65-year-old male with cirrhosis. Evaluate biliary tree for obstruction. Total bilirubin of 35.9 mg/dL. ABDOMEN:Limited exam due to patient's body habitus, ascites, and respiratory motion artifact.LIVER, BILIARY TRACT: Cirrhotic pathology of the liver. Small simple cyst of the posterior right hepatic lobe. No normal flow void is identified in the left portal vein, and there is an incomplete flow void within the main pulmonary vein (axial series 5 image 29). No definite intra or extrahepatic biliary ductal dilatation is identified, however the exam is limited due to the patient's body habitus, ascites, and respiratory motion artifactSPLEEN: Splenomegaly measuring 21.3 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large volume ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
Suboptimal evaluation due to lack of intravenous contrast and artifacts related to ascites and body habitus. No definite intrahepatic biliary ductal dilatation. The lack of a normal left portal vein flow void and incomplete flow void of the main portal vein are concerning for thrombus, however further evaluation with postcontrast imaging is recommended. Additionally, parenchymal lesions cannot be excluded.