Primary biliary cirrhosis, elevated LFTs above baseline, right upper quadrant pain ABDOMEN:LIVER, BILIARY TRACT: Liver measures 16.6 cm in craniocaudal dimension and micronodular contour suggested, may reflect underlying cirrhosis. Hepatic segment 8 lesion measuring 1.5 x 1 cm, image 22 series 301. Lesion demonstrates imaging characteristics suspicious for metastatic disease. Lesion is mildly T2 hyperintense and demonstrates restricted diffusion (image 325 series 701), associated enhancement suggested (subtraction sequences suboptimal due to motion), atypical hemangioma another differential consideration.Marked intrahepatic and extrahepatic biliary duct dilatation. Common bile duct measures up to 1.7 cm. Distal intraluminal abnormal signal seen, measuring approximately 1.2 cm in transverse dimension by 1.2 cm in AP dimension by 2.5 cm in craniocaudal dimension, image 4 series 301 and image 10 series 401, may reflect blood clot or debris/stones, but underlying neoplastic extension a consideration. Lesion demonstrates intrinsic T1 hyperintensity, which would favor hemorrhagic products, assessment for associated enhancement on subtraction sequences suboptimal due to motion.Hydropic gallbladder, measuring 5.2 cm in transverse dimension. Large amount of layering sludge/complex material suggested within the gallbladder, corresponding increased T1 signal seen. SPLEEN: Splenomegaly present, spleen measures up to 15 cm in craniocaudal dimension. PANCREAS: Marked pancreatic duct dilatation present, measuring up to 11 mm, intraductal debris present, particularly near level of ampulla. Smaller subcentimeter T2 hyperintense foci seen in pancreatic body may reflect tiny intraductal papillary mucinous neoplasms (IPMNs) versus sidebranch ectasia. Please note that entirety of pancreas was not imaged on axial imaging. In coronal plane, common bile and pancreatic ductal dilatation seen to level of nonspecific T2 hypointense lobulated signal near junction of ampulla and duodenum, measures approximately 3 x 1.5 cm (image 11 series 401), appearance suspicious for obstructing masslesion. Mild fluid containing prominence of bowel proximally.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal T2 hyperintense foci, most likely cysts. One of these foci medially located in right kidney, measuring 9 x 8 mm, image 9 series 601, contains internal heterogeneity, may be related to some complexity/internal septation.RETROPERITONEUM, LYMPH NODES: Enlarged gastrohepatic and portacaval/peripancreatic lymphadenopathy, small juxtaphrenic lymph nodes also seen. Areas of peripancreatic restricted diffusion presumably related to enlarged adenopathy versus underlying masslesion. BOWEL, MESENTERY: Bowel thickening, nonspecific in setting of ascites.OTHER: Small to moderate ascites incompletely imaged. Heart borderline in size.
1. Marked biliary and pancreatic ductal dilatation, to level of lobulated signal near duodeno-ampullary junction, suspicious for obstructing ampullary or periampullary (e.g., pancreatic head) masslesion, with hepatic and nodal metastatic disease suggested. Correlation with patient's clinical history and further characterization with ERCP and/or histologic sampling recommended.2. Hepatic segment 8 lesion demonstrating imaging characteristics suspicious for metastatic disease. Background of cirrhosis and stigmata of portal hypertension.3. Enlarged upper abdominal lymphadenopathy, may be metastatic.4. Hydropic gallbladder.5. Small to moderate ascites incompletely imaged. 