Evaluate common bile duct and causes for elevated bilirubin. Status post TIPS in 1999. Distal CBD stricture secondary to fibrosis from chronic pancreatitis. Alcoholic cirrhosis. Evaluation is markedly limited due to lack of intravenous contrast and motion artifact.ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology. There is increased intra- and extra- hepatic biliary ductal dilatation, with transition points at the hila and at the pancreatic ampulla, probably strictures. The gallbladder is hydropic, new from prior. There is cholelithiasis, with no definite obstructing stone identified. There is new mild gallbladder wall thickening. Patient is status post TIPS, with metallic artifact present. The common bile duct measures up to 9 mm.SPLEEN: No significant abnormality noted.PANCREAS: There is focal pancreatic ductal dilatation within the pancreatic head. Within the pancreatic head, a T2 hyperintense lesion is similar to prior (series 301, image 18), though evaluation is limited due to motion artifact, probable IPMN. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Increased anasarca. No suspicious osseous abnormality identified.OTHER: No significant abnormality noted.
1.Evaluation is markedly limited due to lack of intravenous contrast, early termination of study and motion artifact.2.Increased intra- and extra- hepatic biliary ductal dilatation, cholelithiasis, newly hydropic gall bladder and probable strictures at the level of the ampula and at the hepatic hila. Findings compatible with mild acute cholecystitis. ERCP recommended.Findings discussed with Dr. Dong at11:11 AM on January 19, 2016.