Suspected pancreatic mass seen on CT. EGD/US revealed an intramural lesion in ampulla, unclear if inflammatory or neoplastic. ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates normal parenchymal signal intensity without focal lesions. There is redemonstration of a percutaneous cholecystostomy tube with tip in the contracted gallbladder. There has been interval decrease in pericholecystic inflammatory changes compared to the 11/4/2015 CT. There is trace intrahepatic biliary ductal dilatation appearing similar to prior. The common bile duct is prominent measuring up to 11 mm which remains dilated up until the ampulla appearing similar to prior.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic parenchyma demonstrates normal signal intensity and enhancement without focal lesions identified. There is once again mild fullness of the uncinate process. The pancreatic duct is tortuous and is mildly dilated in the pancreatic neck and body measuring up to 5 mm in diameter appearing similar to prior CT. There is no associated ductal wall thickening or enhancement. The pancreatic duct abruptly and smoothly narrows in the region of the pancreatic head for length of approximately 2 cm proximal to the ampulla.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: A mildly prominent periportal lymph node appears similar to prior. An IVC filter is present.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1. Interval improvement of pericholecystic inflammatory changes. Cholecystostomy tube remains in place. 2. Dilation of the common bile duct to the level of the ampulla measuring up to 11 mm appearing similar to prior and which may be related to patient's reported ampullary lesion.3. Mild dilation of the pancreatic duct up to 5 mm with smooth narrowing in the pancreatic head for 2 cm proximal to the ampulla. No discrete pancreatic mass identified, findings suggest a stricture. It is unclear whether or not this is related to patient's reported ampullary lesion. An alternative explanation for the prominent pancreatic duct could be a main duct IPMN, but this is considered less likely given that the pancreatic duct is only dilated up to 5 mm and there is a lack of additional associated findings to suggest IPMN such as ductal wall enhancement. Correlation with patient's ERCP/pathology findings recommended.