68 years, Male, Reason: liver lesion ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: There is increased intrahepatic biliary ductal dilatation extending from the Klatskin point. This is particularly prominent in the left hepatic lobe. A hypointense lesion identified on the prior exam is not evident on this exam and in that region of the left hepatic lobe, there is now increased ductal dilatation. There may be subtle ill-defined T2 signal within the hepatic hilum at the Klatskin point, however no discrete mass can be identified. The common bile duct in this region appears mildly irregular and there appears to be mass effect on the left portal vein.Small amount of debris in the gallbladder. Cirrhotic nodular liver contour.SPLEEN: Splenomegaly is unchanged.PANCREAS: Prominent pancreatic duct measuring up to 6 mm. Normal appearing pancreatic parenchyma.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter right upper pole hemorrhagic cyst.RETROPERITONEUM, LYMPH NODES: Mildly enlarged periportal node measuring 1.4 x 1.5 cm (7/60).BOWEL, MESENTERY: Mild bowel wall thickening of the ascending colon is unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Diffuse abdominal ascites is unchanged.
1.Increased intrahepatic biliary ductal dilatation. While this may be due to progression of patient's known primary sclerosing cholangitis, the degree of change raises concern for an obstructing lesion at the Klatskin point. A discrete lesion is not identified on this exam, however there may be subtle T2 abnormality and findings suggesting mass effect.2.Hypointense lesion identified on the prior exam is not evident.3.Stable ascites.4.Colonic wall thickening is stable and may be secondary to portal colopathy.