75-year-old female with PSC, increased bilirubin. Evaluate for dominant stricture. ABDOMEN:LIVER, BILIARY TRACT: There is an irregular appearance of the distal common bile duct and a stricture of the proximal common bile duct at the level of Klatskin's point. Hazy increased enhancement at Klatskin's point is noted on the delayed phase imaging (series 11 image 324). Multiple intrahepatic biliary strictures are also noted.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is dilated to the level of the ampulla and mildly irregular appearance. There are small sidebranch IPMNs at the level of the pancreatic body (series 5 image 79).ADRENAL GLANDS: Small left adrenal nodule demonstrating loss of signal on the in and out of phase sequences compatible with a benign adenoma (series 1001 image 49, series 1002 image 49).KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Within the infrarenal abdominal aorta, there is an intraluminal linear focus, which raises the question of a focal dissection (series 11 image 78). Asymmetric loss of signal of the right proximal common iliac artery is concerning for severe stenosis versus occlusion (series 5 image 384).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.A stricture at the proximal common bile duct at the level of Klatskin's point with hazy increased enhancement of the adjacent parenchyma on the delayed phase imaging. While this could represent inflammation, an underlying mass cannot be excluded. Correlate with ERCP and brushings as clinically indicated.2.Dilatation of the pancreatic duct to the level of the ampulla. Small sidebranch IPMNs also noted. 3.Intraluminal linear focus of the infrarenal abdominal aorta raises the question for a focal dissection. Loss of signal intensity of the right proximal common iliac artery concerning for severe stenosis versus occlusion. No prior imaging is available for comparison.