Male 62 years old; Reason: 62M with AIHA/ITP and splenomegaly, now with conjugated bilirubinemia and elevated tranaminases, ?biliary obstruction, ?venous congestion, ?portal vein clot, ?size of splenomegaly History: 62M with AIHA/ITP and splenomegaly, now with conjugated bilirubinemia and elevated tranaminases, ?biliary obstruction, ?venous congestion, ?portal vein clot, ?size of splenomegaly LIVER: The liver measures 16.8 cm in length. There is slightly coarse increased echogenicity of the liver parenchyma. No focal hepatic lesions. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow measured at 20.1 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 1.9 mm. Sludge is visualized within the gallbladder as seen on the prior ultrasound. However, there is an irregularly thickened wall with several echogenic polypoid foci not visualized on the prior ultrasound. These do not demonstrate shadowing. The patient was unable to be placed in a decubitus position. No discrete stones are visual. No pericholecystic fluid. The common bile duct measures 6.5 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 19.1 cm and is heterogeneous with areas of hypoechogenicity seen.RIGHT KIDNEY: The right kidney measures 11.7 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 11.1 cm in length. The cortex has normal echogenicity. A shadowing echogenic foci seen within the lower pole measuring 1.4 cm x 0.7 cm x 1.0 cm. A renal cyst is seen measuring 5.5 cm x 3.6 cm x 4.7 cm per no hydronephrosis or worrisome masses are seen.OTHER: No ascites is seen.
1. The liver has increased echogenicity compatible with hepatocellular dysfunction. No focal hepatic masses or intrahepatic ductal dilation. No ascites. The portal vein is patent with hepatopetal flow.2. Several polyploid non-shadowing foci are seen along an irregularly thickened gallbladder wall. This was not visualized on prior ultrasound. Evaluation of these lesions is limited as patient was not able to change position. These lesions may represent adherent sludge but gallbladder carcinoma cannot be excluded. Sludge is redemonstrated within the gallbladder.3. Splenomegaly is present with hypoechoic areas within it, compatible with possible splenic infarction seen on prior CT.4. A nonobstructing renal calculi seen in the left kidney as seen on prior CT. No hydronephrosis.