33-year-old male with nocturnal diarrhea. Evaluate for small bowel inflammation. ABDOMEN:LIVER, BILIARY TRACT: There are multiple liver lesions that are T1 hypointense (axial series 14 images 18, 19, 30, 31, 38, 45), T2 hyperintense, and demonstrate restricted diffusion, located relatively peripherally. A thin rim of enhancement with central hypoechoic enhancement are noted on the early/arterial phase imaging on the dynamic series (coronal series 19 images 300, 307, 312). These findings are concerning for multifocal hepatic abscess formation.SPLEEN: Mild splenomegaly measuring 14 cm in craniocaudal length. The timing of the IV contrast injection for the enterography exam poorly evaluated the splenic vein and main portal vein.PANCREAS: In the expected region of the pancreatic neck/proximal body, there is a 5.1 x 3.2 cm centrally T1 hypointense masslesion suggested with suspected peripheral enhancement expanding the lesser sac and causing mass effect on the distal gastric body and antrum (axial series 20 image 51). Normal contours of the pancreas are not clearly seen. This raises the question for a pancreatic phlegmon. There is poor visualization of the distal pancreatic body and tail.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No abnormal wall thickening or significant contrast enhancement. Trace free fluid in the dependent pelvis. Mild apparent thickening of the terminal ileum (coronal series 11 image 25) is likely related to underdistention, as appearance resolves on later imaging sequences. There is no significant upstream dilatation and no abnormal wall enhancement at this level. The stomach is distended with oral contrast, and there is suboptimal distention of the small bowel loops (especially proximally), and a partial gastric outlet obstruction cannot be excluded.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Unremarkable appearance of small and large bowel, please refer to details above.2.Multiple peripherally based rounded hepatic lesions with imaging findings suspicious for multifocal hepatic abscess formation. Correlation with patient's clinical history and laboratory values recommended.3.Findings concerning for necrotizing pancreatitis, centered at level of pancreatic neck/proximal body, with superimposed infection and phlegmon. This finding causes mass effect on the stomach with upstream gastric dilatation noted, appearance concerning for underlying partial gastric outlet obstruction. Correlation with symptomatology and laboratory data is needed. A CT abdomen with pancreas protocol may provide a more detailed assessment, with CT being less prone to image degradation secondary to artifacts including motion artifact.Findings were discussed with Dr. Leslie Yang of gastroenterology on 9/7/2016 at 17:14.