C09973591 / invoice 10000

Admitted for soundiagnosis ultrasound.Pre-op examination:HR: 88, no murmur RR: panting T: not taken (sensitive around area. Premedication: Buthorphanol 0.2mg/kg IVSound preliminary report: Sonographic Findings / ConclusionDiffuse hyperechoic liver, preserving subjectively normal size and margins. Ddx. Vacuolar hepatopathy, steroid hepatopathy,hepatitis/cholangiohepatitis, neoplasiaDiffuse hyperechoic pancreas, preserving normal size and margins. Ddx. Age-related change/fibrosis most likely, pancreatitisA few ill-defined hypoechoic nodules in the spleen, not expanding the margins. Ddx. Benign nodular hyperplasia, extramedullaryhaematopoiesis, neoplasia (less likely)Subjective hyperechoic prostatomegaly with a few small anechoic cavitations in the parenchyma. Ddx. Normal for an entire male,benign prostatic hyperplasia, prostatitis or emerging neoplasia less likelyA small hypoechoic nodule in the left testicle, preserving otherwise normal appearance. Ddx. Incidental finding, benign nodule,neoplasia (less likely)A scant amount of abdominal effusion just cranial to the bladder. Ddx. High vs low protein transudate, exudateMultiple hyperechoic foci in the left and right renal cortices, preserving normal size and margins and corticomedullary definition. Ddx.Normal patient variation, dystrophic mineralisation, emerging renal disease eg. CKD, neoplasia (less likely)A single small anechoic cavitation in the cranial pole of the left kidney - consistent with a benign renal cystComments / RecommendationsThere were some limited views of the left lobar region of the liver today due to a large amount of gas in the region. However, there was notevidence of a mass/cavitations in the visualised hepatic parenchyma. Ultrasound guided fine needle aspirates of the liver may be considered;however, please note that access for sampling is limited today due to his subjectively normal liver size and that for some conditions,histopathology may be more reliable than cytology in diagnosing hepatobiliary disease. Given he is currently clinically well, a repeat blood testcan be performed in 3 to 6 months and if there are further liver enzyme elevations consider paired bile acid testing for evaluation of liverfunction +/- a repeat abdominal ultrasound.Plan:Next step is bile acids test. OR surgical biopsies.      Vital Signs