Macro clinical ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There is a mildly T2 hyperintense mass at the Klatskin point that measures 7.2 x 5.5 cm. This obstructs the biliary tree causing severe intrahepatic biliary ductal dilatation. At the periphery of the liver especially in the left lobe there are multiple T2 hyperintense cystic foci that show restricted diffusion and are suspicious for hepatic abscesses. There are other lesions in the liver that are mildly T2 hyperintense and is suspicious for metastatic disease.Patent vessel flow voids are present within the main portal vein indicating patency.Gallbladder contains multiple gallstones and is mildly distended. The gallbladder neck is obstructed by the Klatskin mass. There are trapped gallstones in the gallbladder neck.Distal common bile duct is normal in caliber.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is normal in morphology without pancreatic ductal dilatation. No focal pancreatic mass is evident.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Upper abdominal small bowel is not distended.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild upper abdominal ascites.
1.Findings of a large mass at the Klatskin point with severe intrahepatic biliary ductal dilatation suspicious for a cholangiocarcinoma.2.Multiple cystic foci in the periphery of the liver near the dilated bile ducts most suspicious for hepatic abscesses.3.Scattered other lesions in the liver suspicious for metastatic disease.4.Cholelithiasis with gallbladder distention.5.Findings discussed with Dr. Wali at 11:40am by the radiology resident on call 