History of abdominal pain, elevated lipase, AST and ALT. ABDOMEN:LIVER, BILIARY TRACT: Numerous bilobar hepatic cysts. No suspicious liver lesion, biliary ductal dilatation or vascular abnormality. Small amount of perihepatic ascites. The common bile duct is dilated up to 10 mm with intrahepatic biliary ductal dilatation. There are two focal round filling defects in the common bile duct (series 901/90 and 86), suspicious for choledocholithiasis.The gallbladder is distended with wall thickening and/or pericholecystic fluid. No cholelithiasis.SPLEEN: Small amount of perisplenic ascites.PANCREAS: Several cystic pancreatic lesions, the largest of which is a uniloculated 1.4 cm lesion in the pancreatic tail which communicates with the main pancreatic duct, compatible with the sidebranch IPMN without suspicious imaging features. Additional 1.1 cm pancreatic body suspected sidebranch IPMN. Punctate cystic lesions in the uncinate process, also likely side branch type IPMNs.There is mild diffuse decrease in intrinsic pancreatic parenchymal signal intensity. The pancreas enhances homogeneously. There is a moderate amount of peripancreatic nonloculated fluid. No evidence of an arterial or venous complication.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys are enlarged and the parenchyma is replaced with innumerable high intensity and intermediate intensity cysts consistent with polycystic kidney disease with simple and minimally complex/hemorrhagic cysts. No suspicious enhancing lesion. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.There are two focal round filling defects in the common bile duct (series 901/90 and 86), suspicious for choledocholithiasis. Distended common bile duct up to 10 mm and intrahepatic ductal dilatation, progressed from prior. ERCP is recommended. 2.Mild pancreatitis without necrosis, acute peripancreatic fluid collection or vascular complication.3.Distended gallbladder with gallbladder wall thickening/pericholecystic fluid, progressed from the prior study and suggesting cholecystitis. 4.Polycystic kidney and liver disease. 1.4 cm IPMN in the pancreatic tail and additional suspected IPMNs and/or parenchymal cysts.Findings discussed with hospitalist service (pager 5866 Kristine) at 0930 on 08/06/2015.