60-year-old woman with history of cirrhosis and dilated intrahepatic biliary ducts seen on ultrasound, evaluate for PSC. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology and low in signal. There is significant, intrahepatic biliary duct dilatation throughout both left and right hepatic lobes measuring up to 14 mm on the left and 15 mm on the right. Of note, the proximal tertiary hepatic ducts are not visualized. The gallbladder is contracted and the extrahepatic biliary ducts are not well seen.At the hepatic hilum, there is abnormally increased T2 signal with delayed enhancement seen at the confluence of the intrahepatic bile ducts (series 301, image 20; series 1401, image 249). Although ill-defined, this area measures approximately 46 x 26 mm (series 1401, image 249).A 7 mm progressively enhancing lesion in segment 8 of the liver (series 1401, image 29) is likely a hemangioma. The portal vein is not visualized past the splenic/SMV confluence.SPLEEN: The spleen is enlarged and measures 163 mm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: A 12 x 9 mm left upper pole lesion (series 1401, image 181) is T1 hyperintense without significant enhancement. A 10 mm lesion in the inferior pole of the left kidney has layering T1 and T2 hyperintensity and does not enhance (series 701, image 1). Additionally a nonenhancing 8 mm T2 hyperintense focus is seen in the mid left pole (series 701, image 3).The right kidney is normal.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted of the partially visualized small bowel or colon. Specifically, there does not appear to be colonic thickening.BONES, SOFT TISSUES: Small perineural cysts are noted in the spine.OTHER: There is a moderate to large amount of ascites.
1.Mass at the hepatic hilum with appears to occlude the proximal tertiary biliary ducts and results in intrahepatic biliary duct dilatation. This mass enhances on delayed phase imaging and is suggestive of an infiltrating cholangiocarcinoma.2.Cirrhosis and portal vein occlusion with collateralization.3.Left renal hemorrhagic and simple cysts.4.Findings paged to ordering provider (p2693) at 11:45 AM on 11/2/2015.