Left upper quadrant pain and shortness of breath. Further history obtained upon discussion with the patient reveals progressively worsening intermittent sharp left chest pain, which on occasion "takes her breath away". LIVER: The liver measures 15 cm in length. Mildly increased parenchymal echogenicity is suggestive of fatty infiltration. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of .2 m/s.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. The sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 3 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 7 cm in length. RIGHT KIDNEY: Kidney measures 9.6 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 9.6 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.OTHER: Evidence of a left pleural effusion. Superficial evaluation of the left chest wall reveals no abnormalities
1.Left pleural effusion.2.Increased echogenicity of the liver suggest hepatic steatosis.These findings were discussed with the ordering service at time of dictation who agreed to order chest x-ray while patient is in radiology department.