History of primary biliary cirrhosis. Evaluate the dilatation as well as pancreatic and hepatic lesions noted previously. ABDOMEN:LIVER, BILIARY TRACT: Small cirrhotic liver with reticular increased T2 signal throughout compatible with fibrosis. Right hepatic vein to right portal vein TIPS shunt is patent.Again seen is a lesion in the hepatic dome with mildly increased T2 signal. Postcontrast images show bright homogenous arterial enhancement which becomes isointense on the portal venous and delayed phases. This measures 2.0 x 2.0 cm, previously 1.6 x 1.5 cm. There is an additional subcentimeter focus of arterial enhancement without associated washout in segment 4/5 which measures 8 x 8 mm. This is also not significantly changed.Unchanged prominent dilatation of the extrahepatic biliary system. No intrahepatic biliary ductal dilatation.SPLEEN: Spleen is upper limit of normal in size.PANCREAS: There is essentially complete replacement of the entire pancreatic parenchyma by cysts of various sizes. The appearance is not significantly changed going back to 2008 and likely represent combined main duct and side branch IPMNs. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Unchanged left lower lobe nodule.
1.Cirrhotic liver with patent TIPS shunt. 2 dysplastic nodules with arterial enhancement, but not meeting criteria for hepatocellular carcinoma. The segment 7 lesion is slightly increased in size compared to prior.2.Unchanged appearance of the pancreas with replacement of the entire gland by cysts compatible with combined main duct and side branch type IPMNs.3.Stable marked dilatation of the extrahepatic biliary system possibly representing a type I choledochal cyst.