Reason: 72yo with DM, HTN, CKD, here for large gastric polyp removal. Found to have pancreatic cysts. iGI requesting an MRCP for further evaluation History: anemia, intermittent abdominal pain. Examination is moderately limited by patient motion. Metallic susceptibility artifact likely related to gastric polypectomy clip also obscures surrounding structures and limits evaluation.ABDOMEN:LIVER, BILIARY TRACT: There is an indeterminate T2 hyperintense lesion within hepatic segment 6/7 with reference measurements below. The lesion does not demonstrate restricted diffusion. No additional focal hepatic lesions are identified within the limitations of a noncontrast examination.The gallbladder is collapsed or surgically absent. No biliary ductal dilatation.SPLEEN: Subcentimeter focus of increased T2 signal within the spleen is nonspecific but likely benign.PANCREAS: There is a large, cystic mass associated with the body and tail of the pancreas along the lesser curvature of the stomach with reference measurements below. The mass demonstrates mural thickening and mural nodularity as well as several probable septations and an internal fluid-fluid level. The mass is highly suspicious for neoplasm, though further discrimination is limited by lack of intravenous contrast.There appears to be intact pancreatic parenchyma in the uncinate process and head as well as along the posterior margin of the cystic mass in the body and tail. The pancreatic duct in the pancreatic tail is tortuous and dilated up until the cystic mass where it becomes nondilated and is not well visualized. The pancreatic duct in the head appears within normal limits and is nondilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Several bilateral T2 hyperintense structures, likely cysts. There is mild prominence of the bilateral renal collecting systems and ureters.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Metallic susceptibility artifact is present in the region of the gastric antrum likely related to recent polypectomy.BONES, SOFT TISSUES: Degenerative changes affect the spine.OTHER: The urinary bladder bladder is distended.INDEX LESION MEASUREMENTS (Current exam date/time: 9/21/2016 17:31:41)HEPATIC SEGMENT 6/7 LESION: 1.7 x 1.3 cm (Image 20, Series 4).PANCREATIC BODY/TAIL LESION: 5.4 cm (Image 15, Series 3); 4.7 x 10.4 cm (Image 28, Series 4).
1.Large cystic mass associated with the pancreatic body and tail with features suggestive of neoplasm, though further discrimination is limited by lack of intravenous contrast. Recommend ERCP for further evaluation.2.T2 hyperintense hepatic lesion, incompletely characterized without intravenous contrast.3.Distended bladder and bilateral mild hydroureteronephrosis suggestive of bladder outlet obstruction.