58-year-old female with pancreatic cancer with increasing liver enzymes and bilirubin. Evaluate. ABDOMEN:LIVER, BILIARY TRACT: Moderate new intrahepatic and extrahepatic biliary ductal dilatation to the level of the hepaticojejunostomy. Additionally, there is evidence of periductal enhancement.Suboptimal arterial phase. There are nonspecific subcentimeter arterially enhancing scattered hepatic foci without evidence of washout, specifically in the right hepatic lobe (series 701, image 31). Segment 2 hepatic cyst again noted. Artifact from metallic clip at the hilum limits evaluation of the main portal vein.SPLEEN: No significant abnormality noted.PANCREAS: Postoperative changes involving the pancreas again noted. Persistent ductal dilatation in the residual pancreas without evidence of a mass. The soft tissue density surrounding the metallic surgical clip on the previous CT scan is not well appreciated given blooming artifact from the hardware. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The biliary jejunal loop is dilated measuring up to 4.4 cm with evidence of an abrupt transition which is not well evaluated on the MR examination (series 401, image 13)BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Dilatation of the biliary jejunal loop up to 4.4cm with an abrupt transition point as above, suggestive of obstruction, but which is not well evaluated on MRI examination. CT examination may be considered for further evaluation if indicated2.Biliary ductal dilatation to the level of the hepaticojejunostomy with findings raising concern for cholangitis; this may be secondary to the aforementioned dilatation of the biliary jejunal loop. 3.Postoperative changes involving the pancreas with persistent dilation of the pancreatic duct.4.Ill-defined soft tissue encasing the metallic surgical clip is better appreciated on the CT examination given blooming artifact on MRI.5.Arterial enhancing subcentimeter lesions without evidence of washout on the suboptimal arterial phase is likely perfusional in etiology; however, attention on subsequent examination is recommended.