50-year-old female with abdominal pain and history of pancreatic cysts, likely IPM and. Now with worsening pain and evidence of pancreatitis. The lack of intravenous contrast limits complete evaluation of the solid parenchymal organs and of the cystic lesions in the liver, pancreas, and kidneys described below.ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No anatomic evidence of cirrhosis.Numerous cystic structures following the intrahepatic biliary ducts are again noted. The known largest central cyst measuring 3.3 x 3.5 cm (axial series 5 image 26) has slightly increased in size (prior 2.8 x 3 cm on 1/29/2016) and again compresses the central ducts (coronal series 9 image 85) with mild intrahepatic biliary ductal dilatation. On the MRCP sequences, some cysts show a possible communication with the biliary ducts. No definite extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: There is thickening of the pancreatic body and tail with loss of the normal parenchymal architecture, and restricted diffusion is also noted. These findings are suspicious of pancreatitis, and autoimmune pancreatitis is in the differential.Multiple pancreatic cystic lesions are again seen. The largest cystic lesion within the pancreatic tail measuring 2.5 cm (axial series 5 image 21) has increased in size (prior 1.3 cm on 1/29/2016). Other cystic lesions have also slightly increased in size, including a septated cyst of the uncinate process (axial series 5 image 17, coronal series 9 image 62). The lack of intravenous contrast limits evaluation for enhancement of a nodular focus. No definite connection with the main pancreatic duct is identified. ADRENAL GLANDS: Stable nodular appearance of the bilateral adrenal glands. No dominant nodule identified.KIDNEYS, URETERS: Multiple bilateral renal cysts, some of which are too small to fully characterize. Each kidney contains greater than 5 cysts. A few T1 hyperintense cysts are again noted bilaterally, predominantly on the right. No suspicious features. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Cardiomegaly.
1. Multiple pancreatic cystic lesions have slightly increased in size as described above. On MRCP, no definite connection with the main pancreatic duct is identified. The differential includes side-branch IPMNs versus mucinous cystic neoplasms versus parenchymal cysts.2. Multiple central hepatic cystic structures, some of which have also increased in size, and again cause mild intrahepatic biliary ductal dilatation. These structures could represent peribiliary cysts versus choledochal cysts. Possible ductal communication with some of these cysts is noted, which would suggest choledochal cysts - this can be confirmed with ERCP. If these are peribiliary cysts, given the absence of cirrhosis, another etiology can be syndromes such as polycystic kidney disease (in which this patient also has greater than 5 cysts in each kidney). 