35-year-old male with history of ulcerative colitis with primary sclerosing cholangitis/cirrhosis. Evaluate for stricture. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic hepatic morphology with areas of T2 hyperintensity and heterogeneous arterial enhancement, which is increased in conspicuity compared to previous examination. This area near the caudate lobe demonstrating the T2 hyperintensity appears to be bulging the capsule mildly. However, the vasculature in this region courses through the abnormal signal and enhancement without attenuation.Again noted is multifocal irregular intra and extra hepatic biliary ductal strictures compatible with the stated history of PSC. The right and left intrahepatic ducts are again poorly seen proximal to the Klatskin point. Common bile duct is patent and noted to be attenuated proximally.SPLEEN: Splenomegaly with the spleen measuring approximately 20 cm, increased from 18 cm. Splenic varices are noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Persistent nonspecific mild periportal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Stable findings compatible with primary sclerosing cholangitis without significant interval change in the biliary system.2.Heterogeneous T2 signal of the hepatic parenchyma as well as arterial contrast enhancement which is more conspicuous compared to previous examination as detailed. Differential considerations include cirrhotic changes from regenerating liver versus perfusional abnormality.3.Worsening splenomegaly, likely secondary to worsening cirrhosis related changes.