Hematemesis, melena, inability to tolerate p.o. intake, gastric outlet obstruction per EGD, abnormality seen on CT concerning for pancreatic mass ABDOMEN:LIVER, BILIARY TRACT: Mild intrahepatic biliary duct prominence with tapering seen distally, transition point located near proximal common bile duct, image 24 series 801, with mild soft tissue surrounding stranding seen, site is near moderate to severe narrowing of pylorus. Duct upstream measures 9 mm, while duct below this level measures 3 mm, length of abnormality/site of transition measures approximately 1.5 cm. Unfortunately, area is not well assessed due to motion artifact at this level but findings are suggestive of focal segmental biliary duct stricture, may be of benign or malignant etiology. Hepatic steatosis. T1 hyperintense material seen in gallbladder, may reflect vicarious excretion of contrast from earlier CT study. SPLEEN: No significant abnormality noted.PANCREAS: Intrinsic T1 signal of pancreas relatively preserved. Lobulated contour of pancreatic head, particularly laterally, may be a normal variant, no discrete pancreatic mass visible. Nondilated pancreatic duct. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Tiny renal cyst formation.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate to marked circumferential luminal narrowing at level of pylorus, image 317 series 1202. Moderately distended fluid and debris containing stomach.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Subcentimeter left axillary lymph nodes. Rounded 1 x 0.9 cm T2 hyperintense focus in deep inferior aspect of left breast, image 40 series 701. 1.7 cm right adnexal T2 hyperintense focus, may be a dominant ovarian follicle. Possible lobulated appearance of the uterus, suggestive of underlying leiomyomatous disease.
1. Mild intrahepatic biliary duct prominence with tapering seen distally, transition point located near proximal common bile duct with mild soft tissue surrounding stranding seen, site is near moderate to severe narrowing of pylorus. Duct upstream measures 9 mm, while duct below this level measures 3 mm, length of abnormality/site of transition measures approximately 1.5 cm. Unfortunately, area is not well assessed due to motion artifact at this level but findings are suggestive of focal segmental biliary duct stricture, may be of benign (e.g., inflammatory/secondary to nearby pyloric disease) or malignant etiology, correlation with patient's clinical history and ERCP recommended. 2. Moderate to marked pyloric narrowing with moderate gastric distention, compatible with patient's reported history of acquired hypertrophic pyloric stenosis.3. Subcentimeter left axillary lymph nodes. Rounded 1 x 0.9 cm T2 hyperintense focus in deep inferior aspect of left breast, may be an additional intramammary lymph node or reflect fibrocystic disease of the breast but indeterminate and mammographic correlation recommended. 