51-year-old female with epigastric pain and fever. Status post pancreatic abscess with percutaneous drainage. Allergic to IV contrast. Known choledochocyst and cholangitis. Right upper quadrant pain and fever. This examination is limited by the absence of intravenous contrast.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: This patient is status post percutaneous choledochocyst drainage on 4/17/09 with catheter removal on 5/12/09. Subsequent hepaticojejunostomy was performed. Compared with the MRI examination dated 7/17/09, the previously drained cyst measured 2.3 x 1.8 cm initially and now measures 4.9 x 4.2 cm. There is new increase in the adjacent serpiginous low density tubular structure compatible with new biliary duct dilatation and obstruction which predominantly affects the left hepatic lobe. The expected pneumobilia is seen in this patient who is status post hepaticojejunostomy. Multiple splenic and gastric varices are present. Mild hepatomegaly, the liver measures 18.5 cm overall.SPLEEN: Mild splenomegaly, the spleen measures 12 cm in length.PANCREAS: No definite evidence of pancreatic cyst as clinically questioned. Further examination examination for smaller cysts or abscess would require contrast enhancement.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of free fluid in the dependent pelvis.
Interval development of enlarged choledochal cyst with probable obstruction of the left biliary tree. Multiple additional findings appear stable since MR examination of 7/17/09.