Evaluate liver mass. ABDOMEN:LIVER, BILIARY TRACT: Heterogeneous expansile mass involving the left hepatic lobe measuring up to 8.8 x 7.4 cm (series 5/29) in axial dimension which extends along its inferior margin laterally to involve the left subhepatic space. In the craniocaudal dimension the lesion measures 9.4 cm (series 4/12). The lesion demonstrates heterogeneous signal intensity with regions of intermediate and high T2-weighted hyperintensity. The lesion has thick peripheral and internal septations which demonstrate enhancement and multiple cystic components. T2 hyperintense foci demonstrate restricted diffusion. The lesion is hypointense on T1-weighted imaging.The liver is otherwise normal in morphology.Cholelithiasis with a gallstone in the gallbladder neck/cystic duct junction. The gallbladder itself is distended without gallbladder wall thickening, pericholecystic fluid or specific evidence of acute cholecystitis.There is mild intrahepatic biliary ductal dilatation. The common bile duct is dilated up to 1.3 cm but tapers smoothly to the level of the ampulla without a definite stone or lesion.SPLEEN: The spleen is normal in morphology size, signal intensity and enhancement without a focal lesion.PANCREAS: The pancreas is normal in morphology and signal intensity without a focal lesion or pancreatic ductal dilatation. Punctate pancreatic head cystic focus measuring 7 mm appears to communicate with the main pancreatic duct and likely represents a sidebranch IPMN.ADRENAL GLANDS: Mild adrenal gland thickening without a discrete lesion.KIDNEYS, URETERS: Kidneys are normal in morphology and enhancement without hydronephrosis or focal lesion.RETROPERITONEUM, LYMPH NODES: No enlarged retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Moderate hiatal hernia with the proximal gastric body within the thorax.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Heterogeneous left hepatic lobe lesion likely represents an abscess, particularly given elevated white count. Follow-up to resolution is recommended. The abscess to appears to have decompressed into the left subhepatic space. The source of infection is not clearly demonstrated.2.Distended gallbladder with gallstone at the hepatic neck/cystic duct junction without additional specific findings of acute gallbladder inflammation. 3.Dilated common bile duct without a definite obstructing lesion or stone. Correlate with LFTs and consider MRCP/ERCP as clinically warranted to evaluate the distal CBD.