Nausea/vomiting. New pancreatic and liver masses on CT. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement without biliary ductal dilatation or vascular abnormality. The segment 8 hypoenhancing lesion seen on the recent CT is poorly seen and measures approximately 1.0 cm (series 1603/78). No additional lesions are evident. Normally distended gallbladder without gallstones.SPLEEN: No significant abnormality noted.PANCREAS: Superior peripancreatic / perihepatic hilar mass measures approximately 4.0 x 3.5 cm (series 1603/54) and demonstrates heterogeneous central hypoenhancement. The more inferior peripancreatic mass measures approximately 4.2 x 3.0 cm (series 1603/32).The pancreatic parenchyma demonstrates normal morphology and signal intensity. The pancreatic duct is normal in caliber.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: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Two stable peripancreatic masses are again favored to represent metastatic adenopathy of unknown primary. A primary pancreatic lesion is considered less likely given the lack of parenchymal atrophy or ductal dilatation, however not entirely excluded. Histological sampling is recommended and may be amenable to endoscopic ultrasound-guided biopsy.2.Indeterminate liver lesion, unchanged.3.No additional sites of disease are identified.