38-year-old male patient with alcohol hepatitis with intra-abdominal bleed status post prior embolization, now with persistent leukocytosis. Evaluate for abscess. Several sequences are degraded by motion artifact.ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly measuring 22 cm in the craniocaudal dimension. Within limitations of motion degradation, there is no new T2 hyperintense/diffusion restricted collection within the liver to suggest a new intrahepatic fluid collection. Previously demonstrated large geographic area of signal abnormality involving the left hepatic lobe and extending into the right hepatic lobe is less clearly delineated on this examination secondary to extensive motion artifact. However, the extent of this region of signal abnormality and enhancement characteristics appear grossly similar to the prior examination.There is a persistent focus of signal void within the middle hepatic vein centrally suggesting nonocclusive thrombus. Furthermore, there is the suggestion of signal void within the anterior branch of the right portal vein which could represent thrombus. The left portal vein is narrowed. The main portal vein appears patent.There is no intra or extra hepatic biliary ductal dilatation. The gallbladder wall is mildly thickened which is nonspecific in setting of ascites.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is large volume abdominal ascites. There is an evolving hematoma within the left hemiabdomen which is causing displacement of the bowel to the right and mild peritoneal enhancement. Small left pleural effusion.
1.Within limitations of the study, no new hepatic lesion is identified to suggest an infected fluid collection.2.Large geographic region of signal abnormality within the liver predominately in the distribution of the left portal vein may be perfusional in etiology and sequela of partial occlusion of the left portal vein as it is narrowed. Furthermore, there is probable non-occlusive thrombus within the middle hepatic vein centrally and the anterior branch of the right portal vein.3.Large volume ascites with evolving hematoma in the left hemiabdomen and non-specific peritoneal enhancement; superimposed infection is not excluded. 4.Small left pleural effusion.