Female 73 years old; pancreatitis , mild chronic peptic duodenitis, cholecystectomy. ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. T2 hyperintense foci may represent cysts but incompletely characterized without contrast. No intra or extra hepatobiliary ductal dilatation. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct is dilated measuring up to 10 mm. There is abrupt termination of the duct near the head of the pancreas due to a slightly T2 hyperintense mass measuring 1.4 x 2.0 cm. There are multiple cystic foci throughout the pancreas that communicate with the pancreatic duct. A larger cystic lesion located in the tail measures 2.1 x 1.8cm and is rounded. The pancreatic parenchyma is atrophic.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is focal masslike thickening of the mesenteric wall of the duodenum with a mass measuring 4.6 x 2.1 cm with infiltration of the mesenteric border with soft tissue spiculations. There are small scattered mesenteric lymph nodes in the vicinity. No T2 hyperintense fluid is evident to indicate acute inflammation. The duodenal mass appears separate from the pancreatic process.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Pancreatic duct stricture likely due to a soft tissue mass (see above) in the pancreatic head causing ductal dilatation with cystic foci. The stricture may be malignant and would be best evaluated on a contrast-enhanced MRI/MRCP. Most of the cystic foci are suggestive of either IPMN's or dilated side branches in the setting of duct obstruction. The cystic focus in the tail is indeterminate and may represent an old pseudocyst or cystic neoplasm as it has a rounded configuration.2.Soft tissue mass in the distal duodenum with extension into the mesenteric border suspicious for an underlying malignancy such as a duodenal adenocarcinoma, lymphoma. Repeat biopsy of the area can be considered as the imaging findings are discordant with pathology results.