25-year-old female with recurrent pancreatitis, with history of multiple pseudocysts. Transferred from outside hospital for further evaluation of pseudocysts. Now with fevers and acute renal failure. Evaluate for progression of pseudocysts. Evaluate for hydronephrosis, urinary obstruction. Fever to 42 degrees with a previous right lower lobe pneumonia. This examination is limited by the absence of intravenous contrast.ABDOMEN:LUNG BASES: Small bilateral, right greater than left, pleural effusions. Subcentimeter lesion in the fat pad at the right cardiophrenic angle is a borderline enlarged lymph node. LIVER, BILIARY TRACT: Re-demonstration of the lesions in the liver as seen on MRI study. A lesion in the right hepatic dome, with central target-like enhancement is identified. Two additional hyperdense lesions are also seen. With review of MRCP study, hepatic adenoma is favored for the dome lesion and slightly atypical hemangiomas are favored for the other two lesions. No new lesions. SPLEEN: No significant abnormality notedPANCREAS: There is mild pancreatic ductal dilatation, most pronounced in the pancreatic head. Pancreatic head is enlarged with surrounding fat stranding and fluid compatible with acute pancreatitis.Superiorly there is a 3.2 x 4.8 cm cystic lesion (axial image 81/215) seen near the gastroesophageal junction, which likely represents a pancreatic pseudocyst when reviewed with current MRCP study performed here. Smaller cystic lesions in region of pancreatic head are probably smaller pseudocysts, but these are not well seen on this exam.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality noted. No hydronephrosis. RETROPERITONEUM, LYMPH NODES: Multiple enlarged and borderline enlarged mesenteric and retroperitoneal lymph nodes are probably reactive to theBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Posterior surgical fusion Harrington rods with mild scoliosis are noted. The surgical appliances are in the expected position and appear intact. Metallic streak artifact from the surgical appliances limit detailed evaluation of adjacent structures.OTHER: Mild abdominal and pelvic ascites is stable.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Posterior surgical fusion rods with mild scoliosis is notedOTHER: Mild abdominal and pelvic ascites is seen.
1) Findings consistent with focal pancreatitis in pancreatic head and multiple pancreatic pseudocysts are stable. 2) Three hepatic lesions are stable, most like due to a hepatic adenoma and slightly atypical hemangiomas.3) Multiple additional findings are unchanged. 