72Yrs male with history of ulcerative colitis s/p colectomy and ileostomy (1970), cholecystectomy (1970), splenectomy (1974), PSC s/p liver transplant (1989), HCV s/p Harvoni (2015), CKD, chronic pancreatitis, presents for evaluation of pancreatitis. Evaluation limited by lack of intravenous contrast.ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes related to liver transplant. Susceptibility artifact at the hepatic hilum mildly limits evaluation of surrounding structures. No significant biliary ductal dilatation. The hepatic parenchyma demonstrates normal signal intensity without focal lesions. No significant biliary ductal dilatation. Trace perihepatic ascites.SPLEEN: Status post splenectomy.PANCREAS: There is irregular dilation of the pancreatic duct in the body and tail measuring up to 13 mm, increased from the 12/6/2013 examination. The pancreatic duct abruptly narrows in the proximal body and is nondilated in the neck and head. Filling defects are noted within the dilated portions of the pancreatic duct compatible with pancreatic duct stones. The pancreas is atrophic. There are subcentimeter cystic structures in the uncinate process which could represent side branch IPMNs. Postsecretin imaging demonstrates that the aforementioned pancreatic duct stenosis remains fixed.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left greater than right renal parenchymal atrophy. Numerous simple and complex cysts are again noted in the kidneys. Several cystic lesions are new or more prominent than on the 12/6/2013 examination, demonstrate intrinsically increased T1 signal, and may reflect proteinaceous and/or hemorrhagic cysts but are incompletely characterized without intravenous contrast.RETROPERITONEUM, LYMPH NODES: Mild lymphadenopathy is again noted with a reference aorto-caval node measuring 1.2 cm in short axis, not significantly changed.BOWEL, MESENTERY: Postsurgical changes related to colectomy and ileostomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Examination limited by lack of intravenous contrast.2.Findings compatible with chronic pancreatitis. 3.Pancreatic duct stenosis with increased pancreatic ductal dilation in the body. Associated pancreatolithiasis. Further evaluation with ERCP may be considered as clinically warranted.4.Numerous renal cystic lesions, some of which are more prominent than on the prior examination. Though these may simply represent proteinaceous/hemorrhagic cysts, they are incompletely characterized without intravenous contrast.