64 year old female with a history of cholangiocarcinoma of the distal common bile duct with elevated lipase and a history of pancreatitis. Evaluate for stone/duct stenosis. ABDOMEN:LIVER, BILIARY TRACT: Percutaneous biliary drainage catheter in place with the tip projecting at the level of the second portion of the duodenum, unchanged in position. There is mild intrahepatic biliary ductal dilation. There is moderate to severe extrahepatic biliary ductal dilation to the level of the distal common bile duct (51; series 701), adjacent to an ill defined mass in the region of the pancreatic head which demonstrates restricted diffusion and subtle delayed enhancement, measuring 4.3 x 3.0 cm (228; series 602). There is associated loss of the fat plane between the second portion of the duodenum and right psoas muscle and apparent extension to involve the right crus of the diaphragm. These findings are suspicious for residual or recurrent tumor in the setting of a known malignancy/cholangiocarcinoma. No common duct stones are identified. Focus of decreased T1 and T2 signal abnormality in the dome of the liver, consistent with the previously demonstrated hepatic dome calcification. Simple cyst in the right lobe of liver.SPLEEN: No significant abnormality noted.PANCREAS: Moderate to severe main pancreatic duct dilation to the level of the confluence with the common bile duct immediately adjacent to the aforementioned mass at the level of the distal common bile duct, appearing increased in diameter when compared to the prior study, when allowing for differences in technique.Multiple subcentimeter foci of fluid signal intensity are identified within the body and tail of the pancreas which are incompletely characterized and may represent branch type IPMNs or cysts. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple simple cysts are identified in the left kidney. Decreased T2 signal abnormality in the kidneys bilaterally can be seen in hemosiderin deposition.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The stomach and proximal duodenum are dilated and filled with fluid and debris to the level of the junction of the second and third portions of the duodenum, with a transition point immediately adjacent to the level of the aforementioned mass within the expected region of the distal common bile duct. These findings are suspicious for tumor involvement/extension into the duodenum. Further evaluation with endoscopy could be considered if clinically indicated. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate-sized bilateral pleural effusions with underlying atelectasis/consolidation.
1.4.3 cm ill defined enhancing mass in the expected region of the distal common bile duct with resultant moderate to severe biliary and main pancreatic duct dilation, appearing increased when compared to the prior study. These findings are suspicious for residual or recurrent tumor in the setting of a known primary malignancy/cholangiocarcinoma.2. Dilation of the stomach and proximal portions of the duodenum to the level of the aforementioned distal common bile duct mass is suspicious for duodenal extension/involvement by tumor, with resultant gastric outlet obstruction. Further evaluation with endoscopy could be considered if clinically indicated. 3. Persistent bilateral pleural effusions. 4. Decreased T2 signal abnormality in the kidneys bilaterally is nonspecific but can be seen in hemosiderin deposition.5. Multiple subcentimeter foci of fluid signal in the pancreas may represent cysts versus branch type IPMNs.