19 year with jaundice, bilirubin of 10 ABDOMEN:LIVER, BILIARY TRACT: Mild to moderate intrahepatic biliary ductal dilatation. There is layering sludge within the gallbladder. No choledocholithiasis. There is probable low insertion of the cystic duct although this is incompletely evaluated due to cyst pancreatic head lesion. The common bile duct is dilated, slightly increased when compared to most recent CT dated 11/14/2015. The distal common bile duct and ampulla are difficult to visualize due to mass effect from cystic pancreatic lesion.Hepatic steatosis is present.SPLEEN: No significant abnormality noted.PANCREAS: There is diminished intrinsic T1 signal of the pancreas suggestive of chronic pancreatitis. The main pancreatic duct and side branches are dilated measuring up to 8 mm. There is a new large cystic lesion in the head of the pancreas measuring 6.2 x 6.8 x 7.2 cm. There is mass effect on both the pancreatic and common bile duct. There is mass effect and displacement of the duodenum. There is no evidence of gastric outlet obstruction. There is no abnormal enhancement. No splenic vein thrombosis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Prominent appearing unusually shaped periportal lymph node may be reactive. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.New large cystic lesion head of the pancreas, likely reflecting a pseudocyst provided history of pancreatitis, with focal mass effect on adjacent structures including the common bile duct and pancreatic duct with slight interval increase in size of biliary dilatation could explain the patient's jaundice and increased bilirubin. An ERCP or US guided drainage of the cyst may be helpful.2.Mild restricted diffusion of the pancreas and diminished intrinsic T1 signal of the pancreas is suggestive of an acute on chronic pancreatitis.