Right upper quadrant tenderness. Evaluate liver in the setting of congestive heart failure. LIVER: The liver measures 16.8 cm in length. The liver parenchymal echotexture is normal. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.25 m/s. The hepatic veins are prominent which can be seen with elevated right heart pressures.BILIARY TRACT: The gallbladder appears contracted and contains gallstones. No associated gallbladder wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 3 mm in diameter.PANCREAS: There is an ovoid soft tissue echogenicity structure adjacent to the pancreas measuring 3.0 x 1.5 x 2.1 cm which appears to have a fatty hilum and thus is favored to reflect a reactive lymph node, however this could be better evaluated with contrast-enhanced CT or MRI if clinically indicated.SPLEEN: No significant abnormalities noted.The spleen measures 10.0 cm in length. RIGHT KIDNEY: Kidney measures 12.2 cm in length. Increased parenchymal echogenicity is suggestive of medical renal disease/parenchymal dysfunction. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 11.7 cm in length. Increased parenchymal echogenicity is suggestive of medical renal disease/parenchymal dysfunction. There is an ovoid structure interposed between the left kidney and spleen which may be a splenule as seen on prior CT.ABDOMINAL AORTA: The abdominal aorta appears patent and is normal in caliber measuring 2.1 x 1.7 cm, 1.7 x 1.6 cm, and 1.9 x 1.8 cm in the proximal, middle, and distal portions.INFERIOR VENA CAVA: Slightly dilated but patent.BLADDER: Not well distended.OTHER: No significant abnormality noted.
1.Cholelithiasis without sonographic evidence of acute cholecystitis.2.Echogenic kidneys suggestive of medical renal disease.3.Findings suggestive of elevated right heart pressures.4.Probable peripancreatic prominent lymph node, favor reactive, although could be further evaluated with dedicated cross-sectional imaging as clinically warranted.