73 year old female with history of metastatic breast cancer abdominal pain, cholestasis. Evaluate for biliary obstruction. Limited exam as patient is laying in left lateral decubitus position and minimally responsive.LIVER: Coarse heterogeneous echotexture of the liver measuring 15.5 cm in length with numerous hypodense solid lesions seen diffusely throughout the liver most consistent with metastatic disease which has progressed from prior CT study dated 10/6/2014. Main portal vein is patent with appropriate directional flow; peak velocity measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: Multiple shadowing stones within the gallbladder. No pericholecystic fluid. No gallbladder wall thickening. Common duct measures 6 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Distal body and tail of the pancreas are obscured by overlying bowel gas. The remaining visualized portions are unremarkable.RIGHT KIDNEY: Measures 9.1 cm in length. No hydronephrosis or shadowing calculi noted.OTHER: Left kidney and spleen are not visualized due to patient positioning.
1. Multiple solid lesions throughout the liver are most consistent with metastatic disease with interval progression compared to prior CT study dated 10/6/2014. Heterogeneous echotexture of the liver parenchyma suggestive of parenchymal dysfunction/fatty infiltration. No biliary obstruction.2. Cholelithiasis with no evidence of cholecystitis. Findings were discussed with Dr. Erica Mackenzie by phone on 3/23/2015 at 3:50 PM. 