52-year-old male with history of right upper quadrant pain, liver mass, and elevated bilirubin. ABDOMEN:LUNG BASES: Trace bilateral pleural effusions with associated atelectasis.LIVER, BILIARY TRACT: There is a segment 5/8 lesion measuring 3.2 x 2.0 cm which demonstrates high T2 signal abnormality with progressive fill-in after contrast administration. Distal to this lesion there is mild wedge-shaped restricted diffusion extending to the periphery with mild intrahepatic biliary ductal dilatation. There appears to be attenuation of the anterior branch of the right portal vein. The main portal vein is open. The hepatic hilum is not involved.There are scattered areas about the left and right hepatic lobes of ductal dilatation with multiple sharp cutoffs.The common bile duct is unremarkable. The gallbladder is unremarkable.SPLEEN: No significant abnormality notedPANCREAS: Mildly increased restricted diffusion within the pancreatic head which may indicate a mild pancreatitis.Normal pancreatic duct.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: There is an enlarged right retroperitoneal lymph node adjacent to the right renal hilum measuring 2.4 x 1.7 cm (image 12 of series 701).The proximal IVC is open however the distal appears relatively attenuated with multiple retroperitoneal and anterior abdominal wall venous collaterals.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
1. Right hepatic lobe segment 5/8 mass with imaging characteristics suggestive of cholangiocarcinoma. The hepatic hilum and main portal vein appear to be spared, however the anterior branch of the right portal vein is not well seen and may be involved.2. Scattered areas of biliary ductal dilatation in both hepatic lobes with multiple sharp cut offs can be seen in PSC, multifocal strictures, or less likely, biliary spread of tumor.3. Enlarged right retroperitoneal lymph node adjacent to the right renal hilum is highly suspicious for metastatic disease.4. Abnormal IVC with multiple venous collaterals in the anterior abdominal wall and retroperitoneum is suggestive of a distal obstruction. This can be further evaluated with a contrast-enhanced CT.5. Mildly increased streaky diffusion about the pancreatic head may indicate pancreatitis.