75 year old female with metastatic breast cancer and pancreatitis status post ERCP on 10/27 with stent placement now with abdominal pain, nausea/vomiting, increasing lipase. Please evaluate for pancreatitis. ABDOMEN:LUNG BASES: Increase in bilateral pleural effusions since prior MRI, right greater than left with adjacent atelectasis/consolidation.LIVER, BILIARY TRACT: Air seen throughout the biliary tract consistent with recent biliary stent placement. Biliary stent appears patent. The portal vein is not well visualized. The SMV at the level of the confluence, confluence and the entire splenic vein are not visualized. The SMV proximal to the confluence appears patent. The gallbladder at the level of the gallbladder neck demonstrates a diffuse low attenuation lesion which enhances on arterial phase is suspicious for metastatic lesion measuring 1 cm x 1 cm best seen on image 4477, series 8.Re-identification of multiple scattered hypodense lesions throughout the liver the largest of which previously measured 1.4 x 1 cm best seen on image 64/97, series 4 now measures 1.1 cm best seen on image 16/138, series 10.SPLEEN: Splenic vein is not visualized however spleen appears unremarkable.PANCREAS: Diffuse pancreas enlargement with some posterior peripancreatic stranding out of proportion to ascites consistent with pancreatitis.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left-sided hydronephrosis and hydroureter with narrowing and loss of visualization of the distal ureter with resultant obstruction, best seen on image 70/138, series 10.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Re-identification of new multiple, sclerotic lesions due to metastatic disease.OTHER: Moderate intra-abdominal ascites.PELVIS:UTERUS, ADNEXAE: Calcified fibroid uterus.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: As described above.OTHER: No significant abnormality noted
1. Worsening of bilateral pleural effusions.2. Poor visualization of the portal vein, confluence, splenic vein and distal SMV consistent with thrombosis.3. New left-sided hydronephrosis and hydroureter with lack of visualization of the distal ureter consistent with obstruction.4. Apparent worsening of intra-abdominal ascites.