57-year-old man with elevated alkaline phosphatase and total bilirubin. Evaluate for suspicious lesion or biliary issues. ABDOMEN:LIVER, BILIARY TRACT: The liver measures 20.6 cm in length. No enhancing liver lesion.The gallbladder is normally distended with no cholelithiasis. No intra or extrahepatic biliary ductal dilatation.SPLEEN: The splenic vein is not well seen however small collateral vessels are present consistent with the previously documented splenic vein thrombosis. The spleen measures 14.0 cm in length.PANCREAS: The pancreatic head and uncinate process are normal in appearance and without focal lesion. The body and tail of the pancreas are not well seen secondary to previous necrotizing pancreatitis. The pancreatic duct is not dilated. Inflammatory changes surrounding the pancreas have resolved.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No suspicious renal lesion or hydronephrosis.RETROPERITONEUM, LYMPH NODES: Small peripancreatic and porta hepatis lymph nodes are nonspecific.BOWEL, MESENTERY: Tubular enhancing structures in the gastric fundus may represent varices.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a small amount of pelvic ascites.
1.No suspicious liver lesion or biliary ductal dilatation.2.Hepatosplenomegaly.3.Chronic splenic vein occlusion with formation of splenic collaterals and possible gastric fundal varices.