Question: I have been having RUQ pain for 4 weeks, constantly. Ended up at the Er. Labs were normal. Had ultrasound and CT Scan. Results of ultrasound wereBILIARY: Trace echogenic layering material within the gallbladder, most
consistent with gallbladder sludge. Possible adenomyomatosis of the
gallbladder fundus. The gallbladder otherwise demonstrates a normal
appearance, without evidence for gallstones, gallbladder wall thickening
or pericholecystic fluid. The ultrasonographer reports absence of
sonographic Murphy's sign. The common bile duct demonstrates a normal
diameter and measures 0.4 cm.

IMPRESSION:
Trace gallbladder sludge. No sonographic evidence of cholelithiasis or
acute cholecystitis. Was told everything looked normal. Saw my doc, who ordered a Hida scan. Was told XXXXXXX ejection fraction was 28% and I should have my gallbladder removed. Pain is constant, not triggered by meals. Have lost 15 pounds and I'm not overweight to begin with. Do you agree that gallbladder surgery is the way to go?
Ct scan results
Report Status: ***Signed***

CT ABDOMEN AND PELVIS WITH INTRAVENOUS CONTRAST

TECHNIQUE:
CT scan of the abdomen and pelvis was performed WITH intravenous
administration of 80 cc of Isovue 370. Coronal and sagittal reformatted
images were generated.

COMPARISON: Same day right upper quadrant and retroperitoneal ultrasound.
CT abdomen and pelvis 2/7/2013.

FINDINGS:
LOWER THORAX: The partially visualized lung bases are without focal
consolidation or pleural effusion. The visualized heart is within normal
limits for size. No pericardial effusion.

HEPATOBILIARY: Tiny area of hypodensity within the anterior liver,
adjacent to the falciform ligament and likely representing focal fatty
deposition versus perfusional variant; findings without significant
interval change. The hepatic parenchyma otherwise demonstrates a normal
enhanced appearance. No intrahepatic or extrahepatic biliary ductal
dilatation is identified. The gallbladder is physiologically distended.

SPLEEN: The spleen demonstrates a normal size and is without focal
lesion.

PANCREAS: The pancreas homogeneously enhances without focal lesion.

ADRENAL GLANDS: Mild thickening of bilateral adrenal glands, without
focal nodularity.

KIDNEYS AND URETERS: Bilateral kidneys demonstrate symmetric enhancement.
No hydroureteronephrosis or nephroureterolithiasis.

STOMACH/GI TRACT: Evaluation performed without enteric contrast. Surgical
clips noted at the gastroesophageal junction. Region of central
hypoattenuation at the gastroesophageal junction (axial image 15),
similar in appearance compared to 2013 and presumably secondary to
postoperative change. The stomach is decompressed, containing a small
amount of fluid. Mild wall thickening of the gastric antrum, likely
secondary to underdistention. Several fluid-filled, nondistended loops of
jejunum. No associated fat stranding surrounding the small bowel. No
small or large bowel dilation or appreciable wall thickening to suggest
inflammation. The distal descending and rectosigmoid colon is
predominantly decompressed. No pericolonic fat stranding. Lipomatous
change of the ileocecal valve, likely physiologic. Colonic diverticulosis
without evidence to suggest diverticulitis. The appendix is patent,
nondistended and without evidence of periappendiceal inflammation.

PELVIC ORGANS/BLADDER: The urinary bladder is underdistended. No
significant perivesical fat stranding. The uterus is anteverted and
anteflexed, and grossly unremarkable. Phleboliths within the pelvis.

PERITONEUM AND RETROPERITONEUM: No free fluid or pneumoperitoneum. In
addition to GE junction clips, surgical clips identified in the left
upper quadrant.

LYMPH NODES: A few subcentimeter lymph nodes are seen adjacent to the
thoracic aorta, without significant interval change from 2013. Scattered
mesenteric and retroperitoneal lymph nodes without lymphadenopathy by CT
size criteria.

VESSELS: Scattered atherosclerotic vascular calcification of the
abdominal aorta and its major branches. The abdominal aorta is
nonaneurysmal. Heterogeneous appearance of the inferior vena cava (for
instance, axial image 10) is likely secondary to mixing of contrast.

BONES AND SOFT TISSUES: Tiny fat-containing umbilical hernia. The
overlying soft tissues are otherwise unremarkable. Mild multilevel
degenerative changes of the visualized spine.

IMPRESSION:
1. No CT evidence of acute intra-abdominal or intrapelvic abnormality.
2. Colonic diverticulosis without specific evidence to suggest
diverticulitis.
3. No evidence of abdominal aortic aneurysm as questioned.
4. Changes at the gastroesophageal junction as described, without
significant interval change compared to 2013 and presumably secondary to
postoperative change. However, clinical correlation is recommended.


Date/Time of Dictation: 02/1

Would you recommend endoscopy before having this procedure?
Also, why would they tell me this test result was normal? My Doctor didn't even seem concerned about the adenomyomatosis, he just said sludge.