History of complicated pancreatitis. ABDOMEN:LIVER, BILIARY TRACT: Moderate intrahepatic and extra hepatic biliary ductal dilatation to the level of the pancreatic head. The common bile duct measures up to 1.5 cm. Susceptibility artifact from embolization coil limits evaluation at the level of the pancreatic head. Heterogeneous biliary system signal intensity suggestive of debris. No focal liver lesion.SPLEEN: The spleen measures 12.3 cm in length without focal lesion.PANCREAS: Between the pancreatic head and second portion of the duodenum is a 2.7 x 2.8 cm heterogeneous T1 weighted hyperintense nonenhancing collection most suggestive of a hematoma with associated mass effect on the distal common bile duct.Loss of intrinsic T1 weighted signal intensity of the pancreatic parenchyma which is mildly atrophic. It enhances relatively homogeneously. No new peripancreatic inflammatory changes.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple appearing left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Loculated fluid collection centered about the left hepatic lobe with predominantly fluid signal intensity with some dependent debris. Complex heterogeneous fluid collections anterior to the liver measuring 9.0 x 6.3 cm, anterior to the pancreatic head measuring 6.8 x 5.1 cm and adjacent to the cecum measuring 10.1 x 6.3 cm in the coronal plane. These collections likely communicate, best seen on the coronal images and recent CT.BONES, SOFT TISSUES: Anasarca.OTHER: Small right-sided pleural effusion with adjacent atelectasis.
1. Increasing intrahepatic and extrahepatic biliary ductal dilatation likely due to the mass effect from a suspected 2.8 cm hematoma between the pancreatic head and second portion of duodenum. Debris in the biliary system is also noted.2. Multiple complex heterogeneous fluid collections adjacent to the pancreatic bed and extending into the right hemiabdomen, compatible with acute necrotic collections/walled off necrosis. Chronic pancreatitis.