39-year-old female with history of gastric cancer status post total gastrectomy. ABDOMEN:LIVER, BILIARY TRACT: There is a right percutaneous biliary drainage catheter with distal tip in the duodenum. There is persistent significant bilateral intrahepatic biliary ductal dilatation with shouldering and sharp cut off of the left hepatic duct near Klatskin's point. There is long segment narrowing of the common bile duct. No focal hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: There is soft tissue fullness of the pancreatic head and porta hepatis which significantly narrows the proximal main portal vein (image 17-18 of series 5). Additionally, there is sharp cutoff of the pancreatic duct at the pancreatic head/neck with atrophy of the remaining pancreas and ductal dilatation measuring up to 7 mm. There is mildly increased restricted diffusion within this area without appreciable differences in enhancement when compared to the background atrophied pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post Roux-en-Y gastrectomy. No drainable fluid collections.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1. Fullness at the pancreatic head extending into the porta hepatis with associated sharp attenuation and narrowing of the main portal vein, dilated pancreatic duct with abrupt cutoff seen at level of head, intrahepatic biliary duct dilatation (more pronounced on left side; right side decompressed by biliary drainage catheter) and long segment narrowing of the common bile duct suggested. Although it is difficult to delineate a measurable obstructing lesion, constellation of findings are suspicious for an infiltrative neoplasm, such as an extrahepatic cholangiocarcinoma or pancreatic head carcinoma. Extrinsic lymphadenopathy and benign stricturing is considered less likely.2. Postoperative changes as above.