57-year-old man with history of metastatic esophageal cancer, lymphadenopathy, and new onset jaundice. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. The left portal vein appears attenuated in caliber. There is narrowing of the extrahepatic common bile duct near the porta hepatis (10/49). An adjacent T2 hyperintense soft tissue mass measures up to 46 x 27 mm (500/25). There is resultant mild, diffuse dilation of the extrahepatic bile duct and moderate diffuse dilation of the intrahepatic bile ducts. The gallbladder wall is irregular and circumferentially thickened measuring up to 9 mm (500/32).SPLEEN: No significant abnormality noted.PANCREAS: The head of the pancreas cannot be reliably differentiated from the porta hepatis/peripancreatic lymph nodes. The remainder of the pancreas appears normal without pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is moderate right hydronephrosis and proximal third hydroureter. No distinct extrinsic compressing lesion identified. Left kidney appears normal.RETROPERITONEUM, LYMPH NODES: There is periportal lymphadenopathy as described above. An additional mass seen anterior to the common hepatic artery (500/21) measures 37 x 22 mm. Retroperitoneal lymphadenopathy also noted.BOWEL, MESENTERY: The stomach is markedly dilated to the level of the aforementioned periportal lymphadenopathy. The partially visualized small bowel appears normal. The hepatic flexure of the colon (500/36) has circumferentially thickened wall. Additionally, there is nonspecific nodularity within the anterior mesentery suspicious for peritoneal disease.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate amount of free fluid within the abdomen. Bilateral pleural effusions noted.
1.Bulky periportal and peripancreatic lymphadenopathy causing extrinsic compression on the common bile duct and moderate degree biliary ductal dilatation.2.Circumferential gallbladder wall thickening with adjacent wall thickening of the hepatic flexure of the colon. In addition to scattered mesenteric nodules, these findings are suspicious for carcinomatosis with possible serosal implants.3.Moderate right hydronephrosis and proximal hydroureter without definite extrinsic compressing lesion identified, at site of transition however is ureteral wall thickening (suspicious for additional site of tumor involvement).4.Dilated stomach secondary to likely outlet obstruction from the aforementioned bulky lymphadenopathy.