Possible choledocholithiasis on CT. Evaluate biliary ductal system. Patient with abdominal pain and acute pancreatitis. LUNG BASES: Mild dependent atelectasis.ABDOMEN:LIVER, BILIARY TRACT: There is moderate intrahepatic biliary ductal dilatation. The common bile duct is dilated to 9 mm with a rounded filling defect just proximal to the ampulla consistent with choledocholithiasis. There are numerous small gallstones in a distended gallbladder with a small amount of pericholecystic fluid suggesting mild acute cholecystitis.Mild loss of liver parenchymal signal on out of phase images suggests fatty infiltration.No focal hepatic lesion is evident.SPLEEN: No significant abnormality noted.PANCREAS: Mild diffuse restricted diffusion of the distal pancreatic body and tail which appears edematous/focal. There is minimal peripancreatic fluid. These findings are compatible with acute pancreatitis. No discrete fluid collection. Limited noncontrast evaluation for vascular complications shows no abnormality.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild left lateral abdominal wall subcutaneous edema.OTHER: No significant abnormality noted.
1.Choledocholithiasis resulting in intra and extrahepatic biliary ductal dilatation.2.Numerous small gallstones within a distended gallbladder. Small amount of pericholecystic fluid. Again these findings suggest mild cholecystitis.3.Mild restricted diffusion of the pancreatic body and tail which appears full with mild peripancreatic nonloculated fluid compatible with mild pancreatitis, especially given the setting of elevated lipase.