80-year-old female with history of fever, right upper quadrant pain, gallstones with gallbladder drain in place. There is also a history of treated hepatocellular carcinoma. LIVER: Cirrhotic liver morphology and increased hepatic echogenicity. The previously seen and treated hepatocellular carcinoma is not clearly visualized on this limited study. There are small focal hyperechoic areas in the right hepatic lobe measuring up to approximately 1.3 cm which are of uncertain etiology and may be iatrogenic in etiology related to prior procedures. There are no correlate lesions in these locations on recent MRI examinations.The portal vein is patent with predominantly antegrade flow measuring 30 cm/sec. However, there is focal prominence of the main portal vein with an area of "to and fro" bidirectional flow which likely represents turbulence in a focally ectatic vessel. GALLBLADDER, BILIARY TRACT: The gallbladder is partially collapsed with a cholecystostomy drain in place. Cholelithiasis is again identified. The bladder wall measures 0.3 cm in thickness. There is no significant pericholecystic fluid. PANCREAS: The pancreas is not clearly visualized due to patient bowel gas.KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.
1. Cholelithiasis with cholecystostomy tube in place as described above, without specific evidence of acute superimposed inflammation. 2. Cirrhotic liver morphology with increased hepatic echogenicity consistent with chronic liver disease. Small echogenic areas in the right hepatic lobe without correlate lesions on recent MRI exams may be iatrogenic in etiology. Continued attention to this region is recommended on subsequent examinations. 