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Ultrasound of upper abdomen
Dyspepsia
Liver has smooth suface and homogeneous increase parenchymal echo, represented fatty change. There is an well defined anechoic lession at right hepatic lobe, size about 1.2 x 1.3 cm which is suspected hepatic cyst. There is an ill defined hypoechoic lesion (4.1 x 4.7 cm) with peripheral IHD dilatation at right hepatic lobe. Peripheral type of CHCA cannot be excluded. Further CT Scan of liver is recommended.
Portal veins appear unremarkable. Gallbladder has smooth thin wall without gallstone, Visualized pancreas shows no detectable mass. Visualized paraaprtic region shows no lymphadenopathy. No splenomegaly is detedted. Both kidneys have normal size and echo without hydronephrosis. No ascites is seen.
Impression: Fatty liver
- An ill definded hyphoechoic lesion with peripheral IHD dilatation at right hepatic lobe. Peripheral type of CHCA cannot be excluded. Further CT scan of liver is recommended.
- A 1.2 x 1.3 cm of hepatic cyst at right lobe.

CT Upper Abdomen
The study reveals right lobe liver enalrgement with normal size of left lobe liver. A focal heterogeneous hypodnese lesion at the most periphery of segment 6 of right lobe liver is noted. Localized dilated of intrahepatic bile ducts at segment 6 is observed. Turbid fluid in dilated duct is observed. Scattering of small hypodense lesions at both lobes liver are noted. No CBD dilatation is noted. Gallbladder is normal, Normall opacified of IVC and main portal veins are notes. Pancreas and spleen are normal. No intraabdominal lymphadenopathy is noted. No ascites fluid is noted.
Impression:
1. A small hypodense lesionat segment 6 of right lobe liver with adjacent IHD dilatation, peripheral type cholangiocarcinoma should be in DDx.
2. Multiple scattering of smal hypodense lession at both lobes liver. liver metastasis can not be excluded.

ผลเลือด
Creatinine = 1.27 mg/dl
ALT (SGPT) = 82 U/L
AST (SGOT) = 28 U/L
AFP = 2.6 ng/mL
CA 19-9 = 71 U/mL

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