Reason: CBD stone, pancreatic head mass obstructing CBD History: elevated t bili; jaundice;. ABDOMEN:LUNG BASES: Elevation of the right hemidiaphragm. Trace right pleural effusion.LIVER, BILIARY TRACT: Significant intrahepatic and extrahepatic biliary ductal dilatation. The common bile duct measures up to 1.4 cm (series 701 image 54) to the level of the pancreatic head, where there is a mixed solid and cystic mass. No evidence of choledocholithiasis. Hydropic gallbladder. Small amount of Pericholecystic and perihepatic fluid. Scattered foci of fat infiltration. No focal hepatic lesions. SPLEEN: No significant abnormality noted.PANCREAS: Again seen in the pancreatic head and uncinate, is a mixed solid and multiloculated cystic mass measuring 4.4 x 3.7 x 6.5 cm (AP x transverse x CC, series 301 image 8, series 401 image 12). Associated calcifications are better seen on CT. No pancreatic ductal dilatation. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Peripancreatic lymphadenopathy again noted. For reference enlarged lymph node measures 1.6 x 1.5 cm (series 1004 image 134). Atherosclerotic disease of aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Pancreatic head/uncinate process mixed solid and cystic mass suspicious for primary pancreatic malignancy. Associated upstream intrahepatic and extrahepatic biliary ductal dilatation and peripancreatic lymphadenopathy. 2.Hydropic gallbladder and mild pericholecystic fluid, may be seen in setting of superimposed acute cholecystitis, findings may be secondary to mass effect from aforementioned pancreatic head mass.