35-year-old female with history of metastatic breast cancer who presents for evaluation of liver nodules seen on recent CT examination. ABDOMEN:LIVER, BILIARY TRACT: There are innumerable ill-defined hepatic lesions. Some of the lesions have coalesced and demonstrate central necrosis and debris; these are most consistent with tumor response. Some of the lesions demonstrate diffusion restriction and peripheral enhancement; these findings are concerning for active metastatic disease. The reference lesion in the right lobe measures 26 x 20 mm (series 1304, image 249), unchanged. Centrally the bile ducts are narrowed secondary to extrinsic compression. Portal vein is patent.SPLEEN: Subcentimeter T2 hyperintense focus at the periphery of the spleen (series 601, image 27) is nonspecific without evidence of enhancement.PANCREAS: There is interstitial and peripancreatic edema.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Linear T1 and T2 hypointensity of the right kidney without evidence of enhancement is consistent with a scar.RETROPERITONEUM, LYMPH NODES: Reference porta hepatis lymph node measures 20 x 12 mm (series 601, image 27), previously measuring 20 x 13 mm. Reference aortic lymph node measures 13 x 12 mm (series 601, image 15), unchanged.BOWEL, MESENTERY: Partially visualized ascites and diffuse mesenteric haziness. Carcinomatosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Persistent small right pleural effusion. Bilateral basilar subsegmental atelectasis.
1.Innumerable ill-defined hepatic lesions. Findings consistent with mixed response with necrosis and active tumor. 2.Findings concerning for acute pancreatitis. Correlation with lipase is recommended.3.Stable porta hepatis lymphadenopathy.4.Centrally bile ducts are narrowed secondary to extrinsic compression5.Stable small right pleural effusion.