64-year-old female with nausea/abdominal pain. Evaluate for mass or blockage. ABDOMEN:LIVER, BILIARY TRACT: Post surgical changes from hepaticojejunostomy. Scattered arterially hyperenhancing peripheral foci of the liver are not present on the venous and delayed phases and are most consistent with perfusional variants. No suspicious lesions are identified. SPLEEN: The spleen is at the upper limits of normal in size measuring 13 cm in length.PANCREAS: Postsurgical changes from a Whipple procedure. The residual pancreatic tail again demonstrates bulbous enlargement with decreased T1-weighted signal intensity. There is increased size of the infiltrative soft tissue lesion involving the distal pancreatic body with dilatation of the pancreatic duct proximally and distally. This lesion extends posteriorly to compress the splenic vein and anteriorly to the posterior wall of the stomach. This lesion measures 3.1 x 2.7 cm (series 1405 image 244) and is at the level of the splenic hilum. There is interval development of gastric collateral vessels. Mildly enlarged regional lymph nodes are also seen. A unilocular cystic lesion in the pancreatic tail has slightly increased in size measuring 1.4 x 1.4 cm (series 301 image 29) (prior 1.2 x 1 cm).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly enlarged peripancreatic retroperitoneal lymph nodes.BOWEL, MESENTERY: Status post distal gastrectomy with gastrojejunostomy. No evidence for bowel obstruction or ascites.BONES, SOFT TISSUES: Findings compatible with a benign osseous hemangioma of the L4 vertebral body (series 201 image 18), unchanged.OTHER: No significant abnormality noted.
1. More pronounced appearance of an infiltrative lesion involving the distal pancreatic body with persistent dilatation of the proximal and distal pancreatic duct. This lesion compresses the splenic vein with new gastric collateral vessels and regional lymphadenopathy. Further evaluation with endoscopic ultrasound is suggested.2. Unilocular cyst of the pancreatic tail has slightly increased in the interval.