Stephen Bird

I am considering the description of the small liver with ascites.
When cirrhosis gets to the late stage the liver shrinks and becomes nodular and scarred. Ascites volume rapidly increase especially if the portal vein thromboses or Budd Chiari develops.

I have not seen the images and if you can upload some that would be brilliant.

I am thinking the echogenic areas are fibrosis and may be interspersed with regenerative nodules. HCC would be impossible to exclude on ultrasound I would think.
Multiple focal fatty infiltration areas may also produce this appearance.
Multiple biliary hamartomas is another possibility.
Multiple echogenic metastatic lesions.

I may think of others when I see the images


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