History of ampullary adenocarcinoma. Questioned liver lesions on CT. ABDOMEN:LIVER, BILIARY TRACT: Multiple T2 mildly to moderately hyperintense liver lesions are noted in both lobes of the liver. These lesions demonstrate very thin peripheral enhancement on postcontrast images compatible with metastatic disease. There are associated with restricted diffusion and some have suggestion of internal complexity/coalescing small cystic components.Intra and extrahepatic biliary ductal dilatation to the level of the ampullary mass. Susceptibility artifact from patient's biliary stent is noted.Air in the gallbladder fundus.SPLEEN: No significant abnormality noted.PANCREAS: Large heterogeneous enhancing solid and cystic mass centered at the ampulla/pancreatic head measuring 7.3 x 7.2 x 8.7 cm resulting in marked pancreatic ductal dilatation and parenchymal atrophy. There is no encasement of the superior mesenteric artery or celiac artery. The mass abuts the portal vein/SMV which is normal in caliber and is otherwise patent. Punctate peripancreatic nonspecific lymph nodes are noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple cysts and minimally complex proteinaceous/hemorrhagic cyst in the left kidney. No hydroureteronephrosis.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.
The bilobar liver lesions demonstrate very thin peripheral enhancement and restricted diffusion. Given their configuration/morphology, the patient's recent leukocytosis and biliary obstruction these could represent small abscess, favored over necrotic metastases although the later cannot be entirely excluded. Large ampullary mass is again demonstrated. Biliary stent with persistent significant biliary ductal dilatation. 