71-year-old female with history of ovarian cancer. Known liver lesions causing biliary obstruction, stent placement on 11/10/08. Now has increased pain and worsening LFTs. Rule out pneumobilia. Evaluate for stent obstruction. ABDOMEN:LUNG BASES: There are small bilateral pleural effusions, unchanged.LIVER, BILIARY TRACT: Redemonstration of multiple solid hypodense lesions. Reference right hepatic lesion is stable measuring 3.5 x 3.2 cm on image 32/96. There an internal biliary stent but no pneumobilia. The intrahepatic portions of metallic stents are in the posterior segment of the right hepatic lobe and anterior segment of the right hepatic lobe. Distal metallic stents are in the duodenum. Contrast noted previously in the anterior segment of the right intrahepatic ducts is not seen. Persistent left intrahepatic ductal dilatation is unchanged. Interval increase in the right-sided intrahepatic ductal dilatation.Gallbladder is surgically absent. Tumor invasion in main portal vein as seen on MRI is redemonstrated (series 4, image 39/96)SPLEEN: Calcified splenic granulomata are unchanged. Large metastatic lesion in the spleen measuring 5.7 x 5 cm on image 25/96 is unchanged.PANCREAS: Mild pancreatic ductal dilatation in the pancreatic head is unchanged.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Reference lymphadenopathy encasing hepatic artery in the porta hepatis is grossly unchanged, measuring 2.5 x 1.7 cm image 39/96. There is new small amount of fluid in the hepatoduodenal ligament. There is thin, curvilinear fluid noted in medial segment of the second portion of duodenum. Adjacent inflammatory fat stranding in the second and third portions duodenum is noted. No free air is seen. Findings suggest inflammatory change from instrumentation without complete perforation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
1) Stable internal biliary stent location with interval increase in right intrahepatic biliary dilatation and persistent left intra-hepatic biliary dilatation and decreased pneuomobilia suggests stent occlusion. 2) Stable inflammatory change and wall edema in second portion of duodenum from recent ERCP, but no free air is seen to suggest duodenal perforation.3) Stable small bilateral pleural effusions.