59-year-old woman with history of alcoholic liver disease, evaluate for cirrhosis or portal vein thrombosis. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. There is no nodular contour or widening of the fissures to suggest cirrhosis. No significant signal dropout on out-of-phase imaging seen to indicate hepatic steatosis. The gallbladder is normal. Preserved signal void in portal veins, SMV and splenic vein, supporting patency. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: There is infiltration of the fat planes surrounding the pancreas along with edema of the tail (5/25). There is mild pancreatic ductal prominence involving the distal body and tail. There is mild diffusion restriction within the distal pancreatic parenchyma. As this is a nonenhanced study, parenchymal enhancement cannot be evaluated, difficult to assess for parenchymal necrosis.Additionally, there is an 11 x 10 mm T1 and T2 hyperintense rounded structure posterior and inferior to the pancreatic tail (5/24). The splenic artery courses adjacent to this structure and may be contiguous with structure. If this in fact a vascular structure, the absence of the normal T2 flow void and increased T1 signal may reflect a thrombosed pseudoaneurysm, or possibly slow flow.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a moderate amount of free abdominal fluid which tracks along the left paracolic gutter.
1. No imaging findings of hepatic cirrhosis as clinically questioned. Noncontrast study but preserved signal void in portal veins, SMV and splenic vein, likely reflecting patent vessels.2. Findings concerning for acute pancreatitis involving the distal body and tail. Correlation with patient's clinical history and laboratory values recommended.3. Rounded structure posterior and inferior to the pancreatic tail adjacent to and possibly contiguous with the splenic artery which could represent a small splenic artery aneurysm/pseudoaneurysm versus a pseudocyst. Further evaluation with contrast-enhanced CT angiography is recommended.