Findings
- Several hypoechoic lesions in the left hepatic lobe measuring up to 3 cm with irregular, thick margins and posterior acoustic enhancement
- Surrounding areas of increased hepatic parenchymal echogenicity
- Gallbladder is distended (measuring up to 6 cm in transverse diameter) with marked mural thickening and layering sludge
- Mild intrahepatic biliary duct dilation
- Extrahepatic duct measures up to 1.4 cm in diameter with no obstructing lesion seen, though the distal common bile duct and insertion of the cystic duct are not visualized
- The visualized portal and hepatic veins are patent with antegrade flow
- Multiple echogenic foci in the spleen, likely calcified granulomas
- Normal appearance of the kidneys
- Visualized portions of the pancreas are normal
- Urinary bladder is mildly distended with a catheter present
- Visualized segments of the abdominal aorta are normal in caliber
Diagnosis
- Hepatic abscesses
- Biliary obstruction
Sample Report
Intrahepatic and extrahepatic biliary duct dilation with nonvisualization of the distal common bile duct. Findings raise concern for a distal biliary obstruction, possibly relating to a gallstone or neoplasm. Recommend MRCP or ERCP for further assessment.
Multiple irregular hypoattenuating lesions in the left hepatic lobe measuring up to 3 cm, concerning for abscesses.
Distended gallbladder with wall thickening and layering sludge. Despite a negative sonographic Murphy sign, these findings could relate to cholecystitis. Alternatively, a common bile duct stone/obstruction or a cystic duct stone obstructing the common hepatic duct (Mirizzi syndrome) could be the etiology for these findings. Again, MRCP or ERCP could further evaluate.
Discussion
References