Male 54 years old status post OLT 6/15 for ETOH cirrhosis and HCC. Elevated liver tests but no rejection on liver biopsy. Evaluate for lesions and assess hepatic vessel patency. ABDOMEN:LIVER, BILIARY TRACT: Stable postsurgical changes related to liver transplant, cholecystectomy and hepaticojejunostomy. There is wedged shaped enhancement within hepatic segments 7/8 on the arterial phase which normalizes on later phases of contrast consistent with transient hepatic intensity difference (THID). The hepatic artery, particularly at expected level of the common hepatic artery, is not well assessed due to significant susceptibility artifact related to prior surgery. However intrahepatic arterial enhancement is suggested. The hepatic and portal veins are patent in appearance.There is new mild right-sided intrahepatic biliary ductal dilatation with multiple filling defects consistent with stones in the common duct and located proximal to an area of apparent luminal narrowing at the expected level of the confluence and appearing to proximal to the biliary-enteric anastomosis (no evidence of left-sided intrahepatic biliary ductal dilatation, which would be expected in the setting of stricture involving the biliary-enteric surgical anastomosis). The narrowing extends over a distance of 9 mm although this may be undermeasured on this exam. As the intrahepatic biliary ductal dilatation is only on the right, findings are favored to represent a nonanastomotic stricture.SPLEEN: The spleen measures 13 cm in craniocaudal dimension.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Gynecomastia. A tiny posterolateral left chest wall cyst is of uncertain significance. Diastases of the rectus abdominis muscles is unchanged.OTHER: No significant abnormality noted.
1. Status post liver transplant. No suspicious hepatic lesion.2. New mild right-sided intrahepatic biliary ductal dilatation and choledocholithiasis. Just distal or inferior to level of stones is a suspected nonanastomotic (favored due to the absence of biliary ductal dilatation on left side) stricture, measuring approximately 9 mm in length. Considering constellation of findings, underlying stricture may have resulted in proximal biliary stasis which in turn led to stone formation. Please refer to discussion above. 3. The hepatic artery, particularly at expected level of the common hepatic artery, is not well assessed due to significant susceptibility artifact related to prior surgery. However intrahepatic arterial enhancement is suggested. Hepatic arterial anatomy may be evaluated with CTA in the future if clinically indicated. The hepatic and portal veins are patent in appearance. 4. Wedged shaped enhancement within hepatic segments 7/8 on the arterial phase which normalizes on later phases of contrast consistent with transient hepatic intensity difference (THID).