Elevated lactic acid. Concern for cholangitis or cholecystitis. LIVER: Diffuse metastatic disease throughout the liver. 17 cm in length. There is reversed flow in the main portal vein, measuring approximately 18 cm/s.GALLBLADDER, BILIARY TRACT: Common bile duct at the upper limits of normal in width at 7 mm. The gallbladder is collapsed, with several small gallstones. Minimal gallbladder wall thickening is non-specific in the setting of ascites.PANCREAS: No sonographic abnormality evident in the visualized pancreatic head and neck. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney is 10.6 cm in length. The left kidney is not well visualized. The renal parenchyma is echogenic bilaterally. No suspicious renal lesions are evident. No hydronephrosis is seen. SPLEEN: 10.2 cm in length, without focal lesions evident.OTHER: Moderate ascites is noted.
1. Diffuse metastatic disease throughout the liver, with reversal of portal venous flow.2. Moderate ascites.3. Cholelithiasis without specific evidence of cholecystitis.4. Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease.