53-year-old female patient with abdominal pain and cholestatic labs. Evaluate for biliary obstruction. Note that the examination is limited by patient motion artifact.ABDOMEN:LIVER, BILIARY TRACT: There is bilateral intrahepatic biliary ductal dilatation. There is obliteration of the common hepatic biliary duct at the hepatic hilum as well as the secondary biliary ducts bilaterally with an infiltrative mass that measures 5.0 x 4.6 cm (series 901 image 24), which demonstrates delayed enhancement. There is invasion and thrombosis of the portal vein and the left hepatic artery.SPLEEN: No significant abnormality noted.PANCREAS: There is an infiltrative, hypoenhancing lesion in the tail of the pancreas that measures 2.6 x 2.7 cm (series 1401 image 196).ADRENAL GLANDS: There is a small right adrenal adenoma.KIDNEYS, URETERS: Subcentimeter right renal cyst noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Delayed enhancing lesion at the hepatic hilum is compatible with a cholangiocarcinoma. There is associated intrahepatic biliary ductal dilatation and invasion of the portal vein.2.Hypoenhancing lesion in the pancreatic tail is compatible with malignancy, such as a primary pancreatic adenocarcinoma or a metastatic lesion.3.Right adrenal adenoma.