History of antral gastric cancer status post resection, now with local recurrence. Staging CT 3/6/15 showed stable subcentimeter liver lesions and steatohepatitis. Now with sudden onset hyperbilirubinemia. Evaluate for obstructive process and also liver lesions. EPIC history: EGD 2/26/15 showed malignant appearing gastric tumor in lesser curvature of stomach. ABDOMEN:LIVER, BILIARY TRACT: Diffuse mild intrahepatic and extrahepatic biliary ductal dilatation, measuring up to 9 mm, with transition point at irregular narrowing at the biliary-enteric anastomosis (series 602, image 3). This is due to extrinsic compression of the duct by an enhancing 2.5 x 2.8 x 4 cm mass at the enteric anastomosis (series 1602, image 73; series 801, images 17 and 18), centered in the pancreaticoduodenal groove; it is unclear if this mass is of pancreatic or bowel origin.Previously noted subcentimeter right hepatic lobe lesion is too small to characterize, unchanged (series 1602, image 114).SPLEEN: No significant abnormality noted.PANCREAS: Markedly atrophic pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral parapelvic cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Post-surgical findings of distal gastrectomy and Roux-en-Y gastrojejunostomy.Eccentric wall thickening of the lesser curvature with associated diffusion restriction compatible with known locally recurrent tumor (series 1602, image 94).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Mild diffuse dilatation of the biliary tree due to an obstructing mass at the biliary-enteric anastomosis highly suspicious for tumor, unclear if this is of bowel or pancreatic origin. Differential is metastatic lesion versus a primary malignancy of the bowel or pancreas.2.Lesser curvature of the stomach eccentric wall thickening consistent with known local recurrence.3.Unchanged subcentimeter right hepatic lobe lesion, too small to characterize; special attention on follow up scans.