Reason: pancreatitis, pancreas graft-lesion, concern for mass History: Abdominal pain ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates normal parenchymal signal intensity without suspicious focal lesions.The gallbladder is again mildly distended but without evidence of cholelithiasis, wall thickening, or pericholecystic inflammatory changes.Minimal intrahepatic biliary ductal dilatation. The common bile duct measures 8 mm. No filling defects are present. SPLEEN: No significant abnormality noted.PANCREAS: There is atrophy of the native pancreatic distal body and tail. There is no ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic native kidneys.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Transplant kidney is present within the left hemipelvis without evidence of hydronephrosis.Transplant pancreas in right lower quadrant. There is redemonstration of a mass lesion which appears to arise from the transplant pancreatic head measuring 4.9 x 4.1 cm in the axial plane. The mass is well-circumscribed, has heterogeneous mildly increased T2 signal, and demonstrates avid enhancement with scattered cystic/necrotic areas. The pancreatic duct appears patent and is nondilated throughout its course. The pancreas transplant vasculature appears patent.Subcentimeter cysts/residual follicles are present within the bilateral ovaries, which are normal in size.
1.Solid enhancing mass which appears to arise from the transplant pancreatic head which is suspicious for neoplasm; suggest biopsy for further evaluation. Differential considerations include neuroendocrine tumor or acinar cell carcinoma among other etiologies. The mass may also arise from the portion of the donor duodenum or mesentery.2.Minimal intra and extrahepatic biliary ductal dilation with no evidence of distal mass or filling defect; a benign distal stricture cannot be excluded.Findings discussed with SAMRA, MANPREET at time of dictation.