80 years, Female, Reason: further assess intra and extrahepatic biliary obstruction seen on US History: jaundice, weight loss, fatigue, pruritis. Limited exam due to lack of intravenous contrast.ABDOMEN:LUNG BASES: Small left pleural effusion.LIVER, BILIARY TRACT: There is lesion within the hepatic hilum at the Klatskin point, involving the proximal and mid common bile duct, which measures 3.2 x 4.4 cm (301/17). This lesion is diffusely infiltrative with additional lesions within the right hepatic lobe seen on T2/DWI (501/310 and 305), suspicious for metastases.The distal common bile duct is also dilated to 1.2 cm without a distal obstructing lesion evident.SPLEEN: No significant abnormality noted.PANCREAS: Prominent pancreatic duct. Pancreatic parenchymal appears normal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple scattered renal cysts with a right upper pole hemorrhagic/proteinaceous cyst measuring 1.1 cm (801/17).RETROPERITONEUM, LYMPH NODES: Prominent portocaval lymph node measuring 1.2 x 0.9 cm (501/318). Enlarged left periaortic lymph node measuring 1.8 x 1.0 cm (501/312).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild abdominal ascites.
1.Evaluation is limited due to lack of intravenous contrast, however there is an obstructing mass within the liver causing severe intrahepatic biliary ductal dilatation which may represent either cholangiocarcinoma or metastases.2.Additional lesions within the right hepatic lobe are suspicious for metastases.3.Retroperitoneal lymphadenopathy.