84-year-old male with hyperbilirubinemia and lower extremity edema. Evaluate for cause of conjugated hyperbilirubinemia, concern for hepatic congestion secondary to heart failure. LIVER: Normal echogenicity of the liver measuring 13.3 cm in length. No focal hepatic lesions. Main portal vein is patent with appropriate directional flow; peak velocity measuring 0.3 m/sec with a pulsatile waveform likely due to congestive heart failure.GALLBLADDER, BILIARY TRACT: Gallbladder is not well distended limiting evaluation for wall thickening. Shadowing gallstones within the gallbladder. Focal adenomyosis of the gallbladder. No pericholecystic fluid. Sonographic Murphy's sign is negative. Common bile duct measures 5 mm in caliber. No intra-or extrahepatic biliary ductal dilatation. PANCREAS: Visualized portions of the pancreas are unremarkable.RIGHT KIDNEY: Mild increased echogenicity of the kidney measuring 9.2 centers in length. Cyst measures 3.8 cm x 3.9 cm x 3.6 cm. no hydronephrosis or shadowing calculi are noted.OTHER: Mild increased echogenicity of the left kidney measuring 10.4 cm in length. No hydronephrosis or shadowing calculi are noted.Normal echogenicity of the spleen measuring 11.1 cm in length.
1. Cholelithiasis with the gallbladder not well distended limiting evaluation for wall thickening, however there is no sonographic evidence of cholecystitis. 2. Patent portal vein with pulsatile waveform likely related to congestive heart failure.2. Mild increased echogenicity of the kidneys suggestive of parenchymal dysfunction. 