Female 66 years old; Reason: assess for thrombosis/duct dilation History: assess for thrombosis/ duct dilation The study was very limited due to patient's intubated status.LIVER: The liver appears coarse, echogenic, nodular and shrunken. The known mass of the hepatic dome is not visualized due to incomplete inspiration. No intrahepatic ductal dilation is seen. The main portal vein is patent with decreased hepatopetal flow measured at 9.7 cm/s. Large volume ascites is noted.GALLBLADDER/BILIARY TRACT: The gallbladder is surgically absent. The common bile duct measures 6.6 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen is enlarged measuring 14.2 cm and no acute abnormalities are noted.RIGHT KIDNEY: The right kidney measures 10.3 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen. There is suboptimal visualization due to incomplete inspiration.LEFT KIDNEY: The left kidney measures 12.2 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.Dopplers:MAIN PORTAL VEIN: The portal vein is not well-visualized but appears to be patent with hepatopetal flow measuring 9.7 cm/s, which is decreased.HEPATIC ARTERIES: The common hepatic artery is patent with hepatopetal flow and peak systolic velocity measured at 136.2 cm/s and RI of 0.7. The left hepatic artery is patent with hepatopetal flow and peak systolic velocity of 84.1 cm/s and RI of 0.7. Normal spectral Doppler wave forms are noted. The right hepatic artery was difficult to evaluate, and a normal spectral Doppler waveform was obtained.The right hepatic vein, main hepatic vein, left hepatic vein were unable to be evaluated with spectral Doppler interrogation.SPLENIC ARTERY: The splenic artery is patent with anterior grade flow to the spleen measured at peak systolic velocity of 125.7 cm/s and RI of 0.7.SPLENIC VEIN: The splenic vein is patent with hepatopedal flow.IVC: The inferior vena cava is patent.
1. The known mass at the hepatic dome was not visualized due to incomplete inspiration. Cirrhotic contour is noted. Large volume ascites, splenomegaly, and decreased velocity of the main portal vein are compatible with portal hypertension.2. Incomplete visualization and interrogation of the hepatic veins due to technical limitations. The hepatic arteries, splenic artery, splenic vein, and IVC are patent.3. No evidence for intrahepatic ductal dilatation.