79 years, Female, Reason: evaluate for metastatic gallbladder cancer History: ERCP today with mass seen in gallbladder. ABDOMEN:LUNG BASES: No specific abnormality notedLIVER, BILIARY TRACT: There is a lesion within the gallbladder that measures 2.1 x 4.3 cm (501/14) which likely corresponds to finding on recent endoscopic ultrasound. This lesion demonstrates diffusion restriction, intermediate T2 signal with only a subtle focus of enhancement along the medial aspect. There are enhancing liver lesions immediately adjacent to and appearing to be in contiguity with this region.There are multiple enhancing hepatic lesions throughout the liver with the reference lesion in the right hepatic lobe measuring 2.6 x 2.9 cm (1201/307). Appearance consistent with metastases.There is thrombosis of the left portal vein. The visualized right portal vein and main portal vein are patent.Multiple large stones are noted throughout the gallbladder. There is a simple cyst in the hepatic dome with additional smaller cysts which are too small to characterize.Common bile duct is dilated to 1.3 cm to the level of the ampulla. No choledocholithiasis. There is also minimal intrahepatic biliary ductal dilatation. No obstructing mass is evident in this region.SPLEEN: No significant abnormality noted.PANCREAS: Main pancreatic duct is dilated up to 1 cm and is tortuous with dilated sidebranches. No stones or obstructing lesion evident. There is low T1 signal and atrophy of the parenchyma, e.g., of the tail.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal simple cyst.RETROPERITONEUM, LYMPH NODES: IVC filter.BOWEL, MESENTERY: Ventral diastasis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.There are multiple lesions throughout the liver, consistent with metastatic disease. 2.A mass within the gallbladder is suspicious for a primary gallbladder malignancy, with associated hepatic metastatic disease, but could also represent hepatic metastatic disease secondarily involving the gallbladder.3.Left portal vein thrombosis.4.Dilated main pancreatic duct up to 1 cm with multiple dilated side branches and parenchymal atrophy. Chronic pancreatitis is favored with a main duct IPMN considered less likely.