Patient presented with colicky abdominal pain and mild icterus.
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Ultrasound of the upper abdomen shows multiple variable sized echogenic areas within the liver parenchyma. These areas demonstrate marked posterior acoustic shadowing and they are arranged in a linear pattern along intrahepatic biliary radicles, compatible with hepatolithiasis.
The other possible etiology for this finding is gas in the intrahepatic biliary tree. These are more likely to be mobile on real time ultrasound imaging. If the diagnosis is uncertain, a CT scan would definitively answer the question.
Cholelithiasis is also noted.