82-year-old male with unexplained weight loss and transaminitis. LIVER:The liver measures approximately 13.5 cm. Increased echogenicity of the parenchyma. No intrahepatic biliary dilation. Mild ascites is noted. Portal vein is patent with pulsatile hepatopedal flow. There is prominence of the intrahepatic veins and inferior vena cava.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended with an anechoic lumen. There is an approximately 1.9 x 1.7 cm well-defined hyperechoic lesion within the lumen of the gallbladder that cast a shadow, consistent with choledocholithiasis or a sludge ball. Does not appear to be impacted. The gallbladder wall measures 1.3 cm. No pericholecystic fluid. Common duct measures 0.3 centimeters.PANCREAS: Unable to evaluate the pancreas due to overlying bowel gas.SPLEEN: Measures 9.5 cm. No sonographic abnormalities.KIDNEYS: Right kidney measures 10.0 cm. Left kidney measures 12.3 cm. Unremarkable and echogenicity. No shadowing calculi or hydronephrosis.There are three large simple renal cysts around the left kidney, the largest measuring 4.9 x 4.4 x 3.5 cm. OTHER: No significant abnormality noted.
1. Increased echogenicity of the liver parenchyma consistent with fatty infiltration and chronic liver disease/parenchymal dysfunction.2. Mild ascites. 3. Gallbladder wall thickening which is nonspecific in the context of ascites. No other secondary signs of acute cholecystitis.4. Pulsatile portal vein and prominence of intrahepatic veins and inferior vena cava consistent with a congestive heart failure.5. Multiple left-sided simple renal cyst as described above.