History of cirrhosis. Presents for HCC screening. Also history of endometrial cancer. Evaluation of the solid organs is limited by lack of intravenous contrast.ABDOMEN:LUNG BASES: There is a partially imaged 2.2 x 2.2 cm nodule within the right lung base.LIVER, BILIARY TRACT: Cirrhotic liver morphology. There are several new small lesions in both lobes of the liver which demonstrate decreased T1 signal, mildly increased T2 signal, as well as restricted diffusion which are incompletely characterized but suspicious for metastases. An example lesion is in hepatic segment 5 with reference measurements below. Additional example lesions are in hepatic segment 2/3 (series 9, image 69).No biliary ductal dilatation. Normally distended gallbladder. Small volume perihepatic ascites. Upper abdominal varices. SPLEEN: Mildly prominent spleen measuring 13 cm in craniocaudal dimension. Note is made of a 2.3 splenic artery pseudoaneurysm, not significantly changed.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal simple cyst.RETROPERITONEUM, LYMPH NODES: IVC filter is noted.BOWEL, MESENTERY: The stomach is distended with debris. There is a new soft tissue mass which appears to arise from the wall of the first portion of the duodenum with reference measurements below, highly suspicious for neoplasm. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 9/20/2016 08:25:19)HEPATIC SEGMENT 5 LESION: 1.7 x 1.1 cm (Image 51, Series 9).DUODENAL MASS: 4.6 x 5.2 cm (Image 27, Series 8).
1.Exam limited by lack of intravenous contrast.2.New soft tissue mass which appears to arise from the proximal duodenum highly suspicious for neoplasm. 3.Several new lesions within both lobes of the liver which are suspicious for metastases.4.New right lower lobe pulmonary nodule, suspicious for metastases. Dedicated thoracic imaging is recommended.5.Cirrhotic liver with sequelae of portal hypertension6.Approximately 2.3 cm splenic artery pseudoaneurysm, not significant changed. Endovascular evaluation for possible treatment is recommended.Findings discussed with Dr. Helen Te by Dr. Thomas at 4:00 p.m. on 9/20/2016. 