73-year-old female with abdominal pain with CT findings and serum markers concerning for cholangiocarcinoma. ABDOMEN:LUNG BASES: Small right and trace left pleural effusions with underlying bibasilar subsegmental atelectasis, partially visualized.LIVER, BILIARY TRACT: Numerous T2 hyperintense lesions with restricted diffusion and perilesional enhancement throughout the liver with dominant, confluent lesion in the right hepatic lobe, unchanged since prior exam and compatible with metastases. There is suggestion of increased enhancement on delayed phase images, which could be seen with cholangiocarcinoma, but there are no other specific findings to suggest this etiology. Moreover, the large burden of disease makes evaluation for a specific etiology difficult.Cholelithiasis. Scattered, isolated intrahepatic ducts in both lobes of the liver are mildly dilated due to obstruction from the above-described lesions. Hepatic and portal veins are patent. Mild perihepatic ascites.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Redemonstration of prominent retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
Diffuse hepatic metastases, for which cholangiocarcinoma is a possibility. Again, biopsy is recommended for further evaluation.