Female; 53 years old. Reason: 53F hx of pancreatitis. MRI/MRCP 12/4/14 large HOP measuring 4.3x3.4cm with narrowing of CBD at head of pancreas. Concern for autoimmune pancreatitis. Now s/p steroid therapy History: Pancreatitis ABDOMEN:LIVER, BILIARY TRACT: No intra-or extrahepatic biliary ductal dilation. Stable mild narrowing of the distal common bile duct near the ampulla. New mild circumferential thickening of the common bile duct with increased enhancement, which is nonspecific and may be related to cholangitis. There is also new geographic increased enhancement of the liver parenchyma near the course of the common bile duct and the gallbladder fossa, which is nonspecific and may be related to reactive hyperemia. No suspicious focal liver lesions. No cholelithiasis or choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: Patchy increased T2 signal the uncinate process, most compatible with edema, has slightly decreased since prior study with stable faint enhancement on post contrast images, which is nonspecific and again may be related to focal pancreatitis, particularly in light of the pancreas divisum anatomy. Normal response to secretin augmentation. No definite focal pancreatic mass. No specific evidence of autoimmune pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1. New mild common bile duct thickening and enhancement could be due to cholangitis. Findings suggestive of reactive hyperemia in the adjacent liver. Clinical correlation is recommended. 2. Decreased but persistent mild edema in the uncinate process with faint enhancement, which is nonspecific and may be related to focal pancreatitis, particularly in light of pancreas divisum anatomy. Continued follow-up is recommended to ensure resolution.