72 years, Female, Reason: eval liver lesion in R dome History: cirrhosis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cirrhotic liver morphology. There is a lesion in segment 8 which is ill-defined with a large necrotic component as well as a minimally enhancing component with multifocal areas of diffusion restriction. No fat is associated with this lesion. There is complete thrombosis of the portal vein which enhances in portions, likely representing tumor thrombus. The SMV and splenic veins are patent.Common bile duct is dilated to 15 mm and there is abrupt transition at the ampulla. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: The distal pancreatic duct is normal in caliber. There are multiple cysts within the pancreatic tail which appear to communicate with the main pancreatic duct which is dilated at portions, compatible with a main duct IPMN.ADRENAL GLANDS: Left adrenal nodule measuring 1.7 x 2.0 cm (601/18).KIDNEYS, URETERS: Multiple bilateral simple renal cysts, some of which are too small to characterize.RETROPERITONEUM, LYMPH NODES: Large necrotic portacaval lymph node measuring 2.4 x 2.4 cm (601/23). Additional large aortocaval lymph node.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of perihepatic ascites. There is a dilated vessel in the right mid abdomen as well as multiple peri-splenic collaterals.
1.Large necrotic mass the pancreatic dome is suspicious for diffuse hepatocellular carcinoma.2.Tumor thrombus within the portal vein.3.Necrotic retroperitoneal lymph nodes suspicious for metastases.4.Left adrenal nodule is indeterminate but suspicious for metastases given other findings.