Right upper quadrant pain, elevated LFTs and leukocytosis. Susceptibility artifact from the patient's spinal fixation hardware limits some of the imaging sequences, particularly the diffusion weighted images which are non-diagnostic.ABDOMEN:LUNG BASES: Small right greater than left pleural effusion with minimal basilar atelectasis.LIVER, BILIARY TRACT: There is intrahepatic and extrahepatic biliary ductal dilatation with the common bile duct measuring 16 mm. The duct is dilated to the level of the superior aspect of the pancreatic head where it tapers abruptly. A short segment of the common bile duct is seen just proximal to the ampulla. At this level the pancreatic head is prominent, measuring 2.7 x 2.3 (series 1405/180), T2-hypointense and demonstrates relatively early and persistent enhancement relative to the background mildly atrophic pancreas. There is mild spiculation of the contours of the pancreatic head. The pancreatic duct is at the upper limits of normal in caliber. There is no soft tissue encasement or caliber abnormality of the adjacent SMV, splenic vein, protal vein or SMA. Posterior peri-pancreatic head lymph node measuring 7 mm in short-axis. No additional prominent lymph nodes.The gallbladder is mildly distended. There is mild smooth focal gallbladder wall thickening to 4 mm along the lateral aspect of the gallbladder which may reflect focal adenomyomatosis. The remainder of the gallbladder is normal in thickness. There is mild pericholecystic fluid. No filling defect to suggest gallstones.Minimal perihepatic fluid.There is mild loss of hepatic parenchymal signal intensity on out of phase imaging suggesting fatty infiltration. No focal suspicious hepatic lesion.SPLEEN: Minimal perisplenic fluid. The spleen is normal in size.PANCREAS: See the discussion above.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted. Symmetric minimal perinephric fat stranding. Subcentimeter left renal cyst.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.Distended gallbladder with significant intra and extrahepatic biliary ductal dilatation to the pancreatic head. A pancreatic head mass is suspected, as described above, specifically a pancreatic adenocarcinoma or less likely a cholangiocarcinoma. EUS/ERCP evaluation and biopsy is recommended.2.Small pleural effusions.