60-year-old male status post Roux-en-Y hepaticojejunostomy for chronic choledocholithiasis. Patient has known duodenal diverticulum. ABDOMEN:LIVER, BILIARY TRACT:Multiple new focal liver lesions, as detailed below:New peripheral segment 8 lesion measuring 1.6 x 2.5 cm (series 9/10) that demonstrates T2 hyperintensity, restricted diffusion, and progressive enhancement, suspicious for metastasis.New peripheral segment 5 lesion measuring 3.3 x 2.2 cm that demonstrates T2 hyperintensity, restricted diffusion, arterial and delayed enhancement, and overlying capsular retraction, suspicious for metastasis.New segment 6 lesion measuring 1.8 x 1.6 cm that demonstrates T2 hyperintensity, restricted diffusion, and progressive enhancement, suspicious for metastasis.A previously seen lesion in the left hepatic lobe, suggestive of FNH, is not evident on the current exam.Postsurgical changes from hepaticojejunostomy with patent biliary enteric anastomosis seen. Stable small loculated fluid collection posterior and medial to the biliary enteric anastomosis, which may be related to postoperative change (series 8/79). The gallbladder is presumably surgically absent.Slight prominence of the central intrahepatic biliary ducts noted. There has been interval increased dilation of the native common bile duct stump, measuring up to 12 mm (series 8/62). There is abrupt transition point at the ampulla of Vater, where there is a small round enhancing mass seen measuring up to 11 x 9 mm (series 23/28).Overall, the findings are most suspicious for cholangiocarcinoma of the native distal common bile duct/ampulla with multiple hepatic metastases.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic ductal dilation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal simple cyst.RETROPERITONEUM, LYMPH NODES: Moderate porta hepatis lymphadenopathy is similar to prior study.BOWEL, MESENTERY: Duodenal diverticulum, similar to prior study.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
Findings are most suspicious for cholangiocarcinoma of the distal common bile duct/ampulla with multiple hepatic metastases.