96-year-old female with sepsis. There is a clinical concern for cholecystitis. LIVER:Measures 19.1 cm. Prominent triads suggestive of parenchymal edema which can be seen in the setting of hepatitis or any infiltrative process. No focal mass. No intrahepatic biliary dilation.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended with an anechoic lumen. The wall measures 0.9 cm. There is some pericholecystic fluid. No stones or sludge. Common bile duct measures 0.3 cm. Sonographic Murphy's sign was equivocal as patient is unresponsive.PANCREAS: Evaluation of the pancreas is limited due to overlying bowel gas.SPLEEN: Measures 10.8 cm. No sonographic abnormalities.KIDNEYS: Right kidney measures 9.4 cm. Left kidney measures 9.5 cm. The kidneys are echogenic. No hydronephrosis, shadowing calculi, or focal mass.OTHER: There is a large right sided pleural effusion.
1. Prominent triads suggestive of parenchymal edema which can be seen in the setting of hepatitis or any infiltrative process.2. Gallbladder wall thickening and some pericholecystic fluid without cholelithiasis or ductal dilatation. Sonographic Murphy's sign equivocal as above. An acute inflammatory process cannot be excluded.3. Large right-sided pleural effusion.4. Echogenic kidneys consistent with medical renal disease/parenchymal dysfunction. No hydronephrosis.