Reason: eval for etiology of pneumobilia History: nausea, vomiting, epigastric abdominal pain, history of ERCP and cholecystectomy ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. Peripheral perfusional abnormalities are present in the right liver. The common bile duct is dilated to 1.5 cm narrowing distally with peripheral enhancement an wall thickening as well as adjacent inflammatory changes. No choledocholithiasis. No intrahepatic biliary ductal dilatation. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: There are 2 tiny cystic lesions in the pancreatic tail measuring up to 3 mm (501/21). At the pancreatic head neck junction, there is a cystic lesion measuring 1.2 cm. Within the pancreatic head there is another adjacent cystic lesion measuring 0.9 cm. No dilatation of the main pancreatic duct. There is atrophy of the pancreatic tail.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal cysts, the largest measuring up to 4.2 cm in the left midpole.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Again seen is duodenal dilatation raising the suspicion of SMA syndrome.BONES, SOFT TISSUES: Rightward curvature of the spine.OTHER: Cardiomegaly.
1.Dilatation of the common bile duct with peripheral enhancement, wall thickening and adjacent inflammatory changes along the mid to distal common bile duct, likely reflecting inflammatory changes, possibly cholangitis. No choledocholithiasis.2.Multiple cystic lesions within the pancreas likely represent side branch IPMN's.3.Dilatation of the duodenum is again seen and may suggest SMA syndrome.