History of IPMN status post distal pancreatectomy and splenectomy. Evaluate for recurrence. 11/25/2009 Pathology demonstrated side-branch IPMN and chronic pancreatitis. ABDOMEN:LIVER, BILIARY TRACT: Lobular dilatation of the common bile duct is not significantly changed in caliber or morphology. No filling defect, stricture or mass lesion is evident. Mild central intrahepatic biliary ductal dilatation.Normally distended gallbladder without gallstones.The liver is normal in morphology, size and signal intensity without a focal suspicious lesion.SPLEEN: Status post splenectomy.PANCREAS: Status post distal pancreatectomy. The main pancreatic duct is irregularly dilated up to 6 mm, increased from the prior study. No focal lesion or filling defect is evident. This may be related to chronic pancreatitis and chronic stricturing (series 7, image 127).There are several punctate cystic foci in the pancreatic head the largest of which measures 4 mm, compared to 6 mm previously.There is intrinsic low T1-weighted signal intensity of the hepatic parenchyma with relatively mild postcontrast enhancement, compatible with stated history of chronic pancreatitis. There is no peripancreatic fat stranding, fluid collection or vascular stigmata of pancreatitis. ADRENAL GLANDS: Stable small left lipid rich adrenal adenoma.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. Interval increase in residual pancreatic ductal dilatation, now measuring up to 6 mm without a focal lesion evident. This may be related to chronic pancreatitis and worsening stricturing although a main duct IPMN cannot be entirely excluded. 2. Stable to decreased size of punctate cystic pancreatic parenchymal foci. 