Female 72 years old; Reason: gall bladder evaluation History: elevated bilirubin LIVER: The liver measures 17.0 cm in length. There is coarse echogenicity of the liver parenchyma. No focal hepatic lesions. Mild intrahepatic ductal dilation is seen which has progressed since the prior CT though the common bile duct is normal in caliber. The main portal vein is patent with normal hepatopetal flow. GALLBLADDER/BILIARY TRACT: The gallbladder wall is distended and asymmetrically thickened measuring up to 5mm. No stones are seen but the gallbladder is partially filled with sludge. No pericholecystic fluid. The common bile duct measures 1.3 mm in diameter. Negative sonographic Murphy's sign.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 8.9 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 11.3 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 11.5 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: No significant abnormality noted.
1. Asymmetrical gall bladder wall thickening is nonspecific. If the clinical service has high suspicion of tumor invasion, this could be further investigated with MRCP. We cannot rule out acute cholecystitis though this would be atypical. 2. Mild intrahepatic biliary duct dilation which has progressed since recent CT