New diagnosis of cholangioadenocarcinoma and gallbladder carcinoma, abdominal pain and elevated LFTs Suboptimal exam due to extensive patient motion artifact.ABDOMEN:LIVER, BILIARY TRACT: Improved biliary duct dilatation, likely related to placement of biliary stent. Thick walled gallbladder, likely combination of inflammation from adjacent ascites and reported gallbladder carcinoma, small sludge/hemorrhagic or proteinaceous material and cholelithiasis in gallbladder, nonspecific rounded restricted diffusion seen in the gallbladder lumen, may also reflect reported gallbladder malignancy. Nodular liver contour. New from prior study are multiple hepatic lesions (examples include located in hepatic dome and hepatic segment 8/5 and hepatic segment 6, see images 524, 396 and 300 series 607) demonstrating mildly increased T2 signal and restricted diffusion, with ill-defined borders and minimal to no internal enhancement seen, appearance suspicious for hypoenhancing metastatic disease. Lesion near gallbladder fossa may reflect metastatic disease or direct tumor invasion. Submitted for reference is a hepatic segment 5 lesion measuring 1.3 x 1.2 cm, image 372 series 1502. Left portal vein and splenic vein not well seen, suspicious for occlusion, heterogeneous left lateral hepatic parenchymal enhancement.SPLEEN: No significant abnormality noted.PANCREAS: Nonspecific peripancreatic soft tissue attenuation and stranding.ADRENAL GLANDS: Diffusely enlarged adrenal glands.KIDNEYS, URETERS: Bilateral renal cortical thinning.RETROPERITONEUM, LYMPH NODES: Again visualized retroperitoneal soft tissue thickening, with associated flattened configuration of the IVC, assessment including patency suboptimal secondary to extensive patient motion artifact. Small inguinal lymph nodes.BOWEL, MESENTERY: Wall thickening, likely reactive in setting of ascites.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Right greater than left small pleural effusions and moderate to large ascites visualized.
1. Suboptimal exam due to extensive patient motion artifact and presence of ascites, contrast-enhanced CT abdomen and pelvic imaging for improved assessment should be considered.2. Hepatic metastatic disease, new. Left portal vein and splenic vein not well seen, suspicious for occlusion, heterogeneous left lateral hepatic parenchymal enhancement.3. Improved biliary duct dilatation, likely related to placement of biliary stent. Thick walled gallbladder, likely combination of inflammation from adjacent ascites and reported gallbladder carcinoma, small sludge/hemorrhagic or proteinaceous material and cholelithiasis in gallbladder, nonspecific rounded restricted diffusion seen in the gallbladder lumen, may also reflect reported gallbladder malignancy. 4. Nonspecific peripancreatic soft tissue attenuation and stranding. Again visualized retroperitoneal soft tissue thickening,5. Right greater than left small pleural effusions and moderate to large ascites visualized.