58 year-old female with cirrhosis. Evaluate for worsening hyperbilirubinemia. Rule out obstruction. ABDOMEN:LIVER, BILIARY TRACT: Note is made of a cirrhotic liver morphology. No enhancing mass lesions are identified. There is no evidence of intra-or extrahepatic biliary ductal dilation. No evidence of focal stricture or obstruction. Note is made of multiple punctate dependent gallstones without evidence of acute cholecystitis. No common duct stones are identified. Again seen is a filling defect at the level of the confluence of the portal vein consistent with the patient's known history of chronic nonocclusive thrombus. There is a small amount of perihepatic free fluid.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral subcentimeter foci of fluid signal intensity are most consistent with simple cysts. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is subcutaneous edema most pronounce along the left posterior hemiabdomen.OTHER: Small left pleural effusion.
1.No evidence of intra- or extra-hepatic biliary ductal dilation to suggest obstruction, as clinically questioned. 2.Cirrhotic liver morphology without evidence of enhancing mass lesion. Chronic nonocclusive thrombosis of the portal venous system, as detailed above.3.Small left pleural effusion and small amount of perihepatic ascites. 