History of primary sclerosing cholangitis with increasing alkaline phosphatase. Cholangiocarcinoma screening. ABDOMEN:LIVER, BILIARY TRACT: Diffuse multifocal stricturing with associated dilatation of the biliary tree with marked atrophy and fibrosis of the right lobe of the liver, appearing similar to the prior study and compatible with PSC. Again seen is long segment narrowing of the distal common bile duct which demonstrates thickening and mild enhancement, grossly unchanged.No new dominant stricture or focal enhancing mass.Normally distended gallbladder without significant gallbladder wall thickening pericholecystic fluid or other specific evidence of gallbladder inflammation. No gallstones.Stable hepatomegaly. Attenuated patent intrahepatic portal veins.SPLEEN: Moderate splenomegaly, unchanged. Splenic varices.PANCREAS: Mild main pancreatic ductal dilatation, slightly improved from the prior. No focal lesion is evident.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Gastroesophageal varices are again noted. Trace pelvic ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Multifocal stricturing and dilatation of the pancreatic and biliary tree appearing similar to the prior without a new dominant stricture or focal lesion.2.Stable long segment stricture of the distal common bile duct.