31-year-old female with history of pancreatic pseudocyst status post cyst gastrostomy in March 2015. Patient now with abdominal pain, nausea, vomiting, and elevated lipase. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. No biliary ductal dilation. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: There is fullness of the pancreatic head with an apparent rounded area measuring up to 2.7 x 2.2 cm (series 1204/63) demonstrating low T2 signal and relative hypoenhancement on delayed phase images. There is mild relative upstream dilation of the main pancreatic duct measuring up to 3-4 mm with multiple side branches visualized with transition point in the pancreatic body, appears to be upstream from the pancreatic head findings. Definite restricted diffusion is not seen. Cyst gastrostomy tube is present, but there are no significant peripancreatic fluid collection seen.There appears to be occlusion of the portal confluence with the splenic vein not visualized. The main portal vein appears to be reconstituted by collateral vessels.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Prominent peripancreatic lymph nodes are seen around the pancreatic head, but these are not pathologically enlarged by size criteria.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
Overall, pancreatic head findings as detailed above are nonspecific and may relate to sequela/devascularization or necrosis from pancreatitis, focal type autoimmune pancreatitis another differential consideration, underlying masslesion not entirely excluded. Clinical and endoscopic correlation is suggested.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.