Elevated bilirubin, assess possible biliary reconstruction, stent status, progression of metastases ABDOMEN: Exam limited by motion artifact.LIVER, BILIARY TRACT: Hepatic metastases increasing in number and overall in size, most notably at the dome. Reference IVb lesion measures 5.7 x 4.5 cm (series 401, image 25), previously 5.2 x 3.8 cm. Reference porta hepatis lesion measures 3.8 x 2.5 cm (series 401, image 25), previously 3.5 x 2.6 cm. The porta hepatis lesions appears to invade / obstruct the main portal vein, unchanged (series 1401, image 49). The intrahepatic branches of the portal vein are not visualized. Common bile duct stent is present with decompression of the extrahepatic ducts. Persistent moderate intrahepatic biliary ductal dilation. Trace ascites.SPLEEN: No significant abnormality noted.PANCREAS: Slight increase in main pancreatic duct caliber. ADRENAL GLANDS: Unchanged left adrenal nodule measures 1.7 x 0.9 cm (series 401, image 24).KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right sided ostomy. No evidence of bowel obstruction.BONES, SOFT TISSUES: Degenerative changes affect the spine.
1.Innumerable hepatic metastases increasing in number and overall in size. 2.Persistent moderate intrahepatic biliary dilation secondary to obstructive metastasis superior to the CBD stent.3.Portal vein invasion / obstruction, unchanged.