72-year-old man with history of cholecystectomy complicated by recurrent pancreatitis and pseudocyst formation status post drainage. ABDOMEN:LIVER, BILIARY TRACT: Scattered hepatic cysts are noted and there are no suspicious hepatic lesions. There is intrahepatic biliary ductal dilatation, left greater than right, with significant stricturing at Klatskin's point. This biliary ductal dilatation appears stable from the prior examinations. No abnormal T2 signal or enhancement is seen at the site of stricturing.Patient is status post cholecystectomy. The extra hepatic bile duct is also mildly dilated with slight narrowing at the ampulla.SPLEEN: No significant abnormality noted.PANCREAS: The cystduodenostomy has been removed and there is now a 22 x 15 mm cystic lesion in the head of the pancreas (4/27). This cystic lesion communicates with the pancreatic duct.The pancreatic parenchyma is otherwise atrophic. A 15 mm bilobed cystic lesion in the head of the pancreas (4/33) appears stable back to 8/2015.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter cysts noted bilaterally, the kidneys are otherwise unremarkable.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.
1.Interval removal of cystduodenostomy stent with new 2.2 cm cystic lesion in the head of the pancreas which could represent an IPMN or pseudocyst.2.Stable irregular stricturing at the Klatskin's point causing intrahepatic biliary ductal dilatation. This may represent stricturing from cholangitis, but an underlying cholangiocarcinoma cannot be excluded.