62-year-old man with history of extrahepatic cholangiocarcinoma status post Whipple, now with abdominal pain and concern for recurrence. ABDOMEN:LIVER, BILIARY TRACT: There is increased intrahepatic biliary ductal dilatation measuring up to 9 mm (201/18), increased from the prior study. The dilated intrahepatic bile ducts narrow and terminate at the Klatskin point. Although no discrete extrinsic mass is identified, there is periductal soft tissue signal and, along the ducts within the atrophic left lobe of the liver (503/344), there is increased diffusion signal. This diffusion signal abnormality was not present on the prior exam (outside MR abdomen dated 8/13/16, B500 sequence, image 27).SPLEEN: No significant abnormality noted.PANCREAS: The patient is status post Whipple procedure and the pancreatic duct is mildly dilated, stable from the prior examADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple cysts are seen bilaterally. There is no hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Partially visualized small bowel and colon appear normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of perihepatic ascites.
1.Examination somewhat limited due to lack of delayed phase perfusion sequence.2.Increased intrahepatic biliary ductal dilatation compared to the prior examination.3.Increased abnormal diffusion signal within the left hepatic lobe from Klatskin's point along the biliary ducts suspicious for lepidic growth of tumor. No discrete measurable lesion identified.