Cholangiocarcinoma status post Whipple now with jaundice. ABDOMEN:LIVER, BILIARY TRACT: There are postsurgical changes from a Whipple procedure including a hepaticojejunostomy. There is marked intrahepatic biliary ductal dilatation to the point of Klatskin where there is abrupt narrowing of the biliary tree. There is very subtle mild T2 hyperintensity and restricted diffusion at the site measuring approximately 2.7 x 2.2 cm (series 8/33). There is thickening and enhancement of the common hepatic duct (series 1404/83). Additionally, there is poorly defined delayed enhancement in the region of biliary duct amputation. These findings are suspicious for infiltrative cholangiocarcinoma recurrence.No additional suspicious intrahepatic lesion. The hepatic artery and hepatic veins appear patent. There is narrowing of the portal vein at the porta hepatis at the level of the ill-defined infiltrative lesion and biliary ductal narrowing with reconstitution distally.Several foci of transient hepatic intensity differences without underlying discrete abnormality are noted.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is moderately atrophic. There is a multiloculated cystic lesion in the pancreatic tail measuring 2.7 x 1.4 cm (series 8/23), not significantly increased from the CT dated 7/28/2014 using similar measurement technique. The lesion appears to communicate with the pancreatic duct which is irregularly dilated up to 5 mm.The pancreatic parenchyma is decreased in intrinsic T1 signal intensity and enhancement compatible with pancreatic dysfunction. It enhances homogeneously.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis or suspicious lesion.RETROPERITONEUM, LYMPH NODES: Atherosclerotic disease of the abdominal aorta with mild infrarenal ectasia.BOWEL, MESENTERY: Postsurgical changes from a gastrojejunostomy. Large volume ascites.There are numerous dilated small bowel loops measuring up to 3.2 cm. There are collapsed distal small bowel loops and the colon is decompressed. These findings raise the possibility of a small bowel obstruction versus partial ileus.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small pleural effusions. Postsurgical changes from sternotomy.
1.Marked intrahepatic biliary ductal dilatation to the level of Klatskin point where the bile ducts are abruptly narrowed and there is an ill-defined lesion suspected suspicious for recurrent cholangiocarcinoma at Klatskin point. Thickening and enhancement of the common hepatic duct likely periductal spread. The portal vein is significantly narrowed at this point as well with distal reconstitution.2.Large volume ascites.3.Stable pancreatic tail cystic neoplasm, likely a side-branch IPMN. 4.Findings of pancreatic dysfunction without specific evidence of acute pancreatitis.5.Small bowel dilatation is partially evaluated raising the possibility of a low-grade small bowel obstruction versus partial ileus. Clinical correlation is recommended.