78-year-old female with hyperbilirubinemia who needs a biliary drain. Evaluate. ABDOMEN: Suboptimal postcontrast images given motion artifact.LIVER, BILIARY TRACT: Again noted is a perihepatic infiltrative soft tissue which measures 4.8 x 5.5 cm (series 8, image 27), previously measuring 6.0 x 5.3 cm. Please note this mass was previously measured on the CT examination. This mass also invades the portal vein and the entire hepatic hilum. Surgical clips are noted within the hilar mass.There are additional multiple hepatic lesions. Segment 7 lesion has increased in size measuring 6.4 x 4.7 cm (series 1501, image 80), previously measuring 4.8 x 3.8 cm and demonstrating rim enhancement.Again noted is significant intrahepatic biliary duct dilatation to the level of the hilum. In segment 8, there are 2 significantly dilated biliary ducts with possibly a vessel coursing in between them. The proximal common bile duct is not opacified, likely extrinsic compression from the hilar infiltrative mass. The common bile duct tapers smoothly to the level of the ampulla without evidence of a lesion or mass at the level of the ampulla.SPLEEN: No significant abnormality noted.PANCREAS: Stable cystic lesion within the pancreas. ADRENAL GLANDS: The infiltrative hilar mass invades the right adrenal gland.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Retroperitoneal adenopathy again noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Right lower lobe dependent subsegmental atelectasis is again noted. Bilateral small pleural effusions.
1.Significant intrahepatic biliary ductal dilatation to the level of the hilum. The proximal common bile duct is not opacified, which may be secondary to extrinsic compression from the infiltrative hilar mass. Of note, in segment 8, there are 2 significantly dilated biliary ducts with possibly a vessel coursing in between them.2.Infiltrative hepatic hilar mass and additional hepatic lesions as detailed.3.Stable cystic pancreatic lesion. Differential considerations include serous cystadenoma versus sidebranch IPMN. 