History of jaundice in a patient with PSC. Evaluate for cholangiocarcinoma. 15 lb weight loss, new jaundice, increased AP and pruritis. Elevated CA19-9 (49). ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with marked left lobar hypertrophy and atrophy of the right hepatic lobe, progressed from prior. Gradual enhancement of the right lobe is compatible with fibrosis.Changes from hepaticojejunostomy.Compared to 2009 there is significant increase in multifocal narrowing and dilatation of the intrahepatic biliary tree. This includes a 7 mm smooth appearing stricture (series 801/71) of the left hepatic biliary duct without associated enhancement. At or near the hepaticojejunostomy anastomosis there is 7 mm focal stricture associated with mild gradual wall enhancement (series 1101/280).Several probable transient hepatic intensity differences, without a suspicious intrahepatic lesion.Cholecystectomy. SPLEEN: Mild to moderate splenomegaly. The spleen is displaced into the left lower quadrant.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Compared to 2009 there has been significant increase in intrahepatic biliary ductal dilatation and multi-focal strictures.2.At or near the hepaticojejunostomy there is 7 mm focal stricturing associated with mild gradual wall enhancement (series 1101/280). A stricture, benign or malignant/with underlying periductal infiltrating cholangiocarcinoma cannot be excluded.