Reason: serial evaluation of liver morphology History: abdominal distension/ascites LIVER: The liver measures 17.8 cm in length, mildly enlarged. Mildly heterogeneous, echogenic hepatic parenchyma with a mildly nodular contour. The portal vein is patent with normal directional hepatopetal portal venous blood flow, peak velocity of 49.5 cm/s, however demonstrates a pulsatile waveform. The hepatic veins appear dilated. No focal mass.GALLBLADDER, BILIARY TRACT: Echogenic shadowing gallstones in a collapsed gallbladder. No evidence of acute pericholecystic inflammation. The gallbladder wall measures 0.4 cm. The common bile duct measures 0.2 cm. No biliary ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 10.2 cm in length. No hydronephrosis or shadowing stonesLEFT KIDNEY: The left kidney measures 10.5 cm in length. No hydronephrosis. Subcentimeter nonobstructive shadowing calculus.OTHER: The spleen measures 11.9 cm in length. Moderate volume ascites.
1. Dilated hepatic veins with pulsatile portal venous waveform, consistent with congestive heart failure.2. Mild hepatomegaly and mildly heterogeneous hepatic parenchyma and nodular contour, which is suggestive of hepatic parenchymal dysfunction.3. Moderate volume ascites.4. Cholelithiasis without evidence of acute inflammation.5. Subcentimeter non-obstructing left renal calculus.