35-year-old male with suspicious lesions on prior imaging. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and morphology. Redemonstrated is a segment 4A/B lesion with mild T1 isointense signal and mild T2 hyperintense (although intrinsic T2 signal difficult to assess given marked hypointensity of background liver) and demonstrating early arterial enhancement without evidence of washout on portal venous or equilibrium phase. There has been no significant change in size of this lesion when compared to recent prior imaging but increased size noted when comparison made to more remote imaging. There is also arterial enhancement of a peripheral satellite lesion that was identified on the prior study, also without definite washout on portal venous or equilibrium phase. No new focal liver lesions are identified.There is no intrahepatic or extrahepatic biliary ductal dilatation. The gallbladder is within normal limits. There is paradoxical increase in signal in the liver and spleen on out of phase imagesSPLEEN: No significant abnormality noted.PANCREAS: Atrophic distal pancreatic body and tail with cystic lesion in the tail of the pancreas stable to slightly decreased in size since the prior examination measuring 10 mm, previously 12 mm. It is difficult to determine whether this lesion communicates with the main pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 11/18/2016 13:58:42)SEGMENT 4A-B LESION: 1.8 x 1.4 cm (Image 12, Series 7); 1.8 x 1.4 cm on prior (1/12/2016) (Image 12, Series 3).ADJACENT SATELLITE NODULE: (Image 12, Series 7); on prior (1/12/2016) (Image 13, Series 3).PANCREATIC TAIL CYSTIC LESION: 1.0 cm (Image 27, Series 7); 1.2 cm on prior (1/12/2016) (Image 27, Series 3).
1.No significant change in size of a segment 4A/B lesion with additional peripheral satellite lesion as described above, when compared to recent prior imaging. Differential includes FNH although a dysplastic nodule is not excluded especially given degree of postcontrast enhancement and increased size when compared to remote imaging; continued follow up recommended. Hemangioma another consideration but expected corresponding T2 hyperintense signal not seen.2.Stable to slight decrease in size of a cystic pancreatic tail lesion. It is difficult to determine whether this lesion communicates with the main pancreatic duct. Differential continues to include sidebranch IPMN or a small pseudocyst.