76 years old, Male, Reason: evaluate biliary tree for obstruction; evaluate pancreas for abscess/pseuodocyst History: sepsis, elevated liver enzymes Technically difficult exam, especially in the left upper quadrant, due to patient's inability to lay decubitus and large body habitus.LIVER: The liver is enlarged measuring 22.1 cm in length. Innumerable confluent hypoechoic masses within the hepatic parenchyma are suspicious for metastatic malignancy. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.15 m/s.BILIARY TRACT: The gallbladder is collapsed without definite evidence of cholelithiasis. No evidence of cholecystitis. No evidence of intrahepatic or extra hepatic biliary ductal dilatation. The common bile duct measures 6 mm in diameter.PANCREAS: The pancreas is not well-visualized on this exam.SPLEEN: The spleen is not well visualized on this exam. RIGHT KIDNEY: Kidney measures 13.9 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: The left kidney is not well visualized.OTHER: No significant abnormalities noted.
1.Innumerable confluent hypoechoic masses in the liver are consistent with metastatic malignancy. 2.The gallbladder appears contracted without evidence of cholecystitis.