Female 75 years old Reason: liver lesions and distal pancreas mass on CT History: weight loss, fatigue, light stool ABDOMEN:LUNG BASES: Bilateral pleural effusions, moderate on the right, trace on the left.LIVER, BILIARY TRACT: Innumerable rim enhancing lesions throughout the right and left hepatic lobes are consistent with diffuse metastatic disease. A reference lesion in the posterior right hepatic lobe measures 1.6 x 1.5 cm (series 1101, image 207).Intrahepatic duct dilatation with narrowing of the common bile duct and subtle hyper enhancement at Klatskin point. The appearance is suspicious for infiltrative tumor.SPLEEN: No significant abnormality noted.PANCREAS: Primary tumor: Hypo enhancing mass replacing much of the distal pancreatic body and pancreatic tail measures 4.6 x 7.8 x 3.5 cm (series 1101, image 222).Pancreatic duct: The pancreatic duct is normal in the pancreatic head and poorly visualized in the pancreatic body and tail.Mesenteric Arteries:Arterial tumor abutment or encasement: (1) Proximal celiac artery, SMA, and hepatic artery: The pancreatic mass encases the celiac artery, superior mesenteric artery and the splenic artery which is attenuated(2) Tumor abutment or encasement of additional arteries: There is encasement of the gastroduodenal artery.Mesenteric Veins:Venous anatomy:  (1) Superior mesenteric vein: The superior mesenteric vein is occluded at the level of the mass.Venous tumor abutment or encasement: SMV-PV-splenic vein confluence: The portal vein is patent. The splenic vein is occluded at the confluence.Portal venous system: The right and left portal veins are patent.Inferior vena cava (IVC): Patent.ADRENAL GLANDS: Bulky left adrenal gland which is inseparable from the pancreatic mass, suspicious for invasion.KIDNEYS, URETERS: Multiple T2 hyperintense lesions throughout the kidneys are compatible with renal cysts. A lesion at the upper pole of the left kidney does not meet criteria for a simple cyst however demonstrates no convincing enhancement on subtraction images and is suggestive of a hemorrhagic cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Multiple prominent mesenteric nodules/nodes suspicious for metastatic disease (for example series 1101, image 142).BONES, SOFT TISSUES: No significant abnormality noted.
Pancreatic body/tail mass which is consistent pancreatic adenocarcinoma with metastatic disease to the liver. There is encasement of the celiac artery, superior mesenteric artery and splenic artery. There is superior mesenteric vein and splenic vein occlusion. There is also suspicion for peritoneal involvement and infiltrative tumor at Klatskin point.