60 yo M hx of metastatic colon cancer s/p duodenal stent for duodenal obstruction presents w/ jaundice and leukocytosis. MRI/MRCP to further evaluate biliary obstruction Examination is limited by motion.ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions are identified. The hepatic vasculature appears patent.There is significant intrahepatic and extrahepatic biliary ductal dilatation. The common hepatic duct at its confluence measures up to 2.1 cm. As best seen on series 601, image 19, there is an abrupt segment of narrowing of the common bile duct with near complete occlusion measuring approximately 1.5 cm in length with associated surrounding infiltrative soft tissue. It is difficult to evaluate this area on other sequences due to motion artifact. The common bile duct reconstitutes more distally. SPLEEN: There is mild splenomegaly measuring up to 13 cm.PANCREAS: Parenchymal signal intensity appears within normal limits. The pancreatic duct is not dilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter renal cysts bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A duodenal stent is present in the transverse portion of the duodenum extending to the region of the ligament of Treitz.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild ascites is present.
1.Examination somewhat limited by motion.2.Significant intrahepatic and extrahepatic biliary dilatation likely related to 1.5 cm segment of abrupt narrowing of the common bile duct with associated surrounding infiltrative soft tissue. This area is difficult to evaluate on other sequences due to motion. ERCP may be helpful for additional evaluation.