Metastatic pancreatic cancer to liver status post biliary stent now with increasing jaundice, assess for biliary obstruction versus worsening liver metastases Suboptimal study secondary to absence of IV contrast, not given due to low GFR.ABDOMEN:LIVER, BILIARY TRACT: Marked hepatomegaly with liver measuring up to 26 cm in longitudinal dimension. New from earlier CT study is moderate perihepatic ascites.Accounting for differences in technique, positioning and modality, enlarging hepatic metastases noted. Left hepatic dome lesion measuring 8 x 7.4 cm on image 21 series 5 previously measured 6.2 x 6.1 cm. Heterogeneous debris-containing lobulated cystic structure in right hepatic lobe is much larger with greater extension seen anteriorly and superiorly, structure appears contiguous with aforementioned metastatic liver lesion, component measuring 8.7 x 7.2 cm on image 25 series 5 previously measured approximately 6.7 x 4.7 cm. Minimal increased T1 signal seen relating to the cystic structure, likely reflecting underlying hemorrhage or proteinaceous material. Evaluation for associated wall enhancement as in the setting of an abscess not possible on this noncontrast study but no definite restricted diffusion identified. Worsening of intrahepatic biliary duct dilatation, primarily in right lobe, seen to level of previously described hepatic cystic lesion and also likely due in part to infiltrative soft tissue and nodal metastatic disease at porta hepatis. CBD stent. Portal venous thrombosis better delineated on prior contrast-enhanced CT imaging.Layering sludge in distended gallbladder, measures 4.7 cm.SPLEEN: No significant abnormality noted.PANCREAS: Atrophic pancreatic body and tail, pancreatic ductal dilatation seen to level of heterogeneous ill-defined soft tissue masslesion centered in pancreatic head/extending into uncinate process, stable to slightly increased in size (measures up to 5.1 cm across, previously measured 4.9 cm). Adjacent mild thickening of duodenum seen. Encasement of common hepatic artery visualized, but better assessed on prior contrast-enhanced imaging. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Thick-walled right-sided colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: New from prior CT exam is large right pleural effusion. Tiny fat containing umbilical hernia. Mild anasarca. MRI is not ideal for evaluation of the lung parenchyma; however, pulmonary micronodularity suggested (see image 44 series 13, left lower lobe), suspicious for pulmonary metastatic disease.
1. Enlarging debris-containing cystic structure in right hepatic lobe that appears to originate from dominant left hepatic dome metastasis (also increased in size), appearance suspicious for collection containing necrotic pus from necrotic liver metastasis and/or an enlarging biloma. Increasing size of other hepatic metastases.2. Increasing intrahepatic biliary duct dilatation, primarily in right hepatic lobe, seen to level of aforementioned enlarging cystic structure, also likely due in part to infiltrative soft tissue and nodal metastatic disease extending from porta hepatis.3. New large right pleural effusion. While MRI is not ideal for evaluation of the lung parenchyma, pulmonary micronodularity is suggested, suspicious for lung metastatic disease.