74-year-old male patient with chronic ascites, abdominal pain. Evaluate for source of abdominal pain. LIVER: The liver measures 15.4 cm in length and demonstrates slightly coarsened parenchymal echotexture. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.3 m/sec.GALLBLADDER, BILIARY TRACT: There are gallstones with borderline gallbladder wall thickening measuring 4 mm, which is non-specific in the setting of ascites. No pericholecystic fluid is identified. The gallbladder is not hydropic. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 4 mm in diameter.PANCREAS: The pancreas is poorly visualized on this examination.RIGHT KIDNEY: The right kidney measures 9.8 cm in length and demonstrates increased cortical echogenicity. No evidence of hydronephrosis. OTHER: The left kidney measures 9.9 cm in length and demonstrates increased cortical echogenicity. No evidence of hydronephrosis. There is a 4.3 x 3.0 x 2.4 cm left upper pole renal cyst.The spleen measures 17.5 cm in length.There is minimal ascites and a right pleural effusion. Catheter noted in the IVC.
1. Cholelithiasis without specific inflammatory changes to suggest acute cholecystitis.2. Coarsened hepatic echotexture which can be seen with hepatic parenchymal dysfunction.3. Splenomegaly and minimal ascites.4. Medical renal disease.5. Right pleural effusion.