Liver: The liver is mildly diffusely enlarged and diffusely hyperechoic. No focal hepatic masses are identified. Capsular margins are smooth and normal.

Gallbladder/Common Bile Duct:The gallbladder is mildly to moderately distended with anechoic bile. The gallbladder wall is normal. The common bile duct is tortuous and mildly dilated measuring up to 0.42 cm.

Stomach: The stomach is empty with a normal rugal fold pattern. Wall layering and thickness are normal measuring 0.22 cm.

Pancreas:The right pancreas is diffusely hypochoic relative to surrounding mesentery. The pancreatic duct is normal measuring 0.10 cm. No lesions are identified at the duodenal papilla. The left pancreatic limb is also hypochoic relative to surrounding tissue. There is no inflammatory pattern noted around the pancreas.

Duodenum: The duodenum is normal in appearance with mildly increased wall thickness measuring 0.25 cm. Wall layering pattern is maintained.

Small Intestine: The small intestine has a mildly diffusely thickened muscularis layer. Overall wall thickness measures 0.23 cm. No lesions are identified at the ICCJ.

Spleen: The spleen has a smooth contour and regular echotexture with no masses or capsular distortions. Thickness is normal measuring 0.91 cm in sagittal plane.

Kidneys: The left kidney measures 6.9 cm and is diffusely enlarged with a heterogeneous echotexture. There are cavitated regions with marked disruption of normal renal architecture, with only a small portion of mildly normal-appearing cortex remaining at the cranial pole. The renal pelvis is dilated measuring 0.28 cm. The right kidney measures 4.29 cm and has a hyperechoic cortex with good corticomedullary definition. No masses, renoliths or pyelectasia are identified in the right kidney.

Urinary Bladder:The urinary bladder is mildly distended. No masses or uroliths are identified.

Lymph Nodes/Vessels/Other:Jejunal lymph nodes are identified. No lesions are noted at the aortic bifurcation. There is no abdominal effusion.

Interpretation

1. Diffusely enlarged left kidney with cavitated regions, markedly distorted architecture, and pyelectasia.
   Differentials include renal neoplasia (lymphoma, carcinoma, sarcoma) congenital renal anomoly or severe pyelonephritis and renal abscess, Ultrasound-guided fine needle aspiration could be considered; however, left kidney nephrectomy with histopathology would be ideal if clinically appropriate. Differentials for the pyelectasia include neoplasia, chronic renal disease, or pyelonephritis. Urine culture is recommended.
2. Mildly diffusely enlarged and hyperechoic liver. Differentials include cholangiohepatitis, hepatic fat deposition, hepatic lipidosis (particularly if the patient is sick and anorexic), and diffuse neoplasia. Ultrasound-guided fine needle aspiration of the liver could be considered. If the patient undergoes left nephrectomy, concurrent liver biopsy is recommended.
3. Diffusely hypochoic pancreas, consistent with pancreatitis.
4. Mildly thickened duodenal wall and mild diffuse thickening of the small intestinal muscularis layer.
   Differentials include enteritis, inflammatory bowel disease, and gastrointestinal lymphoma.
5. Mild dilation of the common bile duct. This may be secondary to hepatic or biliary tract disease. At this time, there is no evidence of a mechanical obstruction such as cholelith, biliary sludge ball, lesion at the duodenal papilla, or mass. Cholangitis or cholangiohepatitis remains a consideration.