Male 62 years old Reason: S/p Peustow procedure, cholecystectomy, with recurrent acute on chronic pancreatitis. Please evaluate and compare to previous. ABDOMEN:LIVER, BILIARY TRACT: Multiple hepatic cysts are identified within the liver. The largest is in the medial right hepatic lobe. Moderate intra and extrahepatic biliary ductal dilatation which appears progressed compared to prior study which abruptly terminates at the ampulla. There is a filling defect within the distal CBD (series 301, image 9) which may represent a small CBD stone.SPLEEN: The spleen is measured at upper limits of normal. There is occlusion of the splenic vein and region of the pancreatic tail with extensive collateral vessel formation.PANCREAS: There is a cystic lesion in the pancreatic head with central T2 hyperintense foci corresponding to calcifications on recent CT. A second smaller cystic abnormality is identified within the pancreatic tail. These communicate with the pancreatic duct. The pancreatic duct is patent however there is a stricture in the neck best seen on series 1001, image 1. There is a blunted response to secretin suggesting a degree of pancreatic dysfunction.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post bilateral nephrectomy.RETROPERITONEUM, LYMPH NODES: Prominent peripancreatic lymph nodes may be reactive.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild peripancreatic fluid is unchanged in size compared to prior study. Abdominal ascites. Diffuse anasarca.
1. No significant change in the appearance of intrapancreatic cystic lesions suggestive of pseudocysts.2. Stricture in the pancreatic neck and blunted response to secretin suggesting a degree of pancreatic dysfunction.3. Filling defect in the distal common bile duct suggestive of a small stone with increasing intra and extrahepatic biliary ductal dilatation.