History of recurrent acute pancreatitis and pseudocyst. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology. The patient is status post cholecystectomy. There is left greater than right intrahepatic biliary ductal dilatation, increased from the prior, involving the left hepatic lobe and some segments of the right hepatic lobe. The common bile duct is minimally prominent which may be related to the patient's postcholecystectomy state and mild mass effect from the enlarging pancreatic head cystic lesion. The common bile duct is circumferentially mildly thickened and hyperenhancing. Similarly, the most central portion of the left hepatic vein demonstrates mild wall enhancement. No discrete mass lesion is evident.Several peripheral wedge-shaped regions of hyperenhancement may be related to peri-ductal inflammatory hyperemia. No discrete underlying lesion. Probable small cysts in the periphery of segment 4A/8 and segment 6, unchanged. SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic head is mostly replaced by a 7.5 x 5.5 cm lobular cystic lesion with internal septations. The upstream pancreatic duct appears to drain into / communicate with this collection. The lesion demonstrates very thin peripheral enhancement. No mural nodularity. Previously this measured approximately 4.5 x 2.9 cm. Similar smaller multilobular septated cystic collection is noted caudally, slightly increased from the prior. There is moderate atrophy of the distal pancreatic parenchyma which is decreased in intrinsic T1 weighted signal intensity with side-branch ectasia. The parenchyma enhances homogeneously. The main pancreatic duct is dilated at the pancreatic tail which may reflect a stricture at the body/tail junction. No discrete mass is evident. No peripancreatic inflammatory changes are identified.No significant excretory response to secretin administration.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate too small to characterize renal hypodensities, likely cysts. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small fat-containing umbilical hernia.OTHER: No significant abnormality noted.
1.Interval increase in biliary ductal dilatation, which may be due to increase in mass effect from the enlarging pseudocyst further described below. The underlying cause of the intrahepatic biliary dilatation is suspected to be multifocal stricturing, probably inflammatory, given the smooth thickening and enhancement seen on postcontrast images. The distribution is similar to prior exam. No mass lesion is evident. 2.Interval increase in size of the pancreatic head cystic lesion without suspicious imaging characteristics, likely a pseudocyst given patient's history. The main pancreatic duct drains into the collection. Mild pancreatic tail pancreatic ductal dilatation without a focal lesion, may reflect a stricture at the pancreatic body/tail, slightly increased from prior. No evidence of acute pancreatitis or vascular complication of previous recurrent pancreatitis. Stigmata of chronic pancreatitis.3.Although atypical, the strictures involving both the biliary tree and pancreatic duct raises the possibility of an autoimmune etiology, consider correlation with serum IgG if indicated.