The liver exhibits a coarse and heterogeneous echo pattern, displaying right lobe atrophy and left lobe hypertrophy with a macronodular surface, indicating cirrhotic changes. Numerous hyperechoic avascular nodules are present, along with an exophytic, well-defined, heterogeneous rounded mass lesion in the lower portion of the right lobe, measuring about 6.1 x 6.5 cm and containing intralesional fat content. A dilated, thrombosed intra and extrahepatic portal vein is observed without detectable colour Doppler flow. The gallbladder displays diffuse wall thickening with internal sludge. The common bile duct is not dilated.
Shear wave elastography, conducted using GE Logic E10s, reveals a shear wave velocity of about 2.39 m/s and kPa of 17.12, indicating a Metavir score of F4 (cirrhosis). The main hepatic artery's resistance index is approximately 0.82, with a peak systolic velocity of about 195 cm/s. Massive abdominopelvic ascites is evident.
The spleen is enlarged, measuring about 13.5 cm, with multiple hyperechoic foci suggesting gamma gandy bodies.
Dilated anterior abdominal wall varicose veins are also visible.