Known sarcoidosis with possible biliary mass. ABDOMEN:LIVER, BILIARY TRACT: The liver is of normal in morphology and size measuring 15 cm in craniocaudal dimension. There is mild intrahepatic biliary ductal dilatation. The common bile duct measures approximately 7 mm, within normal limits. Cholelithiasis within a normally distended gallbladder without wall thickening or pericholecystic fluid. At the gallbladder neck there is a 2.8 x 2.6 cm (series 4/19) focus which is very low signal intensity on all imaging sequences (as are the smaller gallstones) without postcontrast enhancement likely representing a large gallstone. Thrombosed residua of the pseudoaneurysm identified on the CT dated 9/6/2014 is considered unlikely. No hepatic artery pseudoaneurysm is identified compatible with the findings of the 1/12/2015 angiogram.There is a left sided percutaneous biliary drain extending through the left hepatic lobe and common bile duct into the duodenum.At the junction of segment 4A and 4B just anterior to the left sided biliary drain there is a focal masslike region of T1 hypointensity measuring approximately 3.4 x 3.2 cm (series 11/57) on the precontrast imaging which demonstrates gradual postcontrast enhancement measuring up to 2.4 x 2.3 cm (series 13/56). There may be a corresponding hypoattenuating focus in a similar region on the CT dated 9/6/2014 (series 3 image 19). This is associated with subtle T2-weighted hyperintensity and restricted diffusion (series 5/52 and series 10/12).The hepatic veins, portal vein and visualized portion of the hepatic artery are patent.SPLEEN: Mild splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate renal cysts. No hydronephrosis. Symmetric mild perinephric fluid.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Persistent right basilar segmental consolidation/atelectasis. Cardiomegaly.
1. At the junction of segment 4A/4B there is a focal masslike region demonstrating gradual post contrast enhancement along the anterior margin of the left-sided biliary drain. Given the history of sarcoidosis and possible presence on the 2014 examination this may be secondary to hepatic sarcoidosis. However this can't be distinguished on imaging from cholangiocarcinoma which remains in the differential.2. Previously described lesion at the gallbladder neck likely represents a large gallstone. No evidence of an enhancing pseudoaneurysm.3. Persistent right basilar segmental consolidation/atelectasis.