History of pancreatitis and pseudocyst in the past. Recently noted fluid collection status post IR drain. Evaluate for pancreatic duct leak. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size and signal intensity without a focal suspicious lesion. Status post cholecystectomy. The common bile duct measures 8 mm, likely related to postcholecystectomy state. It tapers smoothly distally. There is suboptimal contrast opacification limiting evaluation of the vasculature.SPLEEN: Perisplenic high T2-weighted signal intensity fluid collection measuring approximately 2.8 x 2.5 cm, not significantly changed in size from recent CT. Note is made of the gastro-cystostomy tract (series 601/26) which appears to communicate with the collection.PANCREAS: There are peripancreatic inflammatory changes. Long segment stricture of the main pancreatic duct extending from the body to the tail with mild upstream dilatation at the distal tail measuring 4 mm, similar in appearance to the prior. This dilated duct may communicate with the perisplenic pseudocyst although this is not definitively demonstrated. Note is made of the gastrocystostomy tract (series 601/24). There is a very small peripancreatic pseudocyst measuring 9 x 8 mm at the level of the pancreatic body (series 701/26), unchanged.Due to suboptimal contrast opacification evaluation for pancreatic necrosis is suboptimal.Following secretin administration there is a mild excretory response of the pancreas with fluid filling the proximal duodenum.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: In the anterior pararenal space abutting the lateral chest wall there is a 2.9 x 1.4 cm fluid collection, slightly decreased from the prior study with drainage catheter noted extending to the subcutaneous soft tissues where there is mild induration.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Compared to the recent CT the perisplenic fluid collection is essentially unchanged and the left anterolateral pararenal space fluid collection is slightly decreased in size with drainage catheter in place.2.Persistent main pancreatic duct stricture with distal ductal dilatation. The pancreatic duct at the level of the tail may communicate with the perisplenic fluid collection but this is not definitive. The perisplenic collection does appear to communicate with the gastrocystostomy tract.