Male 54 years old Reason: neuroendocrine CA with pancreatic lesion and high bili. evaluate for obstruction History: Hyperbilirubinemia ABDOMEN:LIVER, BILIARY TRACT: There are two hemangiomas in the liver located in segments 3 and 7. There are a few scattered hepatic cysts. No suspicious hepatic lesions.The hepatic and portal veins are patent. There is new moderate intrahepatic biliary ductal dilatation due to obstruction of the common bile duct at the level of the pancreatic head. The common bile duct measures approximately 9 mm in diameter. Gallbladder is distended with sludge.SPLEEN: The spleen is enlarged.PANCREAS: The pancreatic parenchyma has been replaced by multiple enhancing lesions. The dominant lesion located in the head of the pancreas measures 5.5 x 4.5 cm (image 19/series 701). This lesion obstructs the pancreatic duct and the common bile duct. There is severe narrowing of the main portal vein and splenic vein the head of the pancreas due to the mass.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small bilateral cysts. Subcentimeter lesion at the upper pole of the right kidney is complex.RETROPERITONEUM, LYMPH NODES: Left cardiophrenic lymph node measures 2.5 x 1.8 cm (image 33/series 701). BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Metastatic disease to the L1 vertebral body.OTHER: Trace pelvic ascites.
1.Biliary obstruction due to pancreatic head mass.2. Metastatic disease to the spine and nodes.