Female 59 years old Reason: History gallbladder malignancy, acute elevation in alk phos History: abnormal labs LIVER: Liver measures 15.4 cm in length. The parenchyma is increased in echogenicity and heterogeneous with multifocal and in some areas confluent hypoechoic masslesions seen, primarily involving the right hepatic lobe. Main portal vein patent with normal directional flow, increased velocity measuring 61 cm/sec. BILIARY TRACT: Status post cholecystectomy. Common bile duct stent present, echoes seen within stent. Intrahepatic biliary duct dilatation seen, more pronounced in left lobe and degree of dilatation increased from prior study (intrahepatic biliary duct dilatation measures up to 5 mm, previously measured 3 mm. Constellation of findings suspicious for obstructive stent.PANCREAS: Not well visualized in entirety due to overlying bowel gas. KIDNEYS: The right kidney measures 8.7 cm, mid to lower pole not well assessed but areas of heterogeneity suggested, appearance similar to earlier study. The left kidney measures 10.5 cm cm. Mildly increased renal cortical echogenicity, nonspecific.SPLEEN: The spleen measures 7.7 cm. in length. OTHER: Incompletely imaged small to moderate ascites.
1. Mild interval worsening of intrahepatic biliary duct dilatation and intrastent echoes seen, constellation of findings suspicious for stent obstruction.2. Multifocal/confluent hepatic lesions again seen, metastatic disease/neoplasm among differential considerations, coalescing abscesses not entirely excluded, correlation with patient's clinical history and laboratory values recommended. Again recommended is further evaluation with dedicated contrast enhanced CT or MRI. Unchanged increased portal vein velocity.3. Incompletely imaged ascites.4. Mid to lower pole not well assessed but areas of heterogeneity suggested, appearance similar to earlier study, this, too, may be assessed with contrast enhanced crosssectional imaging.  