Reason: pancreatic cancer with elevated T-bili which continues to rise s/p biliary stent at OSH (6/6, 6/9) History: as above ABDOMEN:LIVER, BILIARY TRACT: Multiple enhancing lesions, likely reflecting metastases. Right hepatic lobe lesion measures 2.2 x 2.6 cm for reference (1103/64). There is a biliary stent. Ill-defined tissue is present within the hepatic hilum which restricts on diffusion-weighted imaging and surrounds the stent, likely representing tumor. The main portal vein is narrowed but remains patent.There hyperenhancement and wall thickening of the gallbladder. Increased T1 signal within the lumen likely represents hemorrhage. Metastatic lesions are present within the liver immediately adjacent to the gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: There is an enhancing mixed solid and cystic lesion in the pancreatic tail measuring 5.1 x 4.7 cm (5/18). The main pancreatic duct is nondilated and there is fatty atrophy within the majority of the body and neck of the pancreas. There is ill-defined soft tissue in the pancreatic head surrounding the common bile duct which demonstrates enhancement and diffusion restriction measuring 4.0 x 2.4 cm (1104/70), suspicious for pancreatic adenocarcinoma. This tissue extends along the course of the common bile duct into the hepatic hilum.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: There is an enlarged portacaval lymph node measuring 2.5 x 1.7 cm (1104/56). Enlarged para-aortic lymphadenopathy with an enlarged left periaortic node measuring 1.6 x 1.1 cm (1101/94).BOWEL, MESENTERY: Perihepatic peritoneal nodule measures 0.9 x 0.4 cm (1104/61).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small right pleural effusion with thickened adjacent pleura which may suggest an empyema.
1.Ill-defined tissue in the pancreatic head extending along the course of the common bile duct into the hepatic hilum is suspicious for a primary pancreatic adenocarcinoma.2.There is an additional mixed solid and cystic lesion in the pancreatic tail which is also likely neoplastic. 3.Multiple hepatic metastases. There is hemorrhage within the gallbladder lumen, which may be due to an adjacent metastases or prior intervention.4.Peritoneal nodularity raises the suspicion of early carcinomatosis.5.Retroperitoneal lymphadenopathy.6.Small right pleural effusion with a thickened pleura likely represents empyema.