81-year-old female with nausea and vomiting. Evaluate for extra/intrahepatic ductal dilatation. ABDOMEN:LIVER, BILIARY TRACT: As seen on the prior exams, there is moderate degree of intra and extrahepatic biliary ductal dilatation. The common bile duct has a somewhat tortuous course, and there is concentric narrowing at the distalmost portion (coronal series 701 image 78). Common bile duct dilatation extends to the level of the ampulla where there is a round T2 hypointense focus (coronal series 201 image 17) with apparent corresponding postcontrast enhancement on image 130 series 1101. Please see key images.SPLEEN: No significant abnormality noted.PANCREAS: Parenchymal atrophy of the pancreas. Of note, no pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small left-sided simple renal cysts. Incidental note is made of a circumaortic left renal vein.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Rectus diastases.OTHER: Cardiomegaly.
Moderate degree intra and extrahepatic biliary ductal dilatation. Tortuous course of the common bile duct demonstrates concentric narrowing at the distalmost segment. A small T2 hypointense focus in bowel lumen at the level of the ampulla could represent a normal ampulla with a focal stricture of the distal common bile duct, however underlying neoplasm (particularly given apparent postcontrast enhancement) cannot be excluded. Correlation with the patient's clinical history recommended and further evaluation with ERCP/EUS should be be considered.