Reason: cholecystitis History: RUQ pain, tenderness, large stone seen on bedside u/s, +U/S murphy LIVER: The liver measures 16.1 cm in length. The portal vein is patent with normal directional hepatopetal flow, peak velocity 36.9 cm/s. No focal masses.GALLBLADDER, BILIARY TRACT: There is a single echogenic stone in the gallbladder at the junction of the body and neck within a collapsed gallbladder. No pericholecystic fluid or inflammation. The gallbladder wall measures less than 3 mm. The common bile duct measures 4 mm proximally. No intrahepatic or extrahepatic biliary ductal dilatation. Positive sonographic Murphy's sign.PANCREAS: No significant abnormalities noted.KIDNEYS: The right kidney measures 9.1 cm. The left kidney measures 9.2 cm. Echogenic renal parenchyma bilaterally. No shadowing stones or hydronephrosis.OTHER: No ascites. The spleen measures 9.1 cm.
1. Cholelithiasis without visualized evidence of acute cholecystitis, however positive sonographic Murphy's sign raises the question of acute inflammation. HIDA scan could be obtained for further evaluation if clinically indicated.2. Echogenic renal parenchyma, consistent with medical renal disease.