90 year-old male with CLL and splenomegaly. Abdominal aortic aneurysm measured 3.5 cm in January 2, 2008. Known pancreatic mass. Bilateral lower quadrant abdominal pain. This examination is limited by the absence of intravenous contrast. ABDOMEN: Lung Bases: Bibasilar dependent atelectatic changes and increased interstitial markings suggesting borderline congestive heart failure. Status post median sternotomy. Small bulla in the right lower lobe. Cardiomegaly. Liver, Biliary Tract: Hypodense lesions in the liver, two in the left lobe and one in the right lobe. Lack of IV contrast precludes further characterization. Ultrasound may be helpful for further evaluation. No evidence of biliary dilatation. Cholelithiasis is present without evidence of cholecystitis. Spleen: Spleen is enlarged measuring 14 cm. Kidneys, Ureters: Punctate stone in the upper pole of the right kidney. Multiple fluid attenuating lesions in both kidneys which cannot be further characterized without IV contrast. Mild caliectasis is present in the left kidney. Complex left renal cyst. Adrenal Glands: No significant abnormality noted Pancreas: 2.5 x 2.5 cm fluid attenuating lesion at the tail of the pancreas. Lack of IV contrast precludes further evaluation. This represents a cystic neoplasm or pseudocyst, unlikely a solid neoplasm. The MRI scan showed two irregular cystic lesions communicating with pancreatic duct, smaller one in the body and larger lobulated lesion in the tail of the pancreas. These most likely represents a branch type duct IPMT (intraductal papillary mucinous tumor). Chronic pancreatitis. Retroperitoneum, Lymph Nodes: Infrarenal abdominal aortic aneurysm measuring 3.2-cm in its largest AP dimension. Common iliac arteries are unremarkable other than atherosclerotic changes.Bowel, Mesentery: Multiple soft tissue masses are present in the small bowel mesentery largest measuring 2.1 x 2.2 cm on image number 77/142. The etiology of these masses is probably CLL. The masses are stable.Bones, Soft Tissues: No significant abnormality noted Other: No significant abnormality noted PELVIS: Prostate, Seminal Vesicles: No significant abnormality noted Bladder: No significant abnormality noted Lymph Nodes: No significant abnormality noted Bowel, Mesentery: Nonobstructive bowel containing right inguinal hernia at axial image 119/142.Bones, Soft Tissues: No significant abnormality noted Other: A trace of ascites are present.
Multiple hypodense liver lesions. Hypodense mass involving the pancreatic duct and tail is stable. Multiple mesenteric soft tissue masses and splenomegaly. The appearance is consistent with known CLL. These findings are stable.