41 year old female patient with recurrent PSC after LDLT, screen for cholangiocarcinoma. Fevers, chills, tenderness to palpation in the right upper quadrant, and epigastrium; also concern for cholangitis. ABDOMEN:LIVER, BILIARY TRACT: There are post-surgical changes of a liver transplant with hepaticojejunostomy. There is a continued mottled appearance of the liver with nodular areas of T1 hyperintensity which demonstrate variable degrees of enhancement without washout on more delaying images. There is no associated restricted diffusion or delayed enhancement. No definite suspicious hepatic mass is identified. The caudate lobe has hypertrophied and compresses the adjacent IVC. There is scattered intrahepatic biliary ductal dilatation, appearing similar to the prior study.The posterior branch of the right portal vein no longer opacifies with contrast and is likely occluded. Furthermore, the peripheral right hepatic vein is filling with contrast, however, centrally there is attenuation of signal which may represent a partial or complete occlusion. The anterior branch of the right portal vein and main portal vein appear patent. The hepatic artery/anastomosis appears patent.There is mild intrahepatic biliary ductal dilatation. No dominant obstructing lesion.SPLEEN: The spleen is enlarged measuring up to 19 cm in length. The splenic vein is prominent in size and patent. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No evidence of hydronephrosis. There is a 8 mm lesion within the right upper pole with T2 hyperintensity and the appearance of enhancing septa. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is marked wall thickening of the ascending and proximal transverse colon with surrounding edema within the abdomen.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small to moderate right pleural effusion. The azygous vein has increased in size compared to the prior study.
1. Mottled appearance of the liver with caudate lobe hypertrophy and central attenuation of signal of the hepatic venous vasculature is concerning for partial or complete central right hepatic venous obstruction. Furthermore, increase in size of the azygous vein also suggests some degree of central venous stenosis.2. Interval occlusion of the posterior branch of the right portal vein. 3. Right colonic wall thickening and surrounding inflammatory changes compatible with a colitis, possibly from an infectious or inflammatory etiology.4. 8 mm right upper pole complex cyst can be followed on subsequent imaging. 5. Scattered intrahepatic mild biliary ductal dilatation without focal dominant obstructing lesion.Findings communicated to K. Davey via telephone at 1159 hrs on 8/5/2016.