30-year-old male patient with jaundice, transaminitis. Concern for PSC, PBC, ascending cholangitis. ABDOMEN:LIVER, BILIARY TRACT: The liver is enlarged measuring up to 25 cm in the craniocaudal dimension. No focal hepatic lesion. No intra or extrahepatic biliary ductal dilatation. No CBD stone seen, image 48 series 8. No significant biliary wall thickening, enhancement or restricted diffusion identified. There is periportal edema. The gallbladder wall is thickened measuring up to 8 mm in thickness and is mildly contracted. No cholelithiasis. SPLEEN: No significant abnormality noted.PANCREAS: The main pancreatic duct is normal in diameter. There is mild peripancreatic edema. Additionally, there is increased diffusion abnormality within the head of the pancreas. No pancreatic mass is identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is mild increased wall enhancement of the duodenum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace ascites and trace bilateral pleural effusions.
1.Hepatomegaly without intra- or extrahepatic biliary ductal dilatation. 2.Thickened gallbladder wall without distension or cholelithiasis; this is non-specific and could be secondary to various etiologies including hepatitis and hypoalbuminemia. 3.Mild peripancreatic edema, diffusion abnormality (primarily within the pancreatic head), and duodenal wall enhancement; these findings raise concern for acute pancreatitis, correlate with lipase and amylase levels and patient's clinical history/physical exam.