Female 92 years old with intrahepatic and extrahepatic dilatation seen on CT in in September. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and contour. No enhancing liver lesion is identified. The hepatic vasculature appears patent.There is a low insertion of the common bile duct. The common bile duct measures 17 mm in diameter and the common hepatic duct measures 13 mm in diameter. There is suggestion of a luminal filling defect within the distal common duct (series 4, image 32). There are a few mildly dilated intrahepatic biliary ducts within the right lobe of the liver.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is dilated in the pancreatic head measuring duct to 8 mm. A smooth area of narrowing seen within the pancreatic body and the pancreatic duct in the distal body and tail is normal in caliber. No discrete pancreatic or ampullary mass is identified. The morphology of the pancreas is appropriate for age.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There are multiple bilateral T2 hyperintense, circumscribed, nonenhancing renal lesion consistent with a cysts. No hydronephrosis.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.
Dilation of the common hepatic duct, common bile duct, and pancreatic duct as described above suggests obstruction at the level of the ampulla. This may be due to ampullary stenosis. A small filling defect within the distal common bile duct may represent debris. This could be further evaluated with endoscopic ultrasound if indicated based on the clinical symptoms and the patient's age.