Leukocytosis. Status post ERCP with stent placement. LIVER: Diffusely heterogeneous parenchymal echogenicity. 17 cm in length. The previously seen focal lesions on CT are not evident by ultrasound. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Cholelithiasis. No gallbladder wall thickening or sonographic Murphy's sign.PANCREAS: No sonographic abnormality evident in the visualized pancreatic body. The head and and tail are obscured by bowel gas, including the patient's known pancreatic head mass.KIDNEYS: The right kidney is 5.7 cm in length, with an inferior pole cyst. The left kidney is not fully visualized. The renal parenchyma is markedly echogenic. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 7.6 cm in length, without focal lesions evident.OTHER: Mild to moderate ascites is again seen.
1. No biliary ductal dilation.2. Heterogeneous hepatic echogenicity compatible with parenchymal dysfunction and/or metastatic disease, similar to prior.3. Cholelithiasis without specific evidence of cholecystitis.4. Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease.