Elevated liver enzymes, history of gallbladder carcinoma. Exam mildly limited by inability to optimally position patient.LIVER: The liver measures 15.9 cm in length. The known previously described liver lesion adjacent to the gallbladder fossa measures 4.9 x 3.6 x 4.6 cm, increased in size from approximately 2.4 x 2.3 cm on recent CT. Previously described portacaval reference mass now measures approximately 3.1 x 3.3 x 3.3 cm, measured approximately 2.7 x 4.7 cm on recent CT. The portal vein is attenuated at the porta hepatis and is patent within the liver with a velocity of 0.25 m/s.BILIARY TRACT: A large stone is present within the gallbladder. The gallbladder wall is not thickened. The sonographic Murphy's sign is negative. There is mild intrahepatic biliary ductal dilatation. The common bile duct measures 3 mm in diameter.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.The spleen measures 10.3 cm in length. RIGHT KIDNEY: Kidney measures 10.8 cm in length. The parenchymal echogenicity is increased. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 9.5 cm in length. The parenchymal echogenicity is increased. No hydronephrosis, shadowing calculus or mass.OTHER: Bilateral pleural effusions and ascites.
1.Interval increase in size of hepatic mass adjacent to gallbladder. Mild intrahepatic biliary ductal dilatation, similar to prior. 2.Persistent ascites and pleural effusions.3.Echogenic kidneys suggesting medical renal disease.