f portal vein thrombosis in pt with advanced cirrhosis History: pt w/ cirrhosis c/f portal vein thrombosis 2/2 reversal of flow on previous u/s LIVER: The liver measures 10.1 cm in length. There is increased, coarse, heterogeneous echogenicity of the liver parenchyma with cirrhotic morphology. Multiple solid parenchymal lesions seen with "bull's-eye" appearance being an echogenic center surrounded by hypoechoic rim. The left-sided lesion measures approximate 1.7 x 1.7 x 1.6 cm which is increased from the prior study and the right-sided lesion measures proximal 2.1 x 2.4 x 2.0 cm. . No intrahepatic ductal dilation is seen. The main portal vein is patent with hepatofugal flow measured at 10.5 cm/s. There is no evidence of thrombus. GALLBLADDER/BILIARY TRACT: The gallbladder wall is circumferentially thickened. No stones are seen, however dependent hypoechoic material partially fills the gallbladder, consistent with sludge. No pericholecystic fluid. The common bile duct measures 1.9 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 10.1 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 8.0 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 8.6 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: There is marked ascites again noted.
1. Hepatofugal flow of the portal vein as described above without evidence of thrombus.2. Cirrhotic morphology with lesions concerning for metastases which have slightly increased in size since the prior examination.3. Diffuse gallbladder wall thickening which is nonspecific in the setting of ascites.