Female 76 years old with metastatic rectal adenocarcinoma s/p diverting ileostomy and neo-adjuvant FOLFOX who was found to have extensive peritoneal disease. Evaluate for peritoneal disease burden. ABDOMEN:LIVER, BILIARY TRACT: Progressive intrahepatic biliary ductal dilatation. The pancreatic duct and common duct are dilated to the level of the ampulla. This may be due to stricture however obstructing stone or layering sludge is not excluded as this is not an MRCP. The gallbladder is decompressed.There is no suspicious hepatic lesion. The hepatic vasculature is patent.SPLEEN: Splenomegaly.PANCREAS: The pancreas enhances homogeneously. The pancreatic duct is dilated to the level of the ampulla as discussed above.ADRENAL GLANDS: Nodular thickening of the left adrenal gland with loss of signal on out of phase imaging indicating benign adenoma.KIDNEYS, URETERS: Multiple bilateral renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: There are scattered small retroperitoneal and mesenteric lymph nodes. Stable infrarenal abdominal aortic aneurysm.BOWEL, MESENTERY: Status post partial colectomy with left lower quadrant ostomy and mucous fistula.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is minimal perihepatic and splenic ascites.Linear restricted diffusion along the left anterior abdominal wall at the level of the splenic and mid anterior abdominal wall at the level of the lower pole of the kidneys (series 12, image 66 and 97 is present has no correlate on T2 or postcontrast images however this is suspicious for peritoneal disease.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is thickening and enhancement of the rectum with restricted diffusion perhaps related to prior radiation therapy. No discrete rectal mass is identified. There are foci of nodular, enhancing soft tissue anterior to the rectum, abutting the cervix, along the left pelvic wall and with extensive involvement of the omentum anteriorly.Status post partial colectomy with left lower quadrant ostomy and mucous fistula. There is diffuse thickening rectosigmoid colon wall over a distance of approximately 12 cm perhaps related to prior radiation therapy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Extensive pelvic peritoneal and mesenteric metastatic disease.2.Restricted diffusion along the left anterior upper abdominal wall and anteriorly along the mid abdominal is suspicious for additional peritoneal disease.3.Progressive intrahepatic ductal dilatation and dilatation of the pancreatic and common duct to the level of the ampulla. This may be due to stricture however an impacted stone layering sludge is not excluded without MRCP.