History of pancreatic head mass. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and size. No biliary ductal dilatation or vascular abnormality. Normally distended gallbladder.There are at least 6 punctate subcentimeter mildly restricting, mildly T2 hyperintense, peripherally enhancing lesions in the liver involving both the right and left hepatic lobe, suspicious for metastatic disease.There are numerous predominantly peripheral wedge-shaped arterially enhancing regions which become gradually isointense to the liver on more delayed imaging compatible with perfusion anomalies. SPLEEN: No significant abnormality noted.PANCREAS: Demonstrated again is an approximately 2.7 x 2.4 cm hypoenhancing pancreatic head mass with associated abrupt termination of a markedly distended main pancreatic duct measuring up to 1 cm with associated pancreatic parenchymal atrophy. The mass abuts approximately 90 degrees of the adjacent superior mesenteric artery (series 1501/177). The celiac artery does not appear to be involved. There is severe narrowing of the SMV just proximal to the portal vein confluence. There are prominent peripancreatic/periaortic lymph nodes better characterized on the prior CT. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left interpolar simple cyst. No hydronephrosis or suspicious lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small right pleural effusion and bibasilar atelectasis.
1.Pancreatic head mass with features more suspicious for pancreatic adenocarcinoma with 90 degrees of abutment of the adjacent superior mesenteric artery. Peripancreatic and periaortic lymphadenopathy.2.Numerous punctate bilobar hepatic lesions with imaging characteristics highly suspicious for metastatic disease.