Male; 67 years old. Reason: Does this patient have hepatosplenomegaly and ascites? History: 67 year old man with insulin dependent diabetes mellitus and recent 20 pound weight loss. History of hepatitis about 30 years ago. Evaluate liver and spleen. LIVER: The liver measures 13.0 cm in length. The liver contour is smooth. The liver parenchyma is coarse and echogenic. Within the left lobe of the liver, adjacent to the gallbladder fossa is an ill-defined hypoechoic area with increased vascularity on color Doppler. There is no ascites.The main portal vein is patent with a peak velocity of 0.31 m/sec.BILIARY TRACT: A large, non-mobile mass (4.8 x 1.9 cm) with internal vascularity occupies much of the gallbladder lumen. This mass is inseparable from the hypoechoic hepatic lesion described above. The common duct measures 5 mm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The head and body of the pancreas are unremarkable. The tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 13.4 cm in length and contains a 2.4 x 2.1 x 2.4 cm hypodense lesion.RIGHT KIDNEY: The right kidney measures local 11.2 cm in length. The cortex is normal in echogenicity. There is no hydronephrosis, shadowing renal stone, or worrisome mass identified. OTHER: The left kidney measures 11.3 cm in length. The cortex is normal in echogenicity. At least two simple cysts are seen within the kidney. The cyst in the upper pole measures 2.7 x 1.7 x 2.1 cm, the lower pole cyst measures 1.8 x 1.6 x 1.9 cm. There is no hydronephrosis, shadowing renal stone, or worrisome mass identified.
1.Large, nonmobile, vascular mass occupying much of the gallbladder lumen inseparable from hypoechoic adjacent liver lesion. These findings are concerning for gallbladder carcinoma with possible hepatic invasion. Follow up with cross-sectional imaging is recommended.2.Mild splenomegaly with indeterminate 2.4 cm hypodense splenic lesion. 3.Coarse, echogenic liver compatible with hepatic steatosis.These findings were discussed by telephone with Dr. Rogers on 2/18/2015 at 12:00 pmI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.