Male 53 years old Reason: 53M w/ PMHx of necrotizing pancreatitis 06/2015 with persistent pain, MRI 01/2015 peri-pancreatic fluid collections, eval for necrotic debris vs fluid? History: abdominal pain ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No definite focal hepatic lesions. Intrahepatic portal vein and hepatic veins are patent. There is mild central intrahepatic biliary ductal dilatation. Common bile duct is dilated measuring up to 14 mm. There is a focal segment of narrowing in the pancreatic head measuring 1.7 cm. This is about the level of the ampulla.SPLEEN: Spleen is mildly enlarged. Splenic vein is severely narrowed and likely thrombosed. The superior mesenteric vein also shows poor filling.PANCREAS: Pancreas is completely necrotic. In its place there is a large heterogeneous collection with internal debris measuring 11.6 x 4.4 cm it extends from the expected location of the pancreatic head to the tail. Very little identifiable normal pancreatic tissue. There are small pockets of fluid in the left upper abdomen lateral to the stomach which might communicate with the pseudocyst.ADRENAL GLANDS: Left adrenal gland is nodular and thickenedKIDNEYS, URETERS: No hydronephrosis either kidney. Left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Wall thickening of the second and third portion of the duodenum with submucosal edema. There is wall thickening of the jejunum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amounts upper abdominal mesenteric ascites.
1.Extensive pancreatic necrosis with a large pseudocyst replacing the pancreatic parenchyma. There is narrowing of the common bile duct for a 1.7 cm segment at the level of the ampulla that causes mild intrahepatic biliary ductal dilatation.2.Thrombosis of the splenic vein and possible poor filling of the superior mesenteric vein.3.Thickening of the duodenal wall involving the second, third portions of duodenum extending to the proximal jejunum.