77-year-old male with elevated LFTs and renal failure. LIVER: The liver measures 18.2 cm in the craniocaudal dimension. There appears to be periportal cuffing. The liver contour is relatively smooth. The parenchyma is mildly coarsened. No focal hepatic lesion or intrahepatic biliary ductal dilatation. Normally oriented portal venous blood flow at 50 cm/sec is slightly pulsatile, which may be seen in the setting of right-sided heart failure. GALLBLADDER, BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common bile duct measuring up to 4 mm. No gallstones are evident, however, the gallbladder is distended with moderate diffuse gallbladder wall thickening and pericholecystic fluid, findings that are nonspecific in the setting of ascites. PANCREAS: The pancreas is obscured by overlying bowel gas shadowing.SPLEEN: The spleen is moderately enlarged, measuring 15.6 cm in length without a discrete abnormality.KIDNEYS: The right kidney measures 12.8 cm in length without hydronephrosis. Note is made of a 2.3 x 2.1 x 2 x 1 cm multiseptated cystic lesion with calcification suspected in the septi. The left kidney is suboptimally visualized, measures 12.8 cm in length without hydronephrosis. There is a 1.5 cm interpolar simple appearing cyst. The renal cortices are mildly hyperechogenic.ABDOMINAL AORTA: The proximal aorta measures 2.2 cm in AP dimension. The mid-distal aorta is not visualized due to overlying bowel gas shadowing.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: The urinary bladder almost entirely contracted around a Foley catheter.Pleural effusions and small volume ascites is present.
1. Hydropic gallbladder with nonspecific gallbladder wall thickening in the setting of ascites. If there is continued clinical concern for acute cholecystitis, a HIDA scan may be considered. 2. Heterogeneous liver parenchyma may represent diffuse fatty infiltration/parenchymal dysfunction.3. Echogenic renal cortices, compatible with medical renal disease.4. Ascites and pleural effusions. 5. Bilateral simple and minimally complex renal cysts.