66 year-old male with history of cholangiocarcinoma. ABDOMEN:LIVER, BILIARY TRACT: There is a large heterogeneous T2 hyperintense/T1 hypointense mass centered within the hepatic hilum with maximal axial dimensions of 10.1 x 7.6 cm (image 19 of series 4). After contrast administration, there is irregular enhancement particularly about the right anterior aspect of the lesion extending to the liver periphery which fills in on delayed series most compatible with cholangiocarcinoma. Large area of central nonenhancement indicates necrosis. There are innumerable other smaller lesions scattered about the liver parenchyma which also demonstrate progressive enhancement compatible with metastatic disease. There is significant intrahepatic biliary ductal dilatation, particularly within the left hepatic lobe. The left portal vein and anterior branch of right portal veins are thrombosed. The right posterior portal vein is intact.There are necrotic appearing portal lymph nodes, the largest measuring 2.9 x 1.8 cm (image 166 of series 12).A right biliary stent is in place.Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No suspicious pancreatic lesions. The pancreatic duct is unremarkable.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral nonenhancing renal cysts.RETROPERITONEUM, LYMPH NODES: Extensive confluent retroperitoneal lymphadenopathy with reference left para-aortic conglomerate measuring 3.8 x 2.5 cm (image 98 of series 10).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There are small enhancing retrocrural lymph nodes, the largest measuring 15 x 9 mm.There is a right lower lobe pulmonary nodule measuring 8 mm.
1. Findings compatible with metastatic intrahepatic cholangiocarcinoma with reference measurements and other findings as above.2. Right lower lobe pulmonary nodule is indeterminant. Chest CT is recommended when clinically appropriate.