History of distal esophageal cancer and chronic pancreatitis. PET CT demonstrated a hypermetabolic focus in the pancreatic head/neck. Evaluate this lesion. ABDOMEN:LIVER, BILIARY TRACT: Demonstrate again is marked intrahepatic and extrahepatic biliary ductal dilatation. A biliary stent is noted.No suspicious liver lesion. The liver is normal in morphology. The hilar portal vein is patent. At the level of the pancreatic head is markedly attenuated. The hepatic veins are patent.Cholelithiasis.SPLEEN: Normal splenic size.PANCREAS: The pancreas is prominent with marked irregular pancreatic ductal dilatation/ectasia with multiple signal voids compatible with calcifications as seen on recent CT. These findings are consistent with severe chronic pancreatitis, although a main duct intrapancreatic mucinous neoplasm cannot be excluded.There is soft tissue enhancement of the pancreatic head/uncinate process which may represent residual pancreatic parenchyma although underlying neoplasm cannot be excluded given the marked parenchymal abnormality.There is a enhancing thick-walled focus along the anterior caudal aspect of the pancreatic head measuring 1.4 x 0.7 cm (series 12/179), which may represent a small pseudocyst or necrotic lymphadenopathy.A 1.8 cm lesion near the pancreatic tail may represent the mobile rim calcified pseudoaneurysm as seen on recent CT.There is no significant peripancreatic acute inflammatory changes/fluid.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal simple appearing cysts and too small to characterize hypointensities.RETROPERITONEUM, LYMPH NODES: Prominent gastrohepatic adenopathy is better characterized on recent CT.BOWEL, MESENTERY: The stomach is distended with heterogeneous debris to the level of the transverse duodenum without a discrete mass lesion seen.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Markedly distended main pancreatic duct may reflect stigmata of severe chronic pancreatitis although a main duct intrapancreatic mucinous neoplasm cannot be entirely excluded. Heterogeneous soft tissue enhancement of the pancreatic head may represent residual parenchyma although an underlying neoplasm cannot be excluded. ERCP/US correlation is recommended.2.Thick rim enhancing small lesion anterior and caudal to the pancreatic body may represent a pseudocyst versus necrotic lymphadenopathy.3.Probable mobile arterial pseudoaneurysm measuring 1.8 cm, better seen on the recent CT.