Female 84 years old Reason: Biliary stone, sludge, etiology of elevated lipase History: nausea, vomiting, pain on exam ABDOMEN:LIVER, BILIARY TRACT: T2 hyperintensities in the liver are suggestive of hepatic cysts. Status post cholecystectomy.SPLEEN: T2 hyperintensity within the spleen without convincing enhancement likely represents a splenic cyst.PANCREAS: There is a focal area of hyperenhancement within the pancreatic head measuring 2.6 x 1.6 cm (series 1201, image 184). There is marked dilatation of the upstream pancreatic duct measuring up to 8 mm (series 1201, image 179). The pancreatic duct remains dilated apart from a segment of narrowing in the distal body/tail measuring approximately 2.6 cm where it is abnormally narrowed. There is no mural nodularity or enhancement of the pole. In the region of the abnormal ductal narrowing there is loss of the normal intrinsic T1 hyperintense signal within the pancreatic parenchyma. There is no normal restricted diffusion within the pancreas. There are no surrounding inflammatory changes to suggest acute pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal cysts measuring up to 6.5 x 6.7 in the right kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.
1.Focal narrowing of the pancreatic duct with abnormal signal in the surrounding pancreatic parenchyma. The appearance is suggestive of chronic pancreatitis.2.Suspicious hypoenhancing focus within the pancreatic head with upstream pancreatic duct dilatation. While chronic pancreatitis could account for the duct dilatation the hypoenhancing focus is suspicious for a pancreatic neoplasm, although the lack of diffusion restriction is somewhat atypical. Consideration given to further evaluation with EUS/ERCP. 