62-year-old male with IR drain, perihepatic abscess, evaluate for bilious drainage ABDOMEN:LIVER, BILIARY TRACT: Mild intrahepatic biliary ductal dilation with narrowing at the level of the anastomosis. Thick walled multiloculated fluid collection in the right upper quadrant lateral to the hepaticojejunostomy measures 2.5 x 4.4 x 4.0 cm (series 501, image 12; series 401, image 15). A percutaneous pigtail catheter courses within the anterior portion of this collection, which is no longer measurable. Along the medial aspect of the larger, persisting posterior collection there is a tract of increased signal on the MRCP images extending superiorly towards the porta hepatis (series 801, image 79, 83, 93). On comparison CT, there is air in this region, which is likely outside the biliary tract. The combination of these findings is suspicious for possible fistulous communication between the biliary tree and perihepatic fluid collection. SPLEEN: Splenomegaly and varices.PANCREAS: Fatty involution of the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left-sided renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.
1.Multiloculated perihepatic abscess with a tract of high signal extending superiorly towards the porta hepatis, where extraluminal air is noted on the comparison CT. This combination of findings is suspicious for possible fistulous communication between the biliary tree and perihepatic collection. If further imaging clarification would be helpful, a contrast enhanced MR scan utilizing Eovist which is excreted in the biliary tract, could determine whether a communication exists between the biliary tract and this collection.2.Pigtail drainage catheter within the anterior portion of the multiloculated perihepatic collection, which is no longer measurable. Posterior component persists without apparent drainage.