Radiologist and Imaging Specialist Note

**Scan date:** 01 2024 **Clinical information:** - Persistent right upper quadrant pain for 3 weeks - Nausea and occasional vomiting - Elevated liver enzymes **Patient information:** - Jane Doe, ID: JD7890, DOB: 01/05/1975 - Referring physician: Dr. Emily White - Date of examination: 01 November 2024 - Type of study with details such as imaging modality used, anatomical part of body studied, side of body studied: Abdominal Ultrasound, right upper quadrant **Clinical history:** - Patient presenting with acute onset right upper quadrant pain, radiating to the back. Associated symptoms include nausea, loss of appetite, and a low-grade fever. Suspected cholecystitis. **Comparison:** - No prior imaging studies available for comparison. **Technique:** - Transabdominal ultrasound performed with a 3.5 MHz curvilinear probe. Real-time imaging obtained in supine and left lateral decubitus positions. Colour Doppler imaging applied to assess vascularity. **Findings:** - Liver: Normal in size and echotexture. No focal lesions identified. Hepatic vasculature appears patent. - Gallbladder: Distended, measuring 9 cm x 4 cm. Wall is thickened, measuring 5 mm, with pericholecystic fluid noted. Multiple calculi are present, the largest measuring 1.5 cm, consistent with cholelithiasis. Murphy's sign is positive on sonographic palpation. - Bile Ducts: Common bile duct measures 4 mm, within normal limits. No intrahepatic biliary dilatation. - Pancreas: Visualised head, body, and tail appear unremarkable. No peripancreatic fluid collection. - Kidneys: Right kidney is normal in size and echotexture. No hydronephrosis or calculi. - Spleen: Not fully visualised, but the visible portion appears normal. - Normal findings: Aorta and Inferior Vena Cava are normal in calibre and course. No ascites. **Impression:** - Acute cholecystitis with cholelithiasis. **Recommendations for follow-up studies, further imaging, or clinical management based on imaging findings:** - Recommend surgical consultation for cholecystectomy. - Recommend blood tests to monitor inflammatory markers and liver function. **Additional notes:** - Limitations of study or factors affecting interpretation: Bowel gas partially obscured visualisation of the posterior aspect of the pancreas. - Comments on quality of study or any technical issues encountered: Good quality images obtained despite patient discomfort during probe pressure over the right upper quadrant.