Abdominal pain in right upper quadrant, evaluate for metastatic disease leading to hepatic obstruction (cancer patient with known metastases now with scleral icterus, dark urine, etc.) ABDOMEN:LIVER, BILIARY TRACT: Multiple enlarging hepatic metastases, demonstrating T2 intermediate signal and postcontrast heterogeneous predominately rim enhancement. At least one possible new lesion, for instance, 1 x 0.9 focus located in hepatic segment 2 on image 31 series 701, not definitely seen on earlier CT study. Hepatic segment 4B lesion now measures 5.2 x 3.8 cm on image 25 series 701, previously measured 3.2 x 3.1 cm. Additional previously referenced porta hepatis lesion now mildly larger, measuring 3.2 x 2.9 cm on image 25 series 701, previously measured 3.1 x 2.2 cm. Associated mass effect on adjacent structures seen with new moderate intrahepatic biliary duct dilatation visualized. Area inferior to this level including pancreatic head not well assessed secondary to susceptibility artifact from postprocedural sequela. Previously alluded to 0.9 cm peripheral right hepatic hypoattenuating focus likely a cyst given corresponding T2 hyperintensity on current MRI. Main portal vein flow void approximately 2 cm from confluence with SMV and splenic vein not visualized, corresponding to tumor invasion and occlusion. Opacification of some intrahepatic peripheral portal venous branches, portion of markedly attenuated right posterior portal venous segment seen on image 26 series 1001, with tumoral invasion, image 409 series 1404. Otherwise, right and left portal veins not well seen. Heterogeneous signal particularly of right hepatic lobe on postcontrast imaging, likely reflecting combination of metastatic disease and perfusional abnormalities secondary to portal venous thrombosis. New luminal narrowing of IVC secondary to mass effect, image 404 series 1/4/2004, and near junction with left renal vein. Gallbladder contracted.SPLEEN: No significant abnormality noted.PANCREAS: Nondilated pancreatic duct. Pancreatic head not well assessed secondary to susceptibility artifact from postprocedural sequela.ADRENAL GLANDS: Accounting for differences in technique/modality, left adrenal nodule without significant change, measuring 1.8 x 0.8 cm on image 23 series 701, previously measured 1.9 x 1.2 cm on CT study.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Bilateral renal cysts.BOWEL, MESENTERY: Right-sided ostomy.BONES, SOFT TISSUES: Spinal degenerative disease.OTHER: Small ascites. Trace pleural fluid. Status post cystoprostatectomy.
Enlarging hepatic metastases with new associated moderate intrahepatic biliary duct dilatation and portal vein invasion/occlusion, at least one new hepatic metastasis suggested, please refer to discussion above.Small ascites, trace pleural effusions.