Female 50 years old; Reason: evaluate liver mass History: acute on chronic abdominal pain Suboptimal exam secondary to motion artifact.ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Hepatic steatosis. Corresponding to the largest areas of focal hypoattenuation on the prior CT study are areas of dropout of signal on opposed phase imaging (compared to in phase imaging), consistent with sites of focal fat deposition; examples include subcapsular lesion in hepatic segment 2/3 on image 148 series 1301 as well as in the right hepatic lobe, refer to key images. The hepatic segment 2/3 lesion is best seen on postcontrast imaging as a relatively hypointense focus on image 283 series 1404 measuring up to 1.2 x 0.9 cm in the portal venous phase (appeared larger on prior CT where measured 2.4 x 1.8 cm), possible mild peripheral rim enhancement in arterial phase on image 257 series 1403. No corresponding restricted diffusion visualized. Additional tiny hypoattenuating foci seen on earlier CT study not well delineated on current exam, this may be due in part image degradation to motion artifact. However no suspicious focus of restricted diffusion identified in liver. No imaging evidence of cirrhosis. No significant biliary ductal dilatation. Status post cholecystectomy.SPLEEN: Tiny splenule formation.PANCREAS: Status post resection of pancreatic body and tail for chronic pancreatitis. Small residual head/uncinate process, accounting for differences in technique this is unchanged from August 2016 MRI. Aforementioned residual pancreatic parenchyma demonstrates mild restricted diffusion and mild delayed enhancement. Corresponding mildly increased T2 signal also noted. No drainable fluid collection.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered small retroperitoneal including left para-aortic lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Partially imaged ventral abdominal and dependent subcutaneous edema.OTHER: No significant abnormality noted.
1. Suboptimal exam secondary to motion artifact.2. Hepatic steatosis. Corresponding to the largest areas of focal hypoattenuation on the prior CT study is dropout of signal on opposed phase imaging (compared to in phase imaging), consistent with sites of focal fat deposition. One of these, a hepatic segment 2/3 lesion containing fat is best seen on postcontrast imaging as a relatively hypointense focus measuring up to 1.2 x 0.9 cm in the portal venous and delayed phases (appeared larger on prior CT where measured 2.4 x 1.8 cm), possible mild peripheral rim enhancement in arterial phase. No corresponding restricted diffusion visualized. No imaging evidence of cirrhosis. Lesion is indeterminate, may be followed up as clinically indicated. Additional tiny hypoattenuating foci seen on earlier CT study not well delineated on current exam, this may be due in part image degradation to motion artifact. 3. Status post resection of pancreatic body and tail for chronic pancreatitis. Small residual head/uncinate process, accounting for differences in technique this is unchanged from August 2016 MRI. Aforementioned residual pancreatic parenchyma demonstrates mild restricted diffusion (newly appearing from earlier MR exam) and mild delayed enhancement. Given patient's provided history, constellation of findings most concerning for early acute on chronic pancreatitis. However correlation with patient's clinical history and laboratory values is also recommended to exclude the possibility of an underlying mass lesion and EUS should be considered as needed.