Reason: eval for bile duct dilation, likely new diagnosis of panc CA History: see above ABDOMEN:LIVER, BILIARY TRACT: Again seen is diffuse infiltration of the liver with a dominant enhancing lesion centered on segments 5/8 measuring approximately 18 x 8 cm (1403/79). There are additional enhancing satellite lesions (1403/89), including a right hepatic lobe reference lesion measuring 2.2 x 3.1 cm (1401/73). In addition, there is diffuse T2 hyperintensity within the liver as well as numerous small subcentimeter hypoenhancing lesions.Portal venous system is patent. No evidence of intra or extrahepatic biliary ductal dilatation.Hepatomegaly. The gallbladder is nondistended without stones, however there is wall thickening which is nonspecific. Mild periportal edema.SPLEEN: No significant abnormality noted.PANCREAS: Hypoenhancing pancreatic tail lesion measures 2.6 x 2.5 cm. No pancreatic ductal dilatation.ADRENAL GLANDS: Bilateral adrenal nodularity. 1.7 cm left adrenal lesion containing fat likely represents a myelolipoma.KIDNEYS, URETERS: Small left lower pole cyst.RETROPERITONEUM, LYMPH NODES: Enlarged portacaval node measuring 2.3 x 1.4 cm. Additional enlarged periaortic lymph nodes, similar to prior CT. Small cardiophrenic and paraesophageal lymph nodes are present.BOWEL, MESENTERY: Small fat-containing ventral hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Perihepatic ascites as well as free fluid in the pelvis.
1.No evidence of intra or extrahepatic biliary ductal dilatation.2.Pancreatic tail lesion, suspicious for neoplasm. In addition, there is a large, dominant infiltrative hepatic mass with smaller satellite lesions which are suspected to represent metastases. While the pancreatic lesion is relatively small compared to the extensive infiltrative hepatic metastases, this may represent a primary pancreatic adenocarcinoma with atypical hepatic metastases. Another consideration may be metastatic disease to both the pancreas and liver.3.Diffusely abnormal signal and subcentimeter hypoenhancing lesions may be related to a hepatitis, possibly infectious. Gallbladder wall thickening is nonspecific but likely related to chronic liver disease.4.Retroperitoneal in mediastinal lymphadenopathy.5.Left adrenal myelolipoma.