History of sclerosing cholangitis. Evaluate for gallbladder carcinoma or cholangiocarcinoma. ABDOMEN:LIVER, BILIARY TRACT: Mildly cirrhotic liver morphology.Multifocal bilobar left greater than right strictures are again noted with focal stricture and irregularity of the proximal common bile duct appearing similar to the prior study.Scattered filling defects in the intrahepatic bile ducts likely represent hepatolithiasis.No dominant stricture or discrete mass is evident.Heterogenous T2 signal near the porta hepatis with restricted diffusion but no definite delayed enhancement - this is stable from 2010, and likely fibrotic change vs periportal lymph node, as it has been measured on prior exams. The measurement is below.SPLEEN: No significant abnormality noted.PANCREAS: Linear cystic lesion in the pancreatic tail communicates with the main pancreatic duct and is unchanged, compatible with a sidebranch IPMN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Stable periportal lymphadenopathy. The reference lymph node measures approximately 2.0 x 1.4 cm (series 3/18).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Multifocal intrahepatic and extrahepatic biliary strictures appearing similar to the prior without a new dominant stricture or focal lesion.2.Stable subcentimeter IPMN in the pancreatic tail without suspicious features.3.Stable periportal lymphadenopathy/fibrotic change near the porta hepatis as above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.