75-year-old male with right upper quadrant abdominal pain, obstructive jaundice, metastatic small cell prostate cancer. Evaluate for biliary obstruction. ABDOMEN:LIVER, BILIARY TRACT: Extensive metastatic lesions of the liver with luminal narrowing of the intrahepatic IVC are again noted. There are prominent periportal lymph nodes. A 2.2 x 3 cm peripancreatic lymph node causes compression of the adjacent common bile duct and results and intra and extrahepatic biliary ductal dilatation (axial series 8 image 42, series 7 image 90).Hydropic gallbladder without wall thickening or inflammatory changes to suggest acute cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic ductal dilatation. Trace ascites including trace peripancreatic fluid, nonspecific. Peripancreatic adenopathy demonstrating restricted diffusion. However no definite restricted diffusion related to pancreatic parenchyma itself to support acute pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild left-sided hydroureteronephrosis, which is again felt to be related to the enlarged pelvic lymph node compressing the distal ureter (coronal series 3 image 18). The enlarged pelvic lymph node is only partially visualized at the anterior aspect of the coronal T2 sequence. A punctate intraluminal hypointense focus seen only on the coronal T2 sequence (series 3 image 18) could represent a nonobstructive stone versus artifact and is not the cause of the left hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace ascites.BONES, SOFT TISSUES: Stable appearance of the known sclerotic osseous metastatic lesions (coronal series 3 images 6, 12).OTHER: Known pulmonary metastatic nodules of the lung bases are appreciated on the diffusion weighted series.
1.Extensive metastatic lesions of the liver. Periportal and peripancreatic adenopathy likely metastatic also present; as seen on prior CT study, an enlarged peripancreatic lymph node compresses the adjacent distal common bile duct and results in mild intra and extrahepatic biliary ductal dilatation.2.Mild left hydroureteronephrosis related to the known enlarged pelvic nodal lesion compressing the distal ureter (partially imaged on current exam but well depicted on earlier CT study).3.Metastatic pulmonary nodules and osseous metastatic lesions are better evaluated on the recent CT exam.