Cholelithiasis transferred from outside hospital with worsening of right upper quadrant pain. LIVER: The liver is mildly echogenic without a focal lesion. It is normal in size measuring 16.5 cm in craniocaudal dimension.BILIARY TRACT: Cholelithiasis at the gallbladder neck within a distended gallbladder with wall thickening and pericholecystic fluid consistent with acute cholecystitis. Lack of focal tenderness is likely due to pain medication. No intra or extrahepatic biliary ductal dilatation with the common duct measuring 4 mm.PANCREAS: Limited evaluation of the pancreas demonstrates no gross abnormality.SPLEEN: The spleen measures 8.4 cm without a focal lesion.RIGHT KIDNEY: The right kidney measures 11.3 cm without hydronephrosis or shadowing nephrolithiasis. OTHER: The left kidney measures 12.5 cm without hydronephrosis or shadowing nephrolithiasis.
Compared to the prior study the gallbladder is now distended with wall thickening and pericholecystic fluid consistent with acute cholecystitis. Lack of focal tenderness is likely due to patient's receipt of pain medication.Increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease. No focal liver lesion.