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PROCEDURE: US ABDOMEN RUQ LIVER GALLBLADDER PANCREAS while hospitalized in 2020
INDICATIONS: Right upper quadrant pain x12 days with jaundice x3 days
TECHNIQUE: Ultrasound examination of the right upper quadrant of the abdomen was performed.
FINDINGS:
LIVER: No focal liver lesion. The liver measures 16.4 cm in length. The liver is normal in echogenicity. Normal hepatopetal flow is seen in the portal vein.
BILIARY: No intrahepatic biliary duct dilation. The common bile duct measures 4 mm in diameter. No evidence of cholelithiasis but there is a 5 mm and a 6 mm echo without shadowing in the gallbladder neck compatible with polyps. There is gallbladder wall thickening up to 8 mm with trace wall edema suspected but without obvious pericholecystic fluid. Positive sonographic Murphy?s sign.
PANCREAS: No pancreatic duct dilation or focal lesion is seen in the partially imaged pancreas.
RIGHT KIDNEY: No hydronephrosis or suspicious renal mass.
OTHER: Negative.
CONCLUSION:
1. No evidence of cholelithiasis but there is gallbladder wall thickening up to 8 mm with trace wall edema suspected and there is a positive sonographic Murphy sign. These findings suggest acute cholecystitis. Correlation with clinical signs/symptoms and laboratory evaluation is recommended.
2. There is a 5 mm and a 6 mm gallbladder polyp. For a gallbladder polyp in the 6 to 9 mm range.
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CT ABDOMEN PELVIS W CONTRAST while hospitalized in 2020
Study Result
Narrative
PROCEDURE: CT ABDOMEN PELVIS W CONTRAST
COMPARISON: None.
INDICATIONS: Right upper quadrant and epigastric abdominal pain for 12 days, jaundice.
TECHNIQUE: After obtaining the patients consent, CT images were created with intravenous iodinated contrast.
FINDINGS:
LIVER: No suspicious liver lesion is seen. The portal and hepatic veins are patent. There is minimal periportal edema centrally.
BILIARY: The gallbladder does not appear significantly distended. There is diffuse gallbladder wall thickening measuring up to 8-9 mm in diameter, corresponding to findings on the concomitant ultrasound. No significant pericystic inflammatory changes are detected. Common bile duct measures up to approximately 5 mm in diameter, within normal limits for age.
PANCREAS: No focal pancreatic lesion. No pancreatic duct dilation.
SPLEEN: No suspicious splenic lesion is seen. The spleen is normal in size.
KIDNEYS: No suspicious renal lesion is seen. No hydronephrosis.
ADRENALS: No adrenal gland nodule or thickening.
AORTA/VASCULAR: No aneurysm.
RETROPERITONEUM: No lymphadenopathy.
BOWEL/MESENTERY: No bowel wall thickening or bowel dilation. Visualized portions of the appendix are nondilated and without surrounding inflammatory change.
ABDOMINAL WALL: Tiny fat-containing umbilical hernia.
URINARY BLADDER: No focal wall thickening or calculus.
PELVIC NODES: No lymphadenopathy.
PELVIC ORGANS: Simple appearing cyst/follicle in the right ovary measuring up to 1.8 cm. Mildly lobular uterine fundus, suggestive of uterine fibroids.
BONES: No acute fracture or suspicious osseous lesion.
LUNG BASES: No pleural effusion or consolidation.
OTHER: No intraperitoneal free air, portal venous gas, or pneumatosis detected.
CONCLUSION:
1. Diffuse gallbladder wall thickening, also seen on the concomitant ultrasound, which is nonspecific and can be seen in the setting of acute and chronic cholecystitis as well as low protein states and liver disease. Given the presence of a positive sonographic Murphy's sign on the ultrasound, cholecystitis is suspected. If there is clinical uncertainty, correlation with a HIDA scan (preferably with ejection fraction) could be performed.
2. No dilated bowel loops to suggest bowel obstruction.