Reason: 27 y/o lady w/ a hx of liver transplant and now w/ RUQ pain and fever History: RUQ pain ABDOMEN: Susceptibility artifact at the porta hepatis likely due to cholecystectomy clips limits examination.LUNG BASES: Small left and trace right pleural effusions, new compared to prior outside CT. LIVER, BILIARY TRACT: Postsurgical changes of a liver transplant and cholecystectomy. No intrahepatic biliary ductal dilatation. See below in pancreas.SPLEEN: Perisplenic varices.PANCREAS: In the pancreatic head, there is a multiloculated fluid collection/cystic lesion measuring approximately 6.2 x 4.6 x 5.7 cm (series 301 image 20, series 401 image 12), not significantly changed. Within this collection/lesion, there is polypoid ill-defined hypointense signal that enhances after gadolinium administration (series 401 image 13). Associated upstream pancreatic ductal dilatation up to 6 mm in the body and tail (series 301 image 17). The pancreatic duct appears to communicate with the fluid collection/cystic lesion (series 301 image 18).This also appears to communicate with a collection/lesion that is within the liver parenchyma or subcapsular region that measures approximately 3.3 x 4.4 x 4.7 cm (series 301 image 29, series 401 image 16), not significantly changed. The polypoid hypointense signal within the pancreatic collection/lesion also appears to communicate with a hypointense nodular focus (series 301 image 26) within the liver collection/lesion (series 401 image 16). Adjacent hyperemia in the surrounding liver parenchyma.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Multiple additional multiloculated collections/cystic lesions throughout the abdomen. The largest in the mid abdomen measures 3.2 x 5.1 x 3.5 cm (series 301 image 6, series 401 image 10), not significantly changed. Small amount of perihepatic and perisplenic free fluid.
Multiloculated fluid collection/cystic lesion within the pancreatic head, which appears to communicate with dilated pancreatic duct and with a multiloculated fluid collection/cystic lesion within/abutting the liver. These collections/lesion have internal enhancing components which may represent granulation tissue or tumor. The size has not significantly changed compared to outside CT. Additional multiloculated collections throughout the abdomen. The constellation of findings most likely represent pancreatic/peripancreatic complex fluid collections related to pancreatitis with upstream pancreatic ductal dilatation from mass effect. Also included in the differential diagnosis is a pancreatic solid and cystic neoplasm. 