54 years, Male, Reason: 54 yo male with newly dx HOP cancer, with questionable liver lesions on OSH imaging. Needs MRI Liver to further characteriize liver lesions History: None. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: There are multiple subcentimeter lesions which are bright on T2 and progressively fill in on delayed phases, compatible with hemangiomas. However, there are 4 lesions which are bright on T2 weighted images and do not completely fill in on delayed images but instead have rim enhancement. For example, a segment 8 lesion measures 1.1 x 1.3 cm (905/320). The portal vein is patent. No intrahepatic biliary ductal dilatation.SPLEEN: There is splenic vein thrombosis with multiple perisplenic collaterals.PANCREAS: There is a hypoenhancing lesion in the in the pancreatic head which measures 2.3 x 1.5 cm (901/27) and likely corresponds to patient's known pancreatic adenocarcinoma. No evidence of vascular involvement including the portal system or hepatic veins.There is loss of the normal contour of the distal pancreas with low T1 signal, diffusion restriction and peripancreatic inflammatory changes suggesting acute pancreatitis. A hypointense rim is observed, a finding which may be seen in autoimmune pancreatitis. There is a thick walled collection superior to the pancreatic tail along the greater curvature of the stomach with adjacent inflammatory changes. Multiple small peripancreatic lymph nodes are noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal nodes including a left para-aortic node measuring 1.3 x 1.0 cm (901/143). An enlarged periportal node measures 2.0 x 1.2 cm (901/233).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Pancreatic head mass likely corresponds to patient's known pancreatic adenocarcinoma.2.There are numerous enhancing lesions with signal characteristics suggestive of hemangiomas. However, there are a few lesions with delayed ring enhancement which would be atypical for a hemangioma and given patient's known pancreatic cancer, are suspicious for neoplasm.3.Mild retroperitoneal lymphadenopathy.4.Inflammatory changes in the body and tail of the pancreas suggests acute pancreatitis. There is loss of the normal lobular contour with a thin rim, a finding which may be seen in the setting of autoimmune pancreatitis. Correlation with serum IgG-4 levels and clinical symptoms is recommended.5.Splenic vein thrombosis.6.Thick rimmed fluid collection adjacent to the pancreatic tail. A peripancreatic fluid collection is favored, however this could also represent an inflamed gastric diverticula.Findings discussed with primary team at 3:30 p.m. on 2/27/2015.