History of necrotizing pancreatitis complicated by walled off necrosis. Status post endoscopic drainage. Previous MR demonstrated improvement in size of fluid collections. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Fatty liver with focal fat sparing. The liver is normal in morphology, and enhancement without a discrete lesion or biliary ductal dilatation. Seen again is strand-like narrowing of the portal vein just distal to the SMV/splenic vein confluence, unchanged. The portal vein is otherwise patent. The hepatic veins are patent.No choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: There is no normal pancreas parenchyma at the level of the pancreatic body and proximal tail with cystogastrostomy stents in place. There is no measurable residual fluid collection in this region. This region demonstrates post-contrast enhancement suggesting post-inflammatory tissue.Again seen is decrease in intrinsic T1 weighted signal intensity of the residual pancreatic tail parenchyma without peripancreatic inflammation, atrophy or ductal dilatation. This parenchyma demonstrates mild post-contrast enhancement.The pancreatic head is normal T1-weighted signal intensity, enhancement and has a normal pancreatic duct caliber.There is discontinuity of the pancreatic duct at the level of the pancreatic body and proximal tail. Following secretin administration there is a decreased exocrine response of the pancreas with fluid only seen filling the proximal duodenum. The pancreatic duct demonstrates no significant caliber increase following secretin administration. The pancreatic duct at the level of the pancreatic tail is not well seen on today's study.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.No measurable residual fluid collection at the level of the previously described intrapancreatic fluid collection/pseudocyst with cystogastrostomy stents in place. There is enhancing inflammatory/fibrous tissue and pancreatic duct discontinuity in this region.2.Diminished intrinsic T1 signal intensity and enhancement of the distal pancreatic tail, unchanged.3.Redemonstrated slitlike narrowing of the portal vein just distal to the SMV splenic vein confluence.4.Diminished excretory response of the pancreatic head following secretin administration. 5.Fatty liver with focal fat sparing.