Metastatic pancreatic cancer. Biliary ductal dilatation. ABDOMEN:LIVER, BILIARY TRACT: Several segments have significant intrahepatic ductal dilatation. Segment 5/8 biliary ductal dilatation terminates at a 0.9 x 0.9 cm hypoenhancing mass, compatible with metastatic disease. There is an associated transient hepatic intensity difference in this segment of the liver.There is severe intrahepatic ductal dilatation in the lateral segment of the left hepatic lobe likely related to a small metastasis which cannot be seen. There is no significant dilatation of the common hepatic duct which is poorly seen at the level of hilum. The common bile duct at the level of the pancreatic head is not significantly dilated.Right hepatic lobe hypoenhancing liver metastasis is again seen, measuring 1.5 x 1.2 cm. Mild perihepatic ascites.SPLEEN: The spleen measures 12 cm in length without focal lesion.PANCREAS: Poorly defined hypoenhancing lesion involving the pancreatic body and extending dorsally is difficult to accurately measure and is better characterized on the recent CT. The pancreatic tail is atrophic and decreased in signal intensity. Again the mass encases multiple vessels, better seen on recent CT. Obliteration of the superior mesenteric and splenic vein confluence with numerous collateral vessels is again noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small volume pelvic ascites. Note is made of distended mid small bowel loops without proximal dilatation. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
Limited by motion. 1.Several hepatic segments with significant intrahepatic biliary ductal dilatation likely related to small metastatic lesions. A lesion in segment 5/8 is well demonstrated. An underlying lesion related to the lateral segment biliary dilatation is not discernable but is suspected given the abrupt bile duct caliber change. Known larger hepatic metastases are not significantly changed. 2.The locally infiltrating pancreatic mass with associated local vascular involvement is better characterized on recent CT.3.Distended mid small bowel loops may reflect an ileus, but are incompletely evaluated. Follow-up imaging may be obtained as clinically warranted.