C10020063 / invoice 10000

Reason for ultrasound ObjectiveMM, CRT <2s, HR:112  RR panting: Chest ausc: 2-/6 HM  Temp:  38.7Catheter placement:  CephalicSedation given:     Butorphanol 0.15ml given IM. Then 0.15ml given IV. Good sedation.  Light but relaxed. Study:  Abdominal ultrasoundFindings:Hepatobiliary:The liver is hyperechoic and moderately enalrged.  There is one hypoechoic nodule 4.5mm in diameter in the left liver.  The gallbaldder is moderately disnteded and contains a large amount of echogenic debris.  The CBD could not be visualised. (CBD RR <3mm)Gastrointestinal tract: Stomach contents: A moderate amount of gas. Gastric wall 2.7mm. Duodenal wall 3.5mm. Jejunum 5.0mm.  Throughout the duodenum and jejunum the mucosal layer has multiple hyperechoic striations running perpendicular to the luminal surfaceIleum 1.4mm. Colon 1.6mm. Spleen: Normal. Pancreas:He pancreas is normal. (Right lobe: 8.5 mm, Body: 6.3 mm. Left lobe: 7.9 mm. 15 kg reference up to 10.17, 7.87, and 8.13 mm, respectively for the R, body, and L lobes)Urinary tract:The kidneys are normal. (L:  4.3cm, R: 4.1cm) The bladder has a very mildly thickened cranioventral bladder wall measuring 2.4mm.. It is otherwise normal. Adrenal glands:The right adrenal gland has a nodule in the cranial pole that is well differentiated, hyperechoic compared to caudal pole and mildly heterogeneous. It measures 10.7mm x 15.1mm (previously  10.7 mm x 14.1mm). There is no evidence of it invading or impeding the CVC.  Caudal adrenal pole is 4.1mm.  THe left adrenal is small but mildly larger compared to previous scan. (L Cr:6.6mm, Ca: 6.3 mm,) 5-10 kg reference up to 6.0 mm L and 7.1 mm RLymph nodes:Lmiln: 2.7mm.  RMILN not seen. Mesenteric LN: 4.1mm. Interpretation:There is minimal free peritoneal fluid. Interpretation: - Nodule in right adrenal cranial pole which is largely unchanged.  DDx: Adenoma (considered most likely). Less likely adenocarcinoma, phaechomocytoma due to no progression of nodule. .  - Biliary sludge DDx: Cholestasis, cholangitis- Hyperechoic liver DDx: Vacuolar hepatopathy, hepatitis, infiltrative disease is less likely. - The left adrenal is mildly enlarged compared to the last scan. - Hyperechoic muscosal striations perpenducular to duodenal wall  DDx: Lacteal dilation (can be secondary to enteritis inflammatory bowel), lymphandiectasia- Minimal peritoneal fluid DDx: Transudate, modified transudateConsider adrenal testings. Dr. Suzanne Leibel BSc (Hons) BVSc (Hons) Grad. Cert. (SAU-A), MANZCVS (SA Radiology)    Vital Signs    Weight: 7.7;