73 year old female with ascites and AKI. Evaluate liver, vasculature and kidneys. LIVER: Large portion of the liver is occupied by a heterogeneous predominantly solid lesion measuring 9.4 cm x 7.1 cm x 9.1 cm. The main portal vein is patent with appropriate directional flow. Peak velocity measures 0.4 m/sec.GALLBLADDER, BILIARY TRACT: Normal echogenicity of the gallbladder. Mild gallbladder wall thickening which is nonspecific in the setting of ascites. No pericholecystic fluid. Common duct measures 9 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Obscured by overlying bowel gas.SPLEEN: Normal echogenicity of the spleen measuring 11.2 cm in length.KIDNEYS: Right kidney measures 10.2 cm in length and is increased in echogenicity. Left kidney measures 10 .is an increase in length and is increased in echogenicity. No hydronephrosis or shadowing calculi are noted bilaterally.ABDOMINAL AORTA: Proximal aorta measures 2.4 cm x 2.4 cm. The mid aorta measures 1.8-cm x 1.4-cm.INFERIOR VENA CAVA: The visualized IVC is patent. OTHER: Moderate ascites.
1. Hepatomegaly with increased echogenicity suggestive of parenchymal dysfunction/fatty infiltration. Large heterogeneous mass corresponds to the lesion noted on CT and does not appear significantly changed. Main portal vein is patent.2. Increased echogenicity of the kidneys suggestive of nonspecific medical renal disease. No obstruction. 3. Moderate ascites.4. Mild gallbladder wall thickening which is nonspecific in the setting of ascites. No sonographic evidence of cholecystitis.