Male 41 years old Reason: 41 y/o man w/ narrowing of the portal vein who p/w abdominal pain and elevated Bilirubin History: CBD dilation on US. ABDOMEN:LIVER, BILIARY TRACT: There is progressive intrahepatic and extrahepatic biliary duct dilatation as well as gallbladder distention. The common duct measures 1.1 cm in maximum transverse dimension and demonstrates diffuse wall thickening and enhancement. There is a focal segment of nonvisualization of the duct at the level of the pancreatic head and this is presumably secondary to the below described pancreatic head/neck abnormality.Patent hepatic vasculature. There is progressive portal vein narrowing with almost complete occlusion at the confluence. Gastrohepatic and perihepatic varices are noted.SPLEEN: No significant abnormality noted.PANCREAS: There is progressive pancreatic duct dilatation in the pancreatic body and tail. There is a tiny filling defect within the pancreatic duct which may represent a small calculus. There is abrupt termination of the pancreatic duct in the region of the pancreatic head/neck where there is masslike enlargement of the pancreatic head and neck. This demonstrates diffuse T2 hypointense signal suggestive of fibrosis and there are infiltrative changes within the peripancreatic fat. Cystogastrostomy tube in situ. There is no fluid collection.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left upper pole renal cyst.RETROPERITONEUM, LYMPH NODES: There are multiple enlarged peripancreatic and portacaval lymph nodes. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.
1.Masslike enlargement of the pancreatic head and neck as described above. The differential considerations include focal autoimmune pancreatitis or evolution of pancreatitis with fibrotic changes in the pancreatic head and neck. Pancreatic neoplasm is not excluded however is felt much less likely.2.There is progressive intra and extra hepatic biliary duct and pancreatic duct dilatation secondary to the aforementioned infiltrative pancreatic abnormality.3.Marked attenuation of the portal vein with almost complete occlusion of the confluence.