35-year-old woman with history of Crohn's disease and prior episodes of pancreatitis, now with abdominal pain and bilious emesis. ABDOMEN:LIVER, BILIARY TRACT: There is mild loss of signal of the hepatic parenchyma on the opposed phase images indicating fatty infiltration. No focal lesions are identified. The gallbladder is normal. Mild intrahepatic biliary duct dilatation appears similar to the prior examination. The common bile duct is stable and measures 8 mm.SPLEEN: The spleen is normal. The splenic vein is not visualized and a few gastrosplenic varices are identified.PANCREAS: The entire pancreas is markedly edematous and there is a small amount of peripancreatic fluid. The pancreatic parenchyma enhances uniformly. There is a multilobulated area of mild T2 hyperintensity located between the pancreas and aorta with components extending into the pancreatic tail (series 501, image 9).In widest axial dimension, this lesion measures 66 x 20 mm (series 501, image 5) and there is mild, peripheral diffusion restriction and mild, peripheral enhancement. There is absence of central enhancement.Pancreatic duct stent is identified. The pancreatic duct is mildly dilated, similar in degree to the prior examination measuring up to 8 mm in the pancreatic head (series 701, image 28). Numerous ectatic side branch ducts are seen. A small focus of T2 hyperintensity in the pancreatic head (series 901, image 15) is unchanged from the prior examination. Additionally, there is a similar, round focus of T2 hyperintensity in the dorsal pancreatic head (series 901, image 12) which measures 9 x 8 mm. ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: The left renal vein is narrowed by the lesion posterior to the pancreas. There is slightly delayed nephrogram on the left, otherwise the kidneys are normal.RETROPERITONEUM, LYMPH NODES: See above for description of retroperitoneal lesion.BOWEL, MESENTERY: There is mild wall thickening of the third portion of the duodenum. The small bowel and colon are otherwise normal.The SMA and SMV are anteriorly displaced by the peripancreatic lesion. The SMV appears narrowed but is patent.BONES, SOFT TISSUES: Midline anterior surgical sutures are noted.OTHER: No significant abnormality noted.
1.Acute on chronic pancreatitis.2.Multilobulated lesion between the pancreas and aorta with mild peripheral diffusion restriction and enhancement. These findings are suggestive of a multiloculated pseudocyst with possible superimposed infection or necrotic lymphadenopathy, differential considerations which may have similar imaging appearances.3.Findings discussed with Jennifer Labas, NP by phone on 9:56 on 10/27/15.