Male 55 years old Reason: US shows pancreatic head mass and liver masses History: weight loss, abd pain ABDOMEN:LIVER, BILIARY TRACT: Multiple T2 hyperintense rim enhancing lesions throughout the liver. A reference lesion in the right hepatic lobe measures 1.8 x 1.9 cm (series 1302, image 124). These are suspicious for liver metastases. Multiple small gallstones within the gallbladder. There is intrahepatic duct dilatation. The common duct is also dilated to Klatskin point where it appears encased by the below described mass. There is a small filling defect within the mid common duct suggestive of choledocholithiasis. SPLEEN: No significant abnormality noted.PANCREAS: Large hypoattenuating mass in the posterior aspect of the lesser sac which appears to arise from the pancreatic neck and measures approximately 4.8 x 3.3 cm (series 1302, image 115). No significant pancreatic duct dilatation. The mass encases the celiac trunk, superior mesenteric artery and proximal hepatic and splenic arteries. There is occlusion of the superior mesenteric vein and splenic vein. The extrahepatic portal vein is occluded.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.
1. Necrotic mass in the posterior aspect of the lesser sac with liver metastases and vascular involvement as detailed above. There is moderate intra-and extrahepatic area duct dilatation secondary to compression from this mass. The findings are most consistent with adenocarcinoma, possibly a pancreatic primary neoplasm.2. Cholelithiasis.