Abdominal pain status post liver transplant. History of abscess; cystic pancreatic mass - FNA showed inflammatory debris. ABDOMEN: Susceptibility artifact at the porta hepatis due to cholecystectomy clips and the TIPS catheter limits examination.LIVER, BILIARY TRACT: No intrahepatic biliary ductal dilatation. The common hepatic and common bile duct are obscured by susceptibility artifact from the patient's TIPS catheter. The hepatic veins appear patent. The SMV and splenic vein appear patent as is the portal vein distal and proximal to the TIPS supporting patency. The hepatic artery is not visualized. Stable 4.5 x 3.3 cm T2 hyperintense well-circumscribed complex mass/collection in the subcapsular region adjacent to the caudate lobe which communicates with a more inferior multilobulated mildly T2 hyperintense lesion measuring 6.4 x 4.9 cm in the gastrohepatic region and pancreatic head with heterogeneous T2 weighted hypointense and intrinsically hyperintense T1 -weighted irregular contents and thin septations. The appearance is unchanged compared to the recent prior MRI. No definite post-contrast enhancement.Additional T2 hyperintense nonenhancing subcentimeter right hepatic lobe lesions, are not significantly changed from the MR dated 5/4/15, but decreased from the CT dated 5/23/15. Associated perfusional changes are again noted. These are compatible with decreasing/treated abscesses including superinfected cysts. Mild diffuse hepatic parenchymal wedge-shaped heterogeneity, likely perfusional.The liver is normal in morphology, contour and size.SPLEEN: Trace perisplenic fluid and perisplenic varices. Splenomegaly, measuring 13.4 cm.PANCREAS: The previously mentioned heterogeneous complex mass/collection extending from the pancreatic head superiorly into the lesser curvature and adjacent to the caudate lobe is not significantly changed in appearance. The pancreatic parenchyma is atrophied and the pancreatic duct distal to this pancreatic head lesion is irregularly dilated up to 6 mm, slightly increased, likely due to mass affect. The pancreatic parenchyma otherwise enhances homogeneously. There is mild mass effect on the gastroduodenal artery.Additional complex cystic mass/collection inferior to the pancreatic body measures 5.0 x 3.3 cm (series 401/12), not significant changed when remeasured on the prior study (series 301/8).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: There are numerous enlarged retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.No intrahepatic biliary ductal dilatation. Evaluation of the common hepatic and common bile duct is obscured by susceptibility artifact from the TIPS catheter. Similarly the hepatic artery is obscured by susceptibility artifact. 2.Relatively stable complex masses/collections inferior to the pancreatic body, within the pancreatic head dissecting cranially to the level of the caudate lobe.3.Subcentimeter intrahepatic cystic lesions with associated perfusion abnormality are now similar in size to the prior MR but decreased from the interval CT; suggesting treatment response of abscesses as opposed to hepatic cysts or biliary hamartomas.4.Mild increase in pancreatic ductal dilatation likely due to mass effect of the complex mass/collection in the pancreatic body.5.No new fluid collections.