Female 86 years old Reason: h/o cirrhosis and hcc, evaluate progression of liver disease History: elevated lfts ABDOMEN: Liver has a cirrhotic morphology with a nodular contour. There is now severe hepatic biliary ductal dilatation with bile duct irregularity. The left hepatic lobe shows progressive atrophy and biliary ductal dilatation. There is a focal area of narrowing about the Klatskin point with findings suggestive of a mass. Patient is status post cholecystectomy. Distal common bile duct is normal in caliber.Hepatic vessel patency cannot be evaluated due to the lack of intravenous contrast. The left portal vein flow void is not well visualized.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple portacaval and upper abdominal lymph nodes which are borderline enlarged.BOWEL, MESENTERY: Bowel wall thickening which may be due to hypoalbuminemia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Large volume upper abdominal ascites.
1.Progression of biliary ductal dilatation with suggestion of a mass near the Klatskin point. Further evaluation with ERCP as previously suggested is recommended.