42-year-old female with gram-negative sepsis, assess for cholecystitis. LIVER: Measures 18.0 cm in length. Coarsened hepatic echotexture without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: The gallbladder is partially collapsed with normal wall thickness. However, there is heterogeneity of the pericholecystic fat with areas of low echogenicity. Additionally, the patient was somewhat tender to palpation during the exam. There is no biliary ductal dilationPANCREAS: The pancreas is incompletely imaged due to bowel gas. The imaged portions of the pancreas appear unremarkable. SPLEEN: Unremarkable in size and echogenicity. KIDNEY: Minimal left hydronephrosis, improved since the prior study. Bilateral renal stents in place.OTHER: No significant abnormalities noted.
1. The collapsed gallbladder and normal gallbladder wall thickness argue against acute cholecystitis. However, there is heterogeneity of the pericholecystic fat as well as tenderness to palpation, the clinical significance of which is uncertain at this time. If further imaging evaluation is warranted, a nuclear medicine hepatobiliary study may be considered as clinically warranted. 2. Minimal left hydronephrosis is improved since the prior study. Renal stents in place. 