76-year-old female with abdominal pain. Assess the pancreas or inflammation and please also do pelvis. Prior imaging showing focal pancreatitis versus diverticulitis. CHEST:LUNG BASES: Again seen is the previously described right lower lobe pulmonary nodule, unchanged in appearance. Follow-up dedicated imaging is still recommended.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: PANCREAS:Inflammatory changes primarily surrounding the tail of the pancreas are again seen. Additional periappendiceal inflammatory changes are seen posterior to the body of the pancreas. The splenic vein is thrombosed with numerous enlarged portosystemic collateral vessels noted. These findings make focal pancreatitis the favored diagnosis. The pancreatic duct is not dilated. There is no evidence of abscess or pseudocyst formation. Additionally, retroperitoneal lymph nodes with indistinct soft tissue haziness surrounding the celiac artery is seen. These may represent further additional inflammatory changes, versus lymph nodes. Follow-up imaging with MRI following resolution of this acute episode is recommended to exclude an occult pancreatic neoplasm.. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Retroperitoneal lymph nodes are noted.BOWEL, MESENTERY: Hiatal hernia is again seen. Focal thickening of the colonic wall near the splenic flexure is again visualized. This is likely secondary to adjacent peripancreatic inflammatory changes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: Hiatal hernia is again seen. Focal thickening of the colonic wall near the splenic flexure is again visualized. This is likely secondary to adjacent peripancreatic inflammatory changes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.
1. inflammatory changes surrounding the tail of the pancreas with thrombosis of the splenic vein is suggestive of focal pancreatitis. Additionally, ill-defined perivascular soft tissue thickening around the celiac artery may represent additional inflammation versus adenopathy. Follow up MRI is recommended following resolution of the patient's acute episode of pancreatitis to exclude an underlying occult pancreatic neoplasm..2. Right pulmonary nodule unchanged from 10/26/2010. Recommend follow up dedicated imaging for further evaluation. 3. Hiatal hernia