Reason: is there hepatic/GB abnormality History: epigastric pain LIVER: The liver measures 15.3 cm in length. The liver demonstrates increased parenchymal echogenicity with coarsened echotexture. There is a round, hypoechoic area within the right lobe of the liver measuring up to approximately 4 cm seen only on a single image; it is unclear whether this is artifactual or represents a focal hepatic lesion. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.34 m/s.BILIARY TRACT: Cholelithiasis without associated significant gallbladder wall thickening or pericholecystic fluid. The sonographic Murphy's sign is negative. No intrahepatic biliary ductal dilatation. The common bile duct is mildly prominent both proximally and distally measuring up to 9 mm. No shadowing choledocholithiasis identified.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 9.6 cm in length. RIGHT KIDNEY: Kidney measures 10.3 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 11.8 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No significant abnormalities noted.
1.Cholelithiasis without sonographic evidence of acute cholecystitis. Prominent common bile duct without shadowing choledocholithiasis identified but distal CBD not well assessed due to adjacent bowel gas. MRCP may be considered for additional evaluation as clinically warranted.2.Increased hepatic echogenicity raising the possibility of parenchymal dysfunction/fatty infiltration.3.Possible hepatic lesion versus artifact in the right hepatic lobe (or possibly the right kidney).Findings discussed with the inpatient service, APN Anna at 8:48 a.m. on 12/15/16; possible hepatic lesion to be evaluated on forthcoming contrast-enhanced MRI/MRCP using liver protocol.