74 years, Female, Reason: eval liver lesions, eval for biliary obstruction History: elevated lfts, cholestatic picture. Evaluation of MRCP sequences is limited due to respiratory artifact.ABDOMEN:LUNG BASES: Bilateral pleural effusions. Left-sided chest tube. Cardiomegaly.LIVER, BILIARY TRACT: There is an enhancing lesion throughout the majority of the right hepatic lobe with patchy high signal on T2 and demonstrates progressive enhancement. For reference, the lesion measures 8.7 x 13.6 cm. There is no significant signal loss on out of phase images to indicate fat. The posterior right portal vein is encased but appears patent. The IVC is also significantly narrowed but appears patent both proximally and distally.Left hepatic lobe subcentimeter simple cysts. Diffuse gallbladder wall thickening is likely related to fluid overload. No cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Minimally complex cystic lesion in the left upper pole with several septations but no suspicious enhancing or nodular components. Left lower pole subcentimeter hemorrhagic/proteinacious cyst. Additional subcentimeter T2 hyperintense lesions likely represents cysts but are too small to characterize. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild abdominal ascites.
1.Large progressively enhancing hepatic lesion occupying the majority of the right hepatic lobe likely represents neoplasm. Cholangiocarcinoma is favored, however the differential diagnosis would also include metastases.2.Minimally complex left upper pole cyst without suspicious enhancing components.3.Mild abdominal ascites and large effusions.