A² + B² = C² "The Telemed Sonogram Theorem": Our Case Of the Month Nov. 2019
The patient was presented for vomiting, lethargy, and painful cranial abdomen. Blood chemistry revealed BUN 5, glob. 4.7, ALT >1000, Alk.Phos. 1342, GGT 25, and T. bili 2.8. A STAT ultrasound was ordered and performed by ASNW with interpretation done by SonoPath.
The right kidney revealed multi-focal, hypoechoic nodular changes with regions of capsular expansion and enhanced peri-capsular fat. This meets neoplastic criteria. Concurrent polycystic changes were noted. The largest cyst at the cranial pole measured 3.56 x 3.54 cm. The patient may have passed a right renal calculus from the right kidney and it is now in the urinary bladder. Disruptive changes to the renal cortex may have occurred secondarily. Slight pyelectasia was noted as well. The left kidney revealed irregular cortical infarcts and pyelectasia. The left kidney measured 5.0 cm.
The gallbladder presented mucocele formation with regional inflammation. The common bile duct was dilated and measured 0.8 cm with mucous debris. This is consistent with mucoduct. Hyperechoic enhancement of the common bile duct was noted. Common bile duct wall thickening was noted.