59-year-old male with known pancreatic pseudocysts. Evaluate fistula. The review of medical records reveals recent MRI showing multiple pancreatic pseudocysts, one of which possibly communicates with the left renal vein. LUNG BASES: No significant abnormality noted.ABDOMEN: LIVER, BILIARY TRACT: Scattered hypoattenuating lesions, some of which are likely benign cysts while others are too small to characterize.SPLEEN: Splenic vein thrombosis with perigastric collaterals.PANCREAS: Three pancreatic pseudocysts as seen on recent MRI, with the largest seen at the pancreatic tail measuring 2.4 x 4.5 cm. The pancreatic tail pseudocyst extends towards and abuts the left renal vein, which is thrombosed. No blood products are identified in the pancreatic cyst to suggest active communication.Dilated pancreatic duct was better visualized on prior MRI. Please refer to that report.Parenchymal calcifications are compatible chronic pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Thrombosed left renal vein with stranding around the left kidney. No hydronephrosis. There is slight asymmetric delay in the corticomedullary differentiation of the left kidney, the venous drainage of which appears to be compensated via collaterals, suggesting that this is a chronic process. No evidence of fistula between the left renal vein and adjacent pancreatic pseudocyst.Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the descending aorta and iliac arteries.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Patchy nodular sclerosis with areas of lucency are noted in the sacrum, appearing similar to prior studies. While this may represent an atypical form of Paget disease, further evaluation with MRI may be considered for further characterization.
1. Findings compatible with chronic pancreatitis with 3 pancreatic pseudocysts. The largest is in the pancreatic tail, which abuts left renal vein. However, there is no evidence of fistula at this location.2. Thrombosis of the left renal vein with slight asymmetric delay in the corticomedullary differentiation of the left kidney. Venous drainage of this kidney is compensated via collaterals, suggesting that this is a chronically evolving process.3. Patchy nodular sclerosis with areas of lucency in the sacrum. While this may represent an atypical form of Paget disease, further evaluation with MRI pelvis is recommended for further characterization.