Reason: MRCP to evaluate possible biliary leak s/p IR direct liver biopsy History: elevated transaminases and bili s/p liver biopsy, abd pain (now resolved) Several sequences are limited by motion artifact.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology of the liver. Small perihepatic ascites. Again seen is a distended gallbladder with mild wall thickening, compatible with acute cholecystitis. There appears to be septated debris, and in conjunction with recent ultrasound findings, this raises the possibility of gangrenous cholecystitis. Gallbladder sludge and stones again seen. Apparent irregularity of the common bile duct is likely due to motion, if there is clinical concern for stricture, consider ERCP. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Multiple subcentimeter IPMNs in the head, body, and tail.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Partially visualized mildly dilated loops of small bowel may represent reactive ileus or related to post-colectomy state. If there is clinical concern for obstruction, continue follow-up.BONES, SOFT TISSUES: Degenerative changes of the lower lumbar spine.OTHER: Trace right and small left pleural effusion. Extensive anasarca.
1.Again seen are findings suggestive of acute cholecystitis. Septated debris in the gallbladder raises the possibility of gangrenous cholecystitis. No intrahepatic or extrahepatic ductal dilatation.2.Small side branch pancreatic IPMN's not fully characterized without contrast but with no obvious suspicious features.3.Findings discussed with Dr. Gampa at 11:13AM on 12/27/16.