70-year-old female with obstructive jaundice and cholecystitis. History of prior gastric bypass and hemicolectomy. Evaluate for CBD stone and determine anatomy. ABDOMEN:LIVER, BILIARY TRACT: Dilated common bile duct with a small intrahepatic stone measuring 4.8 mm in craniocaudal length and 3.8 mm in transverse diameter (coronal series 9 image 84), which is unlikely to be the source of extra hepatic biliary ductal dilatation as flow is seen along the lateral margins. A small stone at the ampulla cannot be excluded. Mild central intrahepatic biliary ductal dilatation. Few scattered hepatic cysts.Distended gallbladder containing small gallstones in the dependent fundus. No pericholecystic fluid identified. No obstructing stones identified in the cystic duct.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic mass. Mild pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left kidney with significant parenchymal atrophy measuring 8.5 cm in length, and a small simple cyst of the left lower renal pole is noted. There is compensatory hypertrophy of the right kidney measuring 12.1 cm in length. In the anterior right upper pole, there is a 2.5 cm cyst (axial series 6 image 34) with a fluid fluid level (axial series 8 image 30 suggesting a hemorrhagic cyst. In the posterior right upper renal pole, there is a 3.3 cm cyst, and smaller scattered renal cysts are also noted on the right.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post right hemicolectomy. Findings compatible with history of gastric bypass including focal dilatation of a left upper quadrant small bowel bowel loop.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Choledocholithiasis with a 4.8 x 3.8 mm stone in the distal common bile duct, however this is unlikely to be a flow-limiting obstruction. A smaller stone at the ampulla or recently passed stone cannot be excluded. No periampullary mass identified. Mild central intrahepatic ductal dilatation and mild pancreatic ductal dilatation also noted. 2.Distended gallbladder with gallstones in the dependent gallbladder fundus. No obstructing stone in the cystic duct.3.Parenchymal atrophy of the left kidney with compensatory hypertrophy of the right kidney. Right renal cysts are noted, including a 2.5 cm suspected hemorrhagic cyst of the right upper pole.