History of laparoscopic cholecystectomy November 2015 now with constant right upper quadrant pain unrelated to eating. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size and signal intensity. No suspicious liver lesion. Moderate intrahepatic and extrahepatic biliary ductal dilatation to the level of the ampulla without an obstructing stone or focal mass. The common bile duct is tortuous just superior to the pancreatic head.The remnant cystic duct is noted.Status post cholecystectomy without a fluid collection in the cholecystectomy bed. Following hepatobiliary contrast intravenous administration the hepatic parenchyma takes up the agent but there is no significant biliary excretion on the delayed hepatobiliary phase imaging.SPLEEN: No significant abnormality noted.PANCREAS: The main pancreatic duct is mildly prominent to the level of the ampulla without a discrete mass lesion. The pancreas is otherwise normal in morphology signal intensity and enhancement.ADRENAL GLANDS: Right adrenal 2.9 x 1.6 cm nodule demonstrate loss of signal on out of phase imaging compatible with a lipid rich adrenal adenoma.KIDNEYS, URETERS: Bilateral simple appearing cysts.RETROPERITONEUM, LYMPH NODES: Tortuous and mildly ectatic abdominal aorta. Note is made of narrowing of the visceral artery origins.BOWEL, MESENTERY: No free fluid or loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.There is moderate intra and extrahepatic biliary ductal dilatation as well as mild prominence of the main pancreatic duct to the level of the ampulla raising the possibility of ampullary stenosis. No discrete mass or stone. No fluid collection to suggest a bile leak.2.No excretion of hepatobiliary agent in the biliary system raises the possibility of parenchymal/hepatocyte dysfunction.3.Tortuous mildly ectatic and atherosclerotic abdominal aorta. Narrowing of the visceral artery origins may be correlated with mesenteric Doppler ultrasound to evaluate for mesenteric angina.