22-year-old woman with history of high-risk neuroblastoma, jaundice, pruritus, and increasing bilirubin levels. ABDOMEN:LIVER, BILIARY TRACT: Diffusely low parenchymal signal in the liver is noted. No focal hepatic lesion is identified.There is moderate intrahepatic biliary ductal dilatation. The peripheral common bile duct measures up to 9 mm in diameter and terminates in the hepatic hilum (401/22). Within the hepatic hilum, there is confluent soft tissue measuring approximately 65 x 37 mm. The portal vein, splenic vein, and superior mesenteric vein are also attenuated by this confluent soft tissue.No significant intra or extrahepatic biliary ductal dilatation. The gallbladder contains sludge but appears otherwise normal.SPLEEN: Diffusely low parenchymal signal is noted without focal splenic lesion.PANCREAS: 19 x 14 mm T2 hyperintense lesion in the pancreatic body (401/22). The T1 signal of the pancreas is diffusely decreased and heterogeneous suggestive of infiltrative tumor.ADRENAL GLANDS: The patient is status post left adrenalectomy. The right adrenal gland appears normal.KIDNEYS, URETERS: There is soft tissue invading the hilum of the left kidney. The right kidney appears normal.RETROPERITONEUM, LYMPH NODES: Numerous enlarged bilateral retroperitoneal lymph nodes noted.BOWEL, MESENTERY: Partially visualized small bowel and colon appear normal.BONES, SOFT TISSUES: There is abnormal heterogeneous signal throughout the pelvis and vertebral bodies.OTHER: Moderate bilateral pleural effusions are seen and there is nodularity along the pleural surfaces.
1.Confluent porta hepatis malignant lymphadenopathy resulting in moderate intrahepatic biliary ductal dilatation with occlusion of the common bile duct.2.Portal vein, SMV, and splenic vein also occluded by malignant lymphadenopathy.3.Additional findings of diffuse metastatic disease involving retroperitoneal lymph nodes, bones, and pleural surfaces.