63 year-old male with ampullary lesion and stable segment 7 liver lesion. Evaluating extent of disease if any in liver. ABDOMEN:LIVER, BILIARY TRACT: Previously seen nonenhancing, low-attenuation lesion in hepatic segment 7 on prior CT measures 1.5 x 2.1 cm on the current MRI, unchanged in size (series 1102/81). The lesion is homogeneously T2 bright and T1 dark with gradual peripheral enhancement superiorly, compatible with hemangioma. Additional scattered T2 bright subcentimeter lesions are too small to characterize but likely due to cysts. No suspicious hepatic lesions. Status post cholecystectomy. Moderate intrahepatic biliary ductal dilation with dilation of the common bile duct usually measuring up to 1.7-cm. At the level of the ampulla, there is a small, low T2 signal ampullary lesion demonstrating enhancement and measuring up to 1.5 x 1.3 cm (series 5/46 and series 1102/34), most compatible with known ampullary adenocarcinoma. Previously seen common bile duct stent is not visualized. Mild circumferential wall thickening of the common bile duct with enhancement, likely related to inflammation given recent instrumentation though tumor infiltration cannot be excluded. Few punctate distal common bile duct stones are seen (series 5/43 and 45).SPLEEN: Small splenule is seen at the splenic hilum near the pancreatic tail. Mild splenomegaly with the spleen measuring up to 16.2-cm in length. No focal splenic lesions.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable subcentimeter T2 bright hypoattenuating lesions in both kidneys, most likely due to simple cysts.RETROPERITONEUM, LYMPH NODES: Portacaval lymphadenopathy is similar to prior CT.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable degenerative arthritic changes of the lumbosacral spine with mild superior endplate compression deformities of the L1 and L3 vertebral body.OTHER: No significant abnormality noted.
1.Ampullary lesion compatible with the known ampullary adenocarcinoma causing biliary tree dilation. Mild circumferential wall thickening and enhancement of the distal common bile duct, likely related to inflammation given recent instrumentation though tumor infiltration cannot be excluded.2.Mild choledocholithiasis.3.No suspicious hepatic lesions.4.Portacaval lymphadenopathy.