Pancreatic lesion found incidentally on CT ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology, no suspicious liver lesion. Adenomyomatosis of level of the gallbladder fundus. Rounded foci of signal void on T2-weighted sequence seen layering in gallbladder, corresponding T1 hyperintensity seen, findings consistent with pigment gallstones.SPLEEN: Splenomegaly, measures 14 cm in longitudinal dimension. 1.4 cm splenule.PANCREAS: At junction of pancreatic head and uncinate process is well-circumscribed 1.1 x 1 cm T2 hyperintense focus, likely a sidebranch intraductal papillary mucinous neoplasm. No suspicious nodularity or enhancement delineated. Nondilated pancreatic duct. Intrinsic T1 signal of pancreatic parenchyma is relatively maintained. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple varices. Small retrocrural, periportal and retroperitoneal lymph nodes, likely reactive in setting of chronic liver disease.BOWEL, MESENTERY: Percutaneous gastrostomy located in distal gastric body. Edematous bowel, likely reactive in etiology/related to hypoalbuminemic state. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Large amount of ascites. Moderate-sized left pleural effusion. Left-sided retroperitoneal hematoma formation seen on prior CT study not well assessed on current exam.
1. Well-circumscribed 11 mm nonenhancing T2 hyperintense focus located at junction of pancreatic head/uncinate process likely a sidebranch IPMN, no suspicious features depicted. Accounting for differences in technique and absence of intravenous contrast on earlier study, lesion was likely present on earlier noncontrast CT study from March 2015 (refer to image 42 series 3 on 3/23/15 CT study). 2. Cholelithiasis.3. Stigmata of cirrhosis, including nodular liver, splenomegaly and variceal formation. Large ascites and moderate-sized left pleural effusion.