38 year old male with rising LFTs and abdominal pain, evaluate for hepatic pathology/cholecystitis. LIVER: The liver is enlarged measuring 18.8 cm in length. The liver parenchyma is again markedly heterogenous. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.4 m/s.BILIARY TRACT: Gallbladder sludge, thickened gallbladder wall, nonspecific in setting of ascites. No additional signs of acute cholecystitis. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 3 mm in diameterPANCREAS: Nonvisualization of pancreas secondary to overlying bowel gas.SPLEEN: The spleen is markedly heterogenous, new from the prior examination.RIGHT KIDNEY: Kidney measures 8.0 cm in length. Increased parenchymal echogenicity is suggestive of medical renal disease/parenchymal dysfunction. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Not visualized. OTHER: Incompletely imaged pleural effusions and complex ascites. Right iliac fossa transplant kidney with mild caliectasis appearing similar to to 5/22/2015 vascular ultrasound.
1.New marked heterogeneity of the spleen which could be related to infarctions and/or hematoma. In the appropriate clinical setting, contrast-enhanced CT recommended for further evaluation.2.Hepatomegaly and marked heterogeneity of the liver which may be related to underlying steatosis/parenchymal dysfunction but underlying mass cannot be excluded. In the appropriate clinical setting, could be further evaluated with dedicated cross-sectional imaging.3.Mild caliectasis of the transplant kidney appearing grossly similar to recent vascular ultrasound.4.Gallbladder sludge. Gallbladder wall thickening which is nonspecific in the setting of ascites.5.Pleural effusions.Findings discussed with MARTIN, ELIZABETH at 4:24 p.m. on 6/12/2015.