50 year-old male with increasing liver function tests and right upper quadrant pain. Evaluate for gallstones and cholecystitis. LIVER: The liver is mildly coarse in echogenicity without a focal hepatic lesion or intrahepatic biliary ductal dilatation evident. Liver measures 18.8 cm in craniocaudal dimension. There is a small amount of perihepatic ascites.Normal hepatopetal portal venous blood flow at 19 cm/sec.BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common bile duct measuring up to 3 mm. There is a normally distended gallbladder with mild diffuse wall thickening of approximately 5 mm, which is nonspecific in the setting of ascites. There is gallbladder sludge. Mild focal tenderness reportedly over the gallbladder fossa is present although the patient is diffusely tender.PANCREAS: The pancreas is obscured by overlying bowel gas shadowing.SPLEEN: The spleen measures 9.3 cm in length without a discrete abnormality.RIGHT KIDNEY: The right kidney measures 10.9 cm in length without hydronephrosis or shadowing calculus evident. OTHER: The left kidney measures 10.5 cm without hydronephrosis or shadowing calculus evident.Incompletely imaged left pleural effusion and small volume ascites.
1. Gallbladder sludge and mild diffuse gallbladder wall thickening is nonspecific in the setting of ascites, and focal tenderness over the gallbladder fossa is also nonspecific in the setting of reportedly diffuse abdominal tenderness. If there is continued clinical concern for acute cholecystitis, a nuclear medicine HIDA scan should be considered.2. Mildly coarse hepatic echogenicity may represent diffuse fatty infiltration/parenchymal dysfunction.3. Partially visualized left pleural effusion and small volume ascites.