Evaluate for insulinoma. ABDOMEN:LIVER, BILIARY TRACT: Multiple biliary hamartomas are noted. No focal suspicious lesion within the limitations of a nonenhanced study. Normally distended gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: There is a mildly bulbous appearance of the pancreatic tail but no definite lesion on this limited nonenhanced study.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys are enlarged and the parenchyma is replaced with innumerable lesions most compatible with cysts, minimally complex cysts and complex lesions which cannot be adequately characterized without contrast. The largest on the right is a 7 cm superior pole region. The largest on the left is an 8.5 cm inferior pole lesion. These have internal complexity.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.
Please note that the study is severely limited by lack of intravenous contrast which could not be administered given the patient's end-stage renal disease.1.Slightly bulbous appearance of the pancreatic tail without a definite lesion seen.2.Polycystic kidney disease with numerous lesions which cannot be adequately characterized without intravenous contrast. Some of the lesions have suspicious features.