History of pancreas cyst. Hx of chronic necrotizing pancreatitis and duct obstruction. Per service patient has a CBD stent. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from hepaticojejunostomy. There is significant intra and extrahepatic biliary ductal dilatation with the common duct measuring up to 2 cm. It tapers smoothly to the level of the anastomosis. The appearance is similar to that seen on the CT dated 3/5/2015. A tubular filling defect likely reflects the reported CBD stent. There appears to be a long-segment smooth walled stricture of the distal CBD at the level of the pancreatic head. No discrete lesion is evident. Mild hepatomegaly measuring 22 cm in craniocaudal dimension.No suspicious liver lesion. There is chronic occlusion of the distal SMV, splenic vein and portal vein confluence with reconstitution of the main portal vein by numerous dilated collaterals. Status post cystectomy with cystic duct noted. SPLEEN: Splenomegaly measuring 18 cm. No focal lesion. Minimal perisplenic fluid.PANCREAS: The pancreas is markedly atrophic with decreased intrinsic T1-weighted signal intensity, likely stigmata of chronic pancreatitis. There is scarring in the pancreatectomy bed, compatible with chronic necrotizing pancreatitis. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left pelvic kidney is not visualized. RETROPERITONEUM, LYMPH NODES: Prominent periportal lymph node is unchanged, likely reactive.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Stigmata of chronic pancreatitis including marked pancreatic parenchymal atrophy. No discrete mass lesion is identified.2.Biliary ductal dilatation with stent in place with distal CBD stricture without a discrete lesion evident. Correlate with EUS/ERCP findings. 