Pancreatic cancer with elevated CA 19 9 status post chemoradiation therapy to periaortic lymph node. ABDOMEN:LIVER, BILIARY TRACT: Steatosis. The liver is normal in morphology and enhancement without a focal lesion biliary ductal dilatation or vascular abnormality. Postsurgical changes from Whipple procedure with hepaticojejunostomy without evidence of complication.SPLEEN: Normal splenic size without a focal lesion.PANCREAS: Postsurgical changes from Whipple procedure. No evidence of recurrent or residual disease in the surgical bed.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Dorsal to the infrarenal IVC is a 1.8 x 1.4 cm enhancing soft tissue nodule(series 17/251). Left periaortic 8 mm enhancing focus at the same level is also noted. These are new from the prior.Celiac axis lymph node measures 1.4 x 0.9 cm (series 17/207) compared to 1.4 x 1.0 cm previously.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bone marrow signal intensity changes related to radiation. OTHER: No significant abnormality noted.
Enhancing soft tissue nodules dorsal to the inferior IVC and in the left periaortic region are suspicious for new sites of tumor. This site appears to be just inferior to the radiation bed.The celiac axis lymph node is essentially unchanged.