34 year old female. History of BRCA with liver mets. Increasing bilirubin. ABDOMEN:LIVER, BILIARY TRACT: The left and right intrahepatic ducts are diffusely dilated with transition in the hepatic hilum at Klatskin's point, where there is an enhancing ill-defined intermediate T2 signal lesion likely representing metastatic disease. Tumor invades the common hepatic duct from Klatskin's point to the mid-CBD, with resultant obstructive dilatation of the cystic duct remnant (series 601, image 19). Innumerable bilobar hepatic metastases, including a 3.4 x 3.1 cm right hepatic lobe lesion (series 401, image 27). Cholecystectomy clips.Hepatic artery and main portal vein as well as right and left branches are patent. The distal portal vein branches are attenuated by the metastases but patent.SPLEEN: Multiple T2 hypointense, mildly enhancing splenic lesions measuring up to 1.2 x 0.8 cm (series 1204, image 49), suspicious for metastases.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple sclerotic foci in the thoracolumbar spine consistent with metastatic disease. At T12-L1 level, there is a left sided 9 mm intradural lesion that is suspicious for a metastasis (series 1203, image 333). OTHER: Small amount of perihepatic ascites.
1. Diffuse intrahepatic biliary ductal dilatation due to obstructing metastatic disease at Klatskin's point. Tumor also invades the common duct from Klatskin's point down to the mid-CBD.2. Innumerable hepatic and multiple bone metastases. Likely splenic metastases.3. Intradural lesion at T12-L1 suspicious for a metastasis. 