Reason: Dedicated liver MRI to rule out mass, evaluate peri-splenic fluid collection, and for signs of pancreatitis History: acute onset abdominal pain, elevated Lipase, questionable liver mass and perisplenic fluid collection on abdominal ultrasound. Mildly elevated lipase of 66. ABDOMEN:LIVER, BILIARY TRACT: The liver is upper normal in size with an otherwise normal morphology. Out of phase images demonstrate diffusely decreased signal intensity with several areas of geographic sparing compatible with hepatic steatosis with areas of sparing. No focal hepatic lesions are identified.The hepatic vasculature appears patent.The gallbladder appears within normal limits without evidence of cholelithiasis or gallbladder wall thickening. There is no biliary ductal dilatation.SPLEEN: No significant abnormality noted. The splenic vasculature appears patent.PANCREAS: The pancreas demonstrates normal parenchymal T1 signal intensity and enhancement without evidence of necrosis. The pancreatic tail is enlarged with associated peripancreatic fat stranding primarily within the left upper quadrant compatible with acute pancreatitis. There is a small perisplenic fluid collection subjacent to the left abdominal wall measuring up to 7 mm in thickness. There is a small area of focally increased T2 signal within the pancreatic tail with reference measurements as below.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 9/16/2016 21:21:32)PANCREATIC TAIL CYSTIC LESION: 1.0 x 0.9 cm (Image 33, Series 301).
1.Focal enlargement of the pancreatic tail and surrounding peripancreatic fat stranding compatible with acute pancreatitis.2.Small cystic lesion within the pancreatic tail which is nonspecific but could represent a small pseudocyst, a sidebranch IPMN, among other etiologies.3.Short-term follow-up MRCP is recommended following resolution of acute symptoms to exclude underlying pancreatic neoplasm.4.Hepatic steatosis with geographic areas of sparing without suspicious hepatic lesions.