26-year-old female patient with right upper quadrant pain, apparent gallstones on bedside ultrasound, elevated transaminases. Evaluate for choledocholithiasis, cholelithiasis, cholecystitis. LIVER: The liver measures 20.7 cm in length. Hepatic parenchymal echogenicity is increased and coarsened in echotexture. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: There are gallstones without gallbladder wall thickening or pericholecystic fluid. No intrahepatic biliary ductal dilatation is seen. The visualized common duct measures 5-6 mm in diameter.PANCREAS: The head and body of the pancreas demonstrate normal echogenicity. The tail is obscured by overlying bowel gas. A small peripancreatic lymph node is noted.RIGHT KIDNEY: The right kidney measures 10.5 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 10.5 cm in length. No evidence of hydronephrosis.The spleen measures 9.9 cm in length.
1. Increased hepatic parenchymal echogenicity which can be seen with hepatic steatosis/hepatic parenchymal dysfunction.2. Cholelithiasis without sonographic evidence of acute cholecystitis. Mild prominence of the common bile duct, depending on the patient's last meal. 