History of 2.5 x 2.6 cm pancreatic tail mass. History of lymphocytic Hodgkin's stage II A in 2000 and right renal cell carcinoma status post resection. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement without a focal suspicious lesion. Large gallstone within an otherwise normally distended unremarkable gallbladder. No intra or extrahepatic biliary ductal dilatation.SPLEEN: The spleen is normal morphology size, and signal intensity of the spleen which demonstrates heterogeneous early enhancement. No discrete lesion. Marked narrowing and probable thrombosis of the splenic vein.PANCREAS: There is mild to moderate interstitial edema involving the pancreatic body and tail compatible with pancreatitis. There is a focal masslike signal abnormality measuring 2.4 x 2.2 cm at the body tail junction with abnormal enhancement characteristics. The pancreatic tail duct is dilated measuring up to 3 mm. At the pancreatic tail near the splenic hilum there is a second masslike enlargement measuring 2.6 x 2.0 cm.There is heterogeneous perfusion of the pancreatic parenchyma.The pancreatic head and uncinate process is without diagnostic abnormality.The splenic vein is thrombosed. No peripancreatic fluid collections.Punctate cystic structure in the pancreatic body (series 4/15) does not definitively communicate with the main pancreatic duct, but may still represent a small sidebranch IPMN.Respiratory motion and peristalsis limits evaluation of the Secretin administration images. Within this limitation no additional abnormality is evident.ADRENAL GLANDS: There is a small enhancing mass in the right adrenal gland measuring 1.8 x 0.9 cm on image 44/series 3.KIDNEYS, URETERS: Status post right nephrectomy. No evidence of tumor recurrence in the nephrectomy bed. No enlarged locoregional lymphadenopathy.RETROPERITONEUM, LYMPH NODES: No enlarged retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Findings of mild pancreatitis involving the pancreas body and tail with suspicion for underlying masses at the pancreatic body/tail junction and pancreatic tail with intervening dilated pancreatic duct. There is thrombosis of the splenic vein. Differential considerations include metastatic renal cell carcinoma vs. Primary pancreatic neoplasm.2.Small enhancing right adrenal mass.3.Cholelithiasis without acute cholecystitis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.