Abdominal pain. History of pancreatic and common bile duct dilatation. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement. No focal suspicious hepatic lesion. Distended gallbladder without cholelithiasis or acute inflammation.There is intrahepatic and extra hepatic biliary ductal dilatation with the common bile duct distended up to 16 mm. It tapers abruptly within the pancreatic head. No filling defect is seen to suggest a gallstone.SPLEEN: No significant abnormality noted.PANCREAS: There is pancreatic ductal dilatation to the level of the pancreatic head with mild pancreatic parenchymal atrophy. There is a subtle hypoenhancing pancreatic head mass measuring approximately 2.2 x 2.1 cm (series 13/2051) at the level of the abrupt common bile duct and pancreatic duct caliber change. This region also shows mild restricted diffusion.No significant peripancreatic lymphadenopathy. The celiac axis and superior mesenteric artery are patent without suspected tumor involvement or encasement. The SMV, splenic vein and portal vein also appear uninvolved.Following secretin administration there is increased caliber of the pancreatic duct and increased secretions through the GI tract.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts. No hydronephrosis or suspicious renal lesion.RETROPERITONEUM, LYMPH NODES: Infrarenal abdominal aortic aneurysmal dilatation measuring 2.2 cm in maximal AP dimension.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
Common bile duct and pancreatic ductal dilatation to the level of pancreatic head with a suspected 2.2 cm pancreatic head mass. An EUS/ERCP is recommended for further evaluation. There is upstream biliary ductal, pancreatic ductal and gallbladder distention. No vascular involvement.