History of cirrhosis with abnormal ultrasound, evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology. A TIPS is again noted connecting the right portal vein and hepatic vein. The hepatic arteries and portal venous system are patent. There is a new lesion within segment 7/8 of the liver (series 501, image 413) measuring 2.3 x 2.4 cm which corresponds to that seen on recent ultrasound. The lesion demonstrates increased T1 signal with loss of signal on out of phase images compatible with microscopic fat content. The lesion also demonstrates increased T2 signal. Evaluation of enhancement characteristics is limited by early timing of arterial phase imaging. No additional new suspicious hepatic lesions are identified. No biliary ductal dilatation.SPLEEN: Splenomegaly. The spleen measures 20 cm in craniocaudal dimension, similar to the prior examination. Multiple collateral vessels are seen in the splenic hilum.PANCREAS: Cystic lesions in pancreatic head and uncinate process, compatible with side branch IPMNs. The larger lesion measures 19 x 12 mm (series 1001, image 17), not significantly changed from the 2012 measurement of 19 x 10 mm. The smaller anterior lesion measures 9 x 9 mm (series 1001, image 17), unchanged from 9 x 9 mm previously. No significant pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small simple renal cysts are present bilaterally.RETROPERITONEUM, LYMPH NODES: Enlarged para-aortic lymph nodes are not significantly changed.BOWEL, MESENTERY: Esophageal and gastric varices, unchanged. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate abdominal pelvic ascites, new from prior.
1.New 2.4 cm segment 7/8 liver mass with features highly suspicious for HCC. Lesion was also described on 11/4/2015 ultrasound at which time findings were communicated to Dr. G. Reddy.2.Cirrhotic liver morphology with sequela of portal hypertension. 3.New mild-moderate ascites.4.Side branch IPMNs in the pancreatic head and uncinate process, unchanged.