Female, 73 years old. AKI, LE edema, diastolic dysfunction, elevated transaminitis. LIVER: The liver measures 20.8 cm, with homogeneous echotexture. A right hepatic lobe mass measures 9.5 x 11.5 x 12.5 cm, heterogeneous with peripheral vascularity and a somewhat stellate central echotexture.The main portal vein is patent, with normal hepatopetal flow.GALLBLADDER, BILIARY TRACT: No intrahepatic or extrahepatic biliary ductal dilatation. The common bile duct measures 0.4 cm. Shadowing gallstones are noted. The gallbladder is contracted with normal wall thickness.PANCREAS: The visualized portions of the pancreas are normal.RIGHT KIDNEY: 11.8 cm in length, with increased cortical echogenicity. A solid-appearing lesion in the upper pole measures proximally 2 cm in diameter. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.2 cm in length with increased cortical echogenicity. No shadowing stones or hydronephrosis.SPLEEN: 7.0 cm in length, without focal lesion.ABDOMINAL AORTA: The abdominal aorta is normal in caliber throughout its course with extensive atherosclerotic calcification.INFERIOR VENA CAVA: The IVC is patent with normal directional flow, but is markedly narrowed by the large right hepatic mass.OTHER: No significant abnormality noted.
1.A large right hepatic lobe mass is indeterminate, and MRI is recommended for further evaluation. Associated displacement/narrowing of the IVC and hepatic veins.2.Solid-appearing right renal lesions are nonspecific and may represent heterogeneous renal parenchyma or a focal lesion, and can be further evaluated on MR imaging.3.Increased renal cortical echogenicity compatible with medical renal disease. No hydronephrosis.4.Cholelithiasis without evidence of acute cholecystitis.