58-year-old male patient with right upper quadrant pain, hepatic dysfunction, and hepatitis C. Altered mental status, LFT abnormalities. LIVER: The liver measures 20.5 cm in length and demonstrates increased hepatic parenchymal echogenicity. There are regions of relatively well-demarcated hypoechogenicity within the right hepatic lobe. The largest measures approximately 5.7 x 3.7 cm. Additional smaller ill-defined areas are noted. Main portal vein flow is hepatopetal and measures 0.6 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder wall is diffusely thickened with obliteration of the lumen. No shadowing gallstone is identified. Sonographic Murphy's sign is negative. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 8 mm in diameter.PANCREAS: The head and body of the pancreas demonstrate normal echogenicity. The tail is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 10.3 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 9.7 cm in length. No evidence of hydronephrosis.The spleen measures 11.6 cm in length.There is mild ascites.
1. Increased hepatic parenchymal echogenicity consistent with hepatic steatosis with regions of hypoechogenicity which may represent focal fatty sparing, however, are incompletely evaluated on this examination. MRI is recommended for further evaluation.2. Diffusely thickened gallbladder wall of uncertain etiology; MRI is recommended for further evaluation. 3. Mild ascites. 