68-year-old female. Patient presented with painless jaundice. CT scanning and EUS here with no definitive lesion on CT scan. Needs MRCP. Probably cholangiocarcinoma. EPIC history: CBD mass suspicious for cancer on ERCP, CA 19-9 206. Images are variably degraded by motion artifact, somewhat limiting evaluation.ABDOMEN:LUNG BASES: Bilateral moderate pleural effusions and nonspecific basilar opacities, possibly atelectasis.LIVER, BILIARY TRACT: No suspicious hepatic mass. No biliary ductal dilatation. CBD stent with small amount of pneumobilia and dependent debris; susceptibility artifact produced by the stent limits evaluation of the duct itself. Within this limitation, no discrete enhancing common duct mass is identified. Patent hepatic vasculature.Susceptibility artifact from cholecystectomy clips.SPLEEN: No significant abnormality noted.PANCREAS: 6 x 5-mm cystic focus in the uncinate process, likely a sidebranch IPMN (series 801, image 4). A second subcentimeter cystic focus in the pancreatic neck which appears to connect to the pancreatic duct (series 801, image 6) is suspicious for another IPMN. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter T2 hyperintense foci in the right kidney, too small to characterize, likely cysts.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy. Subcentimeter small gastrohepatic ligament lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild anasarca.OTHER: No significant abnormality noted.
1.CBD stent with expected mild pneumobilia and no biliary ductal dilatation. Known CBD mass seen on prior ERCP is not visualized possibly due to artifact from the stent.2.No evidence of metastatic disease in the abdomen.3.Moderate bilateral pleural effusions.4.Cystic subcentimeter foci in the pancreatic uncinate process and neck, likely side branch IPMNs.