50 year-old female with pancreatic cancer on chemotherapy (gemcitabine). Additional history reveals patient is status post Whipple and radiation treatment. Please evaluate disease status. CHEST:LUNGS AND PLEURA: Bilateral pleural effusions with compressive atelectasis. Mild emphysema. No lung nodules identified.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right-sided Port-A-Cath tip is in the SVC. No evidence of osseous metastatic disease. Bilateral thyroid nodules.ABDOMEN:LIVER, BILIARY TRACT: The liver is diffusely low-attenuation, due to fatty infiltration. In the posterior inferior right lobe of the liver the hypervascular lesion is grossly stable in size, measuring 2.4 x 1.9 cm (image 94/11 of series 4). This avid enhancement is unusual for a adenocarcinoma metastasis to the liver; however, enhancement on this study may appear exaggerated given the degree of fatty infiltration. The adjacent lesion in the lateral aspect of the liver is also grossly stable in size, currently measuring 1.1 x 0.8 cm (image 96/211 of series 4). This hypodense lesion in the left lobe liver near the falciform ligament is unchanged and had characteristics of a simple cyst on the patient's recent MRI. Attenuation differences within the liver elsewhere are likely due to transient differences due to phase of enhancement.There is a subcapsular fluid collection anterior to the right lobe of the liver. This measures 4.0 x 1.9 cm (image 68/211 series number 4).Extensive postsurgical changes are identified in the porta hepatis. There is fluid attenuation throughout the porta hepatis which may be postsurgical in etiology. Extrahepatic portal vein occlusion noted. Numerous varices are identified throughout the abdomen.SPLEEN: Stable mild splenomegaly. The splenic vein appears to drain inferiorly into the inferior mesenteric vein and there are splenic vein collaterals.PANCREAS: Patient status post Whipple with pancreatic head removal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: The azygos and hemiazygos systems are dilated due to collateral blood flow.BOWEL, MESENTERY: Multiple collateral vessels are identified in the lack of flow through the portal vein. Diffuse ascites. There is diffuse infiltration of the mesentery as well as multiple soft tissue nodules which may be due to ascites. BONES, SOFT TISSUES: No significant abnormality noted. The osseous abnormalities identified on the patient's recent MRI are not seen on this exam.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The well-defined lesion identified medially to the right of the rectum measures 2.0 x 1.4 cm (image 29/211). This has peripheral calcification. Diffuse ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1. Gross stability of the two enhancing lesions in the right lobe of the liver. While the hypervascularity of these lesions is unusual for pancreatic adenocarcinoma, enhancement may be exaggerated given the degree of fatty infiltration throughout the remainder of the liver. Both should be followed to confirm stability.2. Multiple collateral vessels and ascites likely secondary to portal vein occlusion. 