69-year-old female with history of primary sclerosing cholangitis status post left liver lobectomy now with elevated alkaline phosphatase status post ERCP with balloon dilation ABDOMEN:LIVER, BILIARY TRACT: Status post left hepatic lobectomy. Difference in perfusion between the anterior (five, eight) and posterior (six, seven) segments of the right lobe of the liver with moderate intrahepatic biliary ductal dilation involving the anterior segments and mild intrahepatic biliary ductal dilatation involving the posterior segments, progressed since the prior exam. The ducts converge and terminate at an area of enhancement measuring 9 x 9 mm near the biliary enteric anastomosis.There is minimal peaking of the right intrahepatic biliary ducts consistent with the patient's history of primary sclerosing cholangitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a minimally complex renal cyst in the left kidney. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post Roux-en-Y with biliary enteric anastomosis, unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
Slight progression of intrahepatic biliary ductal dilatation with moderate intrahepatic biliary ductal dilatation involving the anterior segments and mild intrahepatic biliary ductal dilatation involving the posterior segments of the right lobe of liver. Ducts converge and terminate at an focal area of mass like enhancement measuring 9 x 9 mm near the biliary enteric anastomosis. Findings are may represent enhancement of a small mass at the level of the anastomosis versus inflammation related to the patient's underlying primary sclerosing cholangeitis resulting in thickened ductal walls. Further evaluation with ERCP may be considered.