75-year-old male with history of colon cancer, metastatic to the liver. Patient status post liver resection now with elevated alkaline phosphatase. Evaluate for etiology. ABDOMEN:LUNG BASES: Bilateral small pleural effusions with the right decreased in size compared to previous examination.LIVER, BILIARY TRACT: Postoperative changes of right hepatectomy. There is thrombus in the hepatic vein in the medial hepatic segment 4A/4B. The thrombus occludes the segment 4 hepatic vein; this is due to narrowing at the confluence of the veins near the dome. This causes perfusion changes in segment 4 of the liver. The segment 2 vein is also narrowed but patent. The IVC is narrowed at the intrahepatic portion. Additionally, there is a fluid collection near the resection margin measuring 3.8 x 1.2 cm (series 6, image 22). Right subdiaphragmatic drain is present.No significant change in T2 hyperintense segment 4 lesion consistent with a cyst measuring 1.3 x 1.3 cm (series 6, image 29), previously measuring 1.5 x 1.2 cm. An additional smaller T2 hyperintense lesion in segment 2 of the liver consistent with a cyst is stable (series 6, image 30).SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is atrophic but otherwise appears normal.ADRENAL GLANDS: Adrenal glands are normal in size and morphology bilaterally.KIDNEYS, URETERS: Kidneys enhance symmetrically without evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Visualized bowel is moderately distended measuring up to 3.5 cm with transition point likely in the right lower quadrant. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Thrombus in the hepatic vein in the medial hepatic segment 4A/4B.2.Segment 2 vein is also narrowed but patent.3.Fluid collection near the resection margin measuring up to 3.8 cm.4.Postoperative changes of right hepatectomy without suspicious hepatic lesions. 5.Findings consistent with small bowel obstruction.6.Bilateral small pleural effusions.Findings relayed to Dr. Xue over the phone at approximately 5:05 PM.