65-year-old female with weight loss, hyperbilirubinemia. Past medical history of metastatic pancreatic cancer with liver metastases. Concern for cholangitis. Elevated AST/ALT. Please characterize pancreatic primary, liver metastases, and biliary tree. Rule out obstruction. Exam limitations include extensive patient motion artifact and susceptibility artifact at the level of the central pancreas.ABDOMEN:LIVER, BILIARY TRACT: Marked hepatomegaly measuring 30 cm in craniocaudal length. The hepatic parenchyma demonstrates innumerable near confluent small lesions of abnormal signal intensity compatible with the history of hepatic metastatic disease. There is narrowing of the hepatic veins and portal veins. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Extensive cystic changes of the pancreatic body and tail, which is favored to represent pancreatic ductal and sidebranch dilatation. These findings extend to the proximal pancreatic body, however a discrete lesion is not clearly identified within the limitations of this exam. The proximal aspect of the SMA demonstrates a normal surrounding fat plane, however there is limited visualization of the midportion SMA due to motion artifact and susceptibility artifact.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Retroperitoneal and upper abdominal lymphadenopathy is seen. For reference, there is a 1.9 x 1.5 cm left paraaortic lymph node (series 401 image 24).There are separate origins of the common hepatic artery and splenic artery from the aorta, normal variant. An IVC filter is noted.BOWEL, MESENTERY: Mild ascites.BONES, SOFT TISSUES: Multilevel degenerative changes of the spine.OTHER: Small right pleural effusion.
1.Extensive cystic changes of the pancreatic body and tail, which is favored to represent pancreatic ductal and sidebranch dilatation. These findings extend to the proximal pancreatic body. However, extensive motion and regional susceptibility artifacts limit the ability to accurately delineate the presumed pancreatic body mass lesion, and CT is recommended for more accurate staging. There is evidence of metastatic hepatic and nodal disease.2.Marked hepatomegaly measuring 30 cm in length. Extensive near confluent hepatic lesions compatible with history of metastases. No intra or extrahepatic biliary ductal dilatation.