69-year-old male with pancreatic cancer undergoing radiation therapy planning. ABDOMEN:LIVER, BILIARY TRACT: See below regarding probable invasion of pancreatic mass into the caudate lobe. There is a 1.8 x 1.6 cm enhancing lesion in segment 7 with restricted diffusion, most suspicious for metastasis (series 11/34). A subcentimeter T2 hyperintense lesion with rim enhancement in segment 8 is likely due to an additional metastasis (series 11/20).SPLEEN: No significant abnormality noted.PANCREAS: Large pancreatic body mass extending posteriorly and superiorly to infiltrate along the celiac trunk measures up to 6.6 x 6.5 x 7.7 cm (AP by transverse by craniocaudal, series 6/18 and series 7/15), increased in size since prior CT on 4/9/2015. Encasement by the mass causes moderate narrowing of the celiac trunk and mild deformity of the abdominal aorta at the level of the celiac trunk. A new cystic component of the mass extends superiorly along the medial portion of the caudate lobe of the liver, which is deformed and likely invaded (series 6/13). The mass is inseparable from and likely invades into the lesser curvature of the stomach near the cardia and the apex of the left adrenal gland. Hypoenhancement of the mass centrally is likely due to tumor necrosis.Again the mass causes obstruction of the portal confluence, including of the splenic vein. There is reconstitution of the main portal vein via collateral vessels.ADRENAL GLANDS: See above regarding the left adrenal gland. Normal appearance of the right adrenal gland.KIDNEYS, URETERS: Left renal cyst.RETROPERITONEUM, LYMPH NODES: Mild upper abdominal lymphadenopathy (e.g. series 11/70).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Large pancreatic body mass has increased since prior study on 4/9/2015, as detailed above.2.Two small focal hepatic lesions, suspicious for metastases.3.Mild upper abdominal lymphadenopathy.