Male 65 years old Reason: 65 y/o male with hepatitis c, with reported history of liver mass, eval for liver mass or biliary obstruction History: belly pain melena LIVER: The background liver parenchyma is heterogeneous and echogenic suggestive of diffuse parenchymal disease. Multiple hepatic masses are visualized. Within the right hepatic lobe there is a mildly hypoechoic and heterogeneous liver mass, which appears encapsulated measuring 11.0 x 8.6 x 10.2 cm. There is a second heterogeneous liver mass in the right hepatic lobe adjacent to the first, larger mass. This second mass measures 5.1 x 4.9 x 5.7 cm. An anechoic, minimally complex, cystic-appearing lesion is present in the far right lobe of the liver measuring 2.1 x 4.1 x 1.6 cm. Main portal vein is patent with normal directional flow and a peak velocity of 18.3 cm/s.BILIARY TRACT: Common bile duct measures 6 mm. The gallbladder is not visualized, possibly obscured by liver masses. No intrahepatic or extrahepatic biliary ductal dilatation.PANCREAS: Pancreas is not well-visualized secondary to overlying bowel gas.SPLEEN: Spleen measures 9.7 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 11.9 cm in length. Anechoic mid right renal cyst measures 1.8 x 1.6 x 1.8 cm. Anechoic left superior renal cyst cyst measures 2.6 x 2.8 x 2.9 cm. The left kidney measures 11.4 cm. OTHER: No significant abnormalities noted.
Multiple large solid hepatic masses. Findings most likely represent hepatocellular carcinoma. Benign hepatic masses are considered much less likely. Dedicated hepatic MRI is recommended for further evaluation. Findings discussed with Dr. Dia in ER at 1610 on 10/5/2016.