History of gastric perforation with repair. History of necrotic cholecystitis status post cholecystectomy. Elevated bilirubin and white blood count. The study is limited by poor image quality secondary to respiratory motion and poor signal-to-noise.ABDOMEN:LUNG BASES: There is at least a moderate right pleural effusion and small left pleural effusion.LIVER, BILIARY TRACT: There is some loss of signal intensity on in phase sequences compared to the out of phase imaging sequences compatible with iron deposition.No suspicious focal hepatic lesion.No biliary ductal dilatation is present. There is no obvious obstructive mass or stone.The patient is status post cholecystectomy. There is an approximately 5.1 x 3.3 cm fluid collection with septations in the gallbladder fossa with equivocal rim enhancement on postcontrast imaging raising the possibility of superinfection of a postoperative fluid collection. Delayed images demonstrate no evidence of hepatobiliary agent excretion into this collection i.e. speaking against a bile leak.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys are atrophic and the parenchyma is nearly completely replaced by numerous subcentimeter simple and minimally complex/hemorrhagic cysts, consistent with acquired cystic kidney disease. No discrete suspicious solid mass is evident.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate volume ascites. There is a more focal suspected loculated perihepatic fluid collection measuring 10.3 x 1. 8 cm (series 601/30). Additional more focal suspected loculated perigastric fluid collection abutting the greater curvature of the gastric body measuring approximately 9 x 1.5 cm.The gastric wall appears edematous which may be posttreatment related.BONES, SOFT TISSUES: Anasarca.OTHER: No significant abnormality noted.
1.Study is limited by poor image quality secondary to respiratory motion.2.No biliary ductal dilatation or obvious obstructing mass or stone.3.Anasarca and moderate volume ascites with more focal suspected loculated perihepatic, perigastric and gallbladder fossa fluid collections. Equivocal rim enhancement raises the possibility of superinfection. No evidence of hepatobiliary agent excretion into the gallbladder fossa collection, speaking against a bile leak. If there is continued clinical concern for a bile leak a nuclear medicine HIDA scan may be considered.4.Changes of acquired cystic kidney disease associated with hemodialysis. No focal suspicious solid renal mass.