65-year-old female with metastatic pancreas and new pancreatic tail lesion seen on recent CT. ABDOMEN:LIVER, BILIARY TRACT:Hepatic steatosis. No discrete suspicious lesion or pathologic enhancement to suggest metastatic disease.Patent portal and hepatic vasculature. No intrahepatic or extrahepatic biliary ductal dilation.SPLEEN: No significant abnormality noted. Patent splenic vein.PANCREAS:Hypodense lesion seen near the tail of the pancreas on prior CT correlates with a low T2 signal lesion with restricted diffusion and enhancement, compatible with tumor and measuring up to 1.6 x 1.8 cm (series 1203/54), not significantly changed in size since prior CT. The lesion demonstrates central hypoenhancement, likely due to central necrosis. Infiltrative, ill-defined tumor in the region of the pancreatic neck is also not significantly changed in size since prior CT. The pancreatic tail lesion is best seen on diffusion weighted images and appears to connect to the pancreatic neck infiltrative lesion. As a result of this finding, the pancreatic tail lesion is most likely related to increased infiltrative tumor rather than a new or metastatic lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of peritoneal metastasis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
Hypodense lesion seen near the tail the pancreas on prior CT is due to tumor, felt to be likely due to increased size of known infiltrative tumor in the region of the pancreatic neck based on appearance on DWI sequence, metastatic lymph node or new additional metastatic lesion considered less likely.