60 years old, Male, Reason: 60 yo M hx with bilirubin, liver enzyme elevation. Pls eval for gallbladder stones, mass, or liver abnormality. History: asymptomatic now, but one episode of abdominal pain last month LIVER: The liver is enlarged measuring 20.5 cm cm in length. The echogenicity of the liver mildly increased suggesting fatty infiltration. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.3 m/s.BILIARY TRACT: The gallbladder is not well visualized due to wall echo shadow sign consistent with a gallstone filled gallbladder. If further evaluation of the gallbladder is clinically warranted CT is recommended. The sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 7 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: A small splenule is present. The spleen measures 13.4 cm in length. RIGHT KIDNEY: Kidney measures 13.4 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 13.4 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.
1.Wall echo shadow sign consistent with gallstone filled gallbladder, less likely porcelain gallbladder. No definite evidence of cholecystitis. If further evaluation of the gallbladder is clinically warranted CT is recommended.2.Increased echogenicity of the liver consistent with fatty infiltration.