Reason: comparison to RUQ US History: hx of HHT. ABDOMEN:LUNG BASES: Small bilateral pleural effusions.LIVER, BILIARY TRACT: The liver is mildly enlarged measuring 20.8 cm in craniocaudal dimension. On out of phase sequence, there is diffuse significant decreased signal compatible with hepatic steatosis. Nodular contour with caudate lobe enlargement and widening of the fissure suggestive of cirrhotic morphology. There is diffusely heterogeneous enhancement of the liver with multiple perfusional abnormalities and early enhancement of the hepatic veins during the arterial phase compatible with shunting. There are innumerable predominantly subcentimeter lesion in both lobes that demonstrate T1 hypointense, T2 iso to slightly hyperintense signal with early and persistent enhancement that are difficult to further characterize due to their size. Although, the largest, which measure 2.1 cm in the left lobe of the liver (series 803 image 328) and 2.0 cm in the right lobe of the liver adjacent to the gallbladder fossa (series 803 image 193), demonstrate homogeneous arterial and persistent enhancement and presumably represent telangiectasias given patient's history. Also adjacent to the gallbladder fossa, there is a T1 hypointense, T2 mildly hyperintense lesion with early peripheral enhancement that progressively fills in and demonstrates restricted diffusion, measuring 2.5 x 1.9 cm (series 803 image 238).Hepatic vasculature is patent with early enhancement of the hepatic veins. No intrahepatic or extrahepatic biliary ductal dilatation. Mild gallbladder wall thickening, likely related to ascites. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left small subcentimeter parapelvic cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Large amount of abdominal ascites.
1.Cirrhotic morphology. 2.5 cm lesion within the right lobe of the liver that demonstrates peripheral arterial enhancement with progressive delayed filling in, suspicious for cholangiocarcinoma. 2.Findings compatible with arteriovenous shunting and innumerable predominately subcentimeter arterial enhancing lesions with persistent enhancement, likely representing telangiectasias given the patient's history. 3.Large amount of ascites and small bilateral pleural effusions. 4.No biliary ductal dilatation. 