70 years, Male, Reason: 1 week jaundice - bili 7.6; no evident stone or mass on RUQ U/S 3/2 History: painless jaundice. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Mild diffuse single loss on opposed phase imaging suggests steatosis.Common bile duct is dilated to 1.8 cm to just above the ampulla. There is concentric narrowing at this point with associated surrounding low T2 signal (9/17). Diffusion and postcontrast images are somewhat limited in this region due to patient motion. There is also moderate to marked intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct is normal in caliber. Small punctate cystic lesions in the neck and tail of the pancreas (8/10, 8/16, 8/15) likely represent small side branch intraductal papillary mucinous neoplasms (IPMNs).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple renal cysts.RETROPERITONEUM, LYMPH NODES: Enlarged peripancreatic lymph nodes, measuring up to 2.1 x 1.4 cm (4/23).BONES, SOFT TISSUES: No significant abnormality noted.
1.Moderate to marked intrahepatic and extrahepatic biliary ductal dilatation to just above the level of the ampulla where there is a region of T2 hypointense concentric narrowing. ERCP is recommended to exclude a periampullary lesion (or stricture) in this region.2.Punctate cystic lesions within the pancreas likely represent sidebranch IPMNs.3.Mildly enlarged peripancreatic lymph node.