53-year-old female with epigastric pain, nausea and vomiting. Evaluate for acute on chronic pancreatitis, pancreatic pseudocyst, and biliary obstruction. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology. No suspicious parenchymal lesions.Intra and extraperitoneal biliary ductal dilatation remain. The common bile duct measures 1.2 cm in diameter. The duct tapers abruptly at the level of the pancreatic head, and a long segment stricture of the distal CBD measuring 2.3 cm (coronal series 3 image 22) is present.SPLEEN: Splenomegaly measuring 17 cm in length. There is interval thrombosis of the splenic vein with development of collateral vessels.PANCREAS: The pancreatic duct remains dilated measuring up to 5 mm in diameter extending to the level of the pancreatic head. Enlargement of the pancreatic head is again seen, and there is increased surrounding inflammatory change that partially extends to the descending duodenum. Findings are compatible with recurrent acute pancreatitis.Within the pancreatic head, a central fluid signal focus (axial series 6 image 33) has recurred within increase in size measuring 2 x 1 cm (prior 1.3 x 1.4 cm). This fluid collection has an anterior-superior exophytic component measuring 1.4 x 0.9 cm (axial series 6 image 31).A separate intraparenchymal fluid collection of the pancreatic head inferiorly has also recurred with increase in size measuring 1.4 x 0.9 cm (axial series 6 image 36) (prior 0.9 x 0.8 cm).There is a new 2.6 x 3 cm exophytic fluid signal intensity focus of the pancreatic tail (axial series 6 image 29).There is interval thrombosis of the splenic vein with development of collateral vessels. The main portal vein is narrowed at its confluence with the superior mesenteric vein. The celiac, superior mesenteric artery, and superior mesenteric vein are patent. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis. Two small simple cysts of the right mid/lower renal pole.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.Findings compatible with recurrent acute pancreatitis of the pancreatic head. New and increasing fluid collections within and adjacent to the pancreas need correlation with timing of symptomatology. Less than 4 weeks duration would classify these as acute peripancreatic fluid collections, however greater than 4 weeks duration would classify these as pancreatic pseudocysts.2.Persistent long segment stricture of the distal CBD with upstream intrahepatic ductal dilatation. Dilatation of the pancreatic duct of the body and tail remain, and underlying stricture of the downstream pancreatic duct cannot be excluded.3.Interval development of splenic vein thrombosis now with collateral flow. Stable splenomegaly.