66-year-old female with CT finding of pancreatic ductal dilatation concerning for ampullary lesion. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and morphology. There is no suspicious hepatic lesion. The hepatic vasculature is patent.Common duct measures 7 mm in diameter. There is no intrahepatic biliary ductal dilatation. The gallbladder is normally distended without cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: As on the prior CT the pancreatic duct is diffusely dilated to the level of the ampulla measuring up to 7 mm in diameter. At the level of the ampulla there is a 10 x 7 mm T2 hypointense soft tissue focus (series 5, image 11) that may represent normal ampulla although a small mass is not excluded. There is mild diffuse pancreatic atrophy. No suspicious pancreatic parenchymal lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The smoothly marginated right renal pelvis lesion is T1 isointense, T2 hypointense and demonstrates mild enhancement and washout. It is unchanged in size compared to the prior day's CT.Multiple nonenhancing subcentimeter T2 hyperintense lesions within the left kidney are too small to accurately characterize but are favored to represent cysts given the degree of T2 hyperintensity.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.The pancreatic duct duct is dilated to the level of the ampulla, a soft tissue focus at this level may represent a prominent ampulla however a small mass is not excluded. Further evaluation with EUS is recommended.2.Mildly enhancing, slowly growing right upper renal pelvis lesion is unchanged from the prior day's CT and is suspicious for a small papillary neoplasm.