Elevated alkaline phosphatase. Concern for biliary stricture. History of AML. Status post transplant. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and morphology. There is abnormal periportal signal diffusely without definite enhancement.The previously seen segment 4A/B lesion has increased in size, see measurements below. It demonstrates T2 weighted moderate hyperintensity, is isointense on T1-weighted imaging and demonstrates arterial enhancement but no washout. There is a more peripheral satellite lesion adjacent to the dominant lesion with similar imaging characteristics.No intra or extrahepatic biliary ductal dilatation. Normally distended gallbladder without gallstones.SPLEEN: The spleen is normal morphology and size. Suspected iron deposition.PANCREAS: 1.3 cm pancreatic tail cystic lesion without suspicious enhancement. This does not clearly communicate with the pancreatic duct. There is also mild atrophy and pancreatic ductal dilatation distal to this lesion. Stable atrophy of the distal pancreatic body/proximal tail without a focal lesion.The remainder of the pancreatic parenchyma is unremarkable. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1. There is diffuse abnormal periportal signal intensity which does not definitively show dropout on out of phase imaging. Although this may still represent nodular fatty infiltration an infectious or infiltrative process cannot be excluded. There is no discrete associated enhancement.2. Nonspecific enhancing segment 4A/B lesion is increased in size from the prior with a new satellite lesion. It does not demonstrate washout or other specific imaging characteristics. Differential considerations include focal nodular hypertrophy or a regenerative nodule amongst other possibilities. A malignant etiology is considered less likely as the lesion does not wash-out.3. New cystic pancreatic tail lesion does not clearly communicate with the main pancreatic duct and may represent a mucinous neoplasm, a small intrapancreatic pseudocyst or cystic islet cell neoplasm.