The liver in this patient presented a complex, mixed echogenic nodular mass with areas of cavitation and likely necrosis. The mass measured 10 x 7 cm. The liver mass appears to derive from the caudal aspect of the left lateral lobe. Minor vascular congestion was noted. This mass is at predisposition for lobe torsion. Relatively, simple left lobectomy would be recommended. The bridge of normal to abnormal tissue was approximately 2.0 cm. The surgeon should be prepared for large vascular congestion within the bridge from to normal to abnormal. The right liver, common bile duct and gallbladder appeared relatively normal. However, the bilirubin elevation in the history is of concern. This should be rechecked prior to surgery to ensure a global parenchymal issue is not occurring. Enough normal hepatic parenchyma appears to be adequate to not be in liver failure; therefore, the bilirubin elevation is perplexing. This may be artifactual. If it is persistently elevated then general parenchymal aspirates would be recommended for further definition. Regional inflammation associated with the liver mass was noted. This may be owing to torsion already at this point. No free fluid was noted. However, this is a significantly precarious presentation.
Both adrenal glands were sonographically normal.