Female; 69 years old. Reason: nephrotic syndrome of unclear etiology, elevated liver enzymes. please eval for pathology History: BLE, weakness LIVER: The liver measures 14.9 cm in length. The liver has a smooth contour. The parenchyma is normal in echotexture. Within the left lobe of the liver there is a cluster of mildly complex cystic structures. The largest the cyst measures 2.4 x 1.9 x 1.9 cm. There is ascites. The portal vein is patent but and demonstrates hepatopetal flow with a peak velocity of 0.17 m/sec.BILIARY TRACT: The gallbladder has an anechoic lumen. There is no gallbladder wall thickening or pericholecystic fluid. Common duct measures 0.4 cm. There is no intrahepatic biliary ductal dilatation.PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 10.2 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. The left kidney measures 10.6 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 9.8 cm. in length. ABDOMINAL AORTA: Proximal: 2.0 x 1.7 x 2.4 cmMid: Obscured by overlying bowel gasDistal: 1.6 x 1.5 x 1.6 cmINFERIOR VENA CAVA: No significant abnormality noted.OTHER: There are bilateral pleural effusions.The urinary bladder is unremarkable.
1.A cluster of mildly complex cystic structures in the left liver may simply be related to a complex cyst/hamartoma however biliary cystadenoma remains a possibility.2.Ascites and bilateral pleural effusions.3.Echogenic kidneys bilaterally compatible with medical renal disease.