54-year-old female with pancreatitis and hyperbilirubinemia and elevated transaminases ABDOMEN: Significant motion artifact limits evaluation of the pancreatic parenchyma. LIVER, BILIARY TRACT: Marked intrahepatic and extrahepatic biliary ductal dilatation. Common bile duct measures up to 16 mm in diameter with filling defect in the distal CBD. The gallbladder is normal in appearance. No cholelithiasis. SPLEEN: No significant abnormality noted.PANCREAS: Atrophic and calcified (calcifications better delineated on prior CT) pancreatic parenchyma with significantly dilated main pancreatic duct in body/tail, findings consistent with chronic pancreatitis. Pancreatic divisum anatomy is noted. There are filling defects noted within the main pancreatic ducts compatible with stones (55/7). There is mass-like enlargement of the pancreatic head with equivocal diffusion restriction. No definitive abnormal enhancement pattern is present but evaluation is suboptimal due to extensive motion artifact. Multiple T2 hyperintense foci arising from the main duct in the setting of chronic pancreatitis most likely related to sidebranch ectasia. Clustered subcentimeter increased T2 signal foci at the pancreatic head and neck (series 5, image 19).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: No significant abnormality noted.
1.Findings compatible with acute on chronic pancreatitis at level of pancreatic head. No definite enhancing lesion is noted in the pancreatic head however the exam is severely limited secondary to motion artifact and a small lesion cannot be entirely excluded. Correlation with results of recent endoscopic ultrasound exam recommended. 2.Clustered subcentimeter increased T2 signal foci at the pancreatic head and neck. Differential includes septated IPMN, interdigitating fluid, or possibly serous cystadenoma. 3.Severe intrahepatic and extrahepatic ductal dilation, and pancreatic duct dilation with sidebranch ectasia. Small stones in the main pancreatic duct and the distal CBD suspected to contribute to aforementioned significant duct dilation. Underlying ductal stricturing not entirely excluded.