59 year-old female history of abdominal pain and mass seen on recent CT. ABDOMEN:LIVER, BILIARY TRACT: There is no intra or extrahepatic biliary ductal dilatation. Common bile duct measures 5 mm. There is smooth narrowing noted at the pancreatic head, however the distal duct appears normal..The main portal vein, SMV, and splenic vein are thrombosed, likely chronic, with cavernous transformation of the portal vein. There is also extensive increased T2 signal abnormality within the porta hepatis and near the head of the pancreas with delayed enhancement and restricted diffusion. No discrete masses identified.Moderate gallbladder wall thickening, edema, and small amount of pericholecystic fluid.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct measures 3 mm. Abrupt cutoff is noted in the pancreatic head, however the distal duct reconstitutes near the ampulla . No discrete mass or filling defect.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonenhancing left renal cyst.RETROPERITONEUM, LYMPH NODES: Prominent para-aortic lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Chronic thrombosis of the portal, superior mesenteric, and splenic veins with cavernous transformation of the main portal vein. Soft tissue thickening and extensive surrounding signal abnormality including delayed enhancement most likely secondary to combination of scarring/fibrosis and cavernous transformation and less likely due to extrahepatic cholangiocarcinoma given the lack of corresponding significant biliary ductal dilation.2.Gallbladder wall thickening and edema with pericholecystic fluid can be seen in acute cholecystitis, however this appears similar to the prior study, and probably chronic due to the aforementioned fibrosis.