Abdominal pain and CBD dilatation on outside study. History of liver transplant for PBC. ABDOMEN:LIVER, BILIARY TRACT: The patient is status post liver transplant. The liver is normal in morphology, size and signal intensity.The CBD-CBD anastomosis appears patent with dilated donor and native cystic duct remnants present.There is intra and extrahepatic biliary ductal dilatation with the common bile duct measuring up to 8 mm. There are low signal intensity filling defects in the distal CBD compatible with stones/debris. Additionally there is smooth tapering of the distal CBD measuring approximately 2.2 cm in length without a discrete mass lesion, favoring a benign stricture. Small porta hepatis lymph nodes are noted.SPLEEN: The spleen is normal in size and morphology without a focal lesion.PANCREAS: The main pancreatic duct is dilated up to 6 mm with moderate smooth narrowing proximal to the ampulla measuring 1.3 cm in length. In the proximal pancreatic tail there is a cystic 7.0 mm lesion, decreased from the prior study where it measured 1.4 cm.In the pancreatic tail there is a 3.6 x 2.6 cm multiloculated cystic lesion, unchanged. It contains a central scar which demonstrates delayed enhancement.ADRENAL GLANDS: Subcentimeter nodularity of the right adrenal gland. The left adrenal gland is unremarkable.KIDNEYS, URETERS: Bilateral simple appearing cysts and too small to characterize hyperintensities. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple presumed injection granulomata in the anterior abdominal wall soft tissues.OTHER: No significant abnormality noted.
1.New intrahepatic and extrahepatic biliary dilatation to the level of the pancreatic head without a mass lesion with a benign-appearing stricture. Upstream there is debris/stones in the CBD. Similarly the main pancreatic duct is also dilated up to 7 mm with a benign-appearing 1.3 cm stricture at the level of the pancreatic head.2.Stable lobular pancreatic tail mass - prior pathology reported as a serous cystadenoma.3.Decreasing size of the pancreatic body/tail cystic focus now measuring 7 mm.