58-year-old female with right upper quadrant pain, elevated alkaline phosphatase. LIVER: Measures 20.2 in length. Increased hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: Small gallstones layer dependently within the gallbladder, without gallbladder wall thickening or pericholecystic fluid. There is dilation of the common bile duct proximally measuring up to 1.3 cm at the level of the porta hepatis. However, the distal common bile duct is not well visualized due to bowel gas.PANCREAS: The pancreas is incompletely imaged due to bowel gas. The imaged portions of the pancreas appear unremarkable. SPLEEN: Unremarkable in size and echogenicity. KIDNEY: No hydronephrosis, nephrolithiasis, or solid mass. OTHER: No significant abnormalities noted.
1. Cholelithiasis without specific evidence of acute cholecystitis. Dilation of the common bile duct proximally up to 1.3 cm, with incomplete visualization of the distal common bile duct due to bowel gas. If there is high clinical suspicion for choledocholithiasis, an MRCP may be considered as warranted clinically.2. Hepatomegaly with increased echogenicity consistent with hepatic steatosis or parenchymal disease.