History of cholangiocarcinoma, status post chemotherapy and TARE, now with bilirubin of 8. Evaluate for cholangiocarcinoma recurrence and dominant biliary obstruction. ABDOMEN:Scattered artifacts throughout the exam are noted due to patient motion and ascites.LIVER, BILIARY TRACT: Liver with nodular cirrhotic contour and moderate ascites. A dominant mass at the hepatic dome measuring 8.4 x 6.4 cm is stable or slightly decreased in size compared to the 2/2/2016 CT exam. The mass is again located at the confluence of the hepatic veins and extends inferomedially into the caudate lobe. There is mild intralesional amorphous enhancement, however majority of the lesion is nonenhancing. Biliary ductal dilatation has increased in the interval. At the level of the hepatic hilum, portal venous branches are narrowed, and occlusion of the right anterior portal vein cannot be excluded.SPLEEN: Stable splenomegaly.PANCREAS: Stable pancreatic atrophy.Imaging before and after administration of secretin demonstrate pancreatic ductal diameter increase at least 1 mm, indicating satisfactory ductal compliance. Increased duodenal distention indicates appropriate exocrine response. Motion artifacts limit the evaluation of side branch dilatation for the body and tail, which limits the exam.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Surgical changes of a cholecystectomy, distal gastrectomy, presumed gastrojejunostomy, and a blind-ending duodenal stump abutting the hepatic hilum are better appreciated on the 2/2/2016 CT exam. Suboptimal evaluation of the GI tract due to motion artifacts. BONES, SOFT TISSUES: Multiple osseous hemangiomas, unchanged.OTHER: New small right pleural effusion.
1.Central hepatic dome mass is grossly stable in size. There is worsening intrahepatic biliary ductal dilatation, mild amorphous intralesional contrast enhancement, and narrowing of the central portal venous branches. Occlusion of the right anterior portal vein cannot be excluded. A small right pleural effusion is also new. Given the extensive artifacts related to patient motion and ascites, follow-up imaging with CT should be considered.2.Cirrhotic liver morphology with splenomegaly and ascites compatible with portal hypertension.3.Surgical changes of the upper GI tract.