82-year-old male with cholangiocarcinoma per outside hospital abutting the hepatic artery. Evaluate for extent of disease and vascular involvement. ABDOMEN:LIVER, BILIARY TRACT: There is infiltrative enhancing tumor involving the proximal common bile duct, Klatskin point, and extending into the left bile duct. This results in moderate intrahepatic ductal dilatation and moderate dilatation of the common bile duct which measures up to 1.0 cm. Approximately 2 cm of the proximal common bile duct is severely attenuated. The tumor invades the right hepatic artery (series 1903, image 56; series 21, image 55).Two subcentimeter diffusion restricting foci with peripheral enhancement in hepatic segment 7 and 4A/B (series 1902, image 78). Reference segment 7 focus measures 0.9 x 0.7 cm (series 1902, image 49). SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is normal in intrinsic T1 hyperintensity. Multiple T2 hyperintense lesions within the pancreas with the largest measuring approximately 0.9 x 0.7 cm in the pancreatic body most consistent with side branch type IPMNs. No evidence of pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral T2 hyperintense foci within the kidneys most compatible with cysts; the largest is on the left measuring approximately 1.2 cm.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Findings compatible with cholangiocarcinoma involving the proximal common bile duct, Klatskin point, and extending into the left bile duct. There is invasion of the right hepatic artery.2.Two subcentimeter hepatic lesions most concerning for metastatic disease.3.Multiple side branch IPMNs.