Evaluate for biliary tract obstruction. Abnormal liver enzymes. ABDOMEN:LIVER, BILIARY TRACT: Increased size of multiple hepatic lesions, which contain peripheral rim enhancement, suspicious for metastases. For example, segment 4A T2 hyperintense reference lesion measures 2.1 x 2.0 cm (series 601, image 28), previously 1.0 by x 0.9 cm. There is a T2 hyperintense nodule within the porta hepatis measuring 3.7 x 3.0 cm (series 601, image 25), previously 1.3 x 1.3, which causes mass effect on the common bile duct and upstream biliary ductal dilatation. The portal and hepatic veins are patent. SPLEEN: Multiple T2 hypointense lesions within the spleen, compatible with calcifications, probably sequela of prior granulomatous infection.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple right renal cyst, unchanged. Left kidney is unremarkable. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Increased hepatic hilar adenopathy, with mass effect on the proximal and mid common bile duct. For example, a periportal lymph node measures 2.6 x 1.5 cm (series 701, image 85), previously 1.8 x 1.2 cm.BOWEL, MESENTERY: Right upper quadrant heterogeneous lesion measures 8.1 x 6.5 x 6.1 cm (series 12 1, image 42), unchanged. There is resultant scalloping of the inferior right hepatic lobe. There is no evidence of bowel obstruction or ileus.BONES, SOFT TISSUES: Lumbar levo curvature.OTHER: No significant abnormality noted.
1.Increased hepatic metastases and hilar adenopathy with mass effect on the proximal and mid common bile duct, resulting in mild intrahepatic biliary ductal dilatation.2.Unchanged nonspecific right upper quadrant cystic lesion, possible peritoneal implant.