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A 30-year-old man with a history of alcoholic cardiomyopathy, congestive heart failure, cirrhosis and chronic liver disease presents to the emergency department with intermittent right upper quadrant (RUQ) pain that becomes worse after eating fatty fried foods. He reports some associated nausea with pain episodes but no vomiting or diarrhoea. He denies any fever; however, vital signs taken on presentation reveal a temperature of 38.0°C. On examination the patient demonstrates tenderness of the RUQ with a palpable liver edge and a positive Murphy's sign. No pedal oedema or gross ascites was present. The patient underwent an ultrasound with the results shown in figure 1. Additionally, the ultrasound revealed a small amount of fluid in Morrison's pouch and the splenorenal recess. Of note, there was no sonographic Murphy's sign, which occurs when compression of the gallbladder with the ultrasound probe results in maximal tenderness out of proportion to compression of the rest of the RUQ.
What is the correct interpretation of the ultrasound images?
Provenance and peer review Commissioned; internally peer reviewed.