77-year-old male patient with suspected acute cholecystitis. History of hepatitis B. LIVER: The liver measures 12.5 in length and has increased echogenicity. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder is distended and contains what appears to be a combination of sludge and shadowing gallstones. The gallbladder wall measures approximately 3-4 mm in thickness. The patient reported mild pain with sonographic palpation. There is no significant pericholecystic fluid. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 5 mm in diameter.PANCREAS: The pancreas is poorly visualized on this examination.RIGHT KIDNEY: The right kidney measures 8.6 in length. No evidence of hydronephrosis. OTHER: The left kidney measures 10.2 cm in length. No evidence of hydronephrosis.The spleen measures 8.7 in length.
1. Hydropic gallbladder containing gallstones though no definite pericholecystic inflammatory changes; these findings may represent early acute cholecystitis. Correlate with lab values and consider HIDA scan if clinically warranted.2. Hepatic steatosis.