History of hilar/intrahepatic stricture status post stenting and ERCP with brushings showing reactive changes. Now with abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology size and signal intensity.Right hepatic lobe cyst. No new suspicious liver lesion.Demonstrated again is left greater than right intrahepatic biliary ductal dilatation to the level of Klatskin's point, slightly improved from the prior study. The previously described adjacent region of poorly defined enhancement on delayed imaging (series 18/54) is less conspicuous on today's study. The main common bile duct is normal in caliber with mild circumferential thickening.Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Redemonstrated cystic lesion at the pancreatic head/neck junction measuring 4.5 x 2.9 cm (series 5 image 18), compared to 2.7 x 2.6 cm previously. The lesion appears to communicate with the main pancreatic duct. The main pancreatic duct is normal in caliber. Small additional cystic foci in the pancreatic head and body are noted.No evidence of acute pancreatic inflammation. Several prominent peripancreatic lymph nodes, the largest measuring 2.3 x 1.5 cm (series 10/20) disease, unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate renal cysts.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.Persistent intrahepatic biliary ductal dilatation to Klatskin's point, slightly improved. The previously described adjacent region of poorly defined enhancement on delayed imaging (series 18/54) is less conspicuous on today's study.2.Mild interval increase in size of the cystic lesion at the pancreatic head neck junction which communicates with the main pancreatic duct, a pancreatic pseudocyst or a cystic neoplasm (such as a mucinous cystic neoplasm fistulized to the duct) remain diagnostic possibilities. No suspicious post-contrast enhancement of this lesion. 