37 year-old female with abdominal distention. Evaluate for liver dysfunction and for ascites. LIVER: Echogenicity of the hepatic parenchyma is minimally coarse without focal mass. The liver measures 12.7 centimeters in length. No dilatation or cystic changes are noted of the intrahepatic or extrahepatic biliary ducts.The main portal vein is patent with normal hepatopedal flow and velocity of 25.6 cm/s.GALLBLADDER, BILIARY TRACT: The gallbladder is normal in appearance. There is no pericholecystic fluid, gallbladder wall thickening or cholelithiasis. The common bile duct measures 0.4 cm in diameter. PANCREAS: The head and proximal body of the pancreas are normal. The tail is obscured by bowel gas.SPLEEN: The spleen is normal in echogenicity and measures 8.7 cm in length. RIGHT KIDNEY: The right kidney measures 12.6 cm in length. Again seen is marked multifocal dilatation of the renal calyces and infundibula, without dilatation of the renal pelvis or ureter, unchanged compared to the previous study. The cortex is markedly atrophic with increased echogenicity. The amount of debris within the dilated calyces of the mid and lower moieties has decreased.LEFT KIDNEY: The left kidney measures 8.2 cm in length. There is mild pelvic calyceal dilatation. Echogenicity is increased. A subcentimeter midpole cyst without septation or solid component is again noted.URINARY BLADDER: The urinary bladder is normal in appearance.OTHER: There is no free or loculated fluid. Left adnexal cystic structure is again noted, incompletely visualized by ultrasound.
Severe hydronephrotic replacement of the right kidney with decreased amount of debris seen on today's examination. Mild pelvicalyceal dilatation and increased echogenicity of the left kidney are unchanged in appearance. No ascites.