Reason: biliary obstruction, stent migration, patient with pancreatic cancer History: n/v, abd pain, jaundice ABDOMEN:LIVER, BILIARY TRACT: There is a stent within the common bile duct which appears to be obstructed with increased moderate intrahepatic biliary ductal dilatation.Multiple hepatic metastases are not significantly changed. A right hepatic lobe lesion measures 2.2 x 2.4 cm (13/153), previously 2.2 x 2.6 cm. A Increased enhancement on arterial phase images is likely due to technique.There is increased T1 signal within the lumen of the gallbladder with surrounding hyperenhancement and increased DWI signal. This likely represents tumor with associated hemorrhage, similar to the prior exam.The main portal vein is narrowed (13/265), but remains patent. Tumor extending into the porta hepatis is slightly increased.SPLEEN: No significant abnormality noted.PANCREAS: Enhancing mixed solid and cystic lesion in the pancreatic tail is unchanged in size measuring 5.1 x 4.6 cm (5/27), previously 5.1 x 4.7 cm. There is increased dilatation of the main pancreatic duct with dilated side branches. The main pancreatic duct is cystically dilated up to 1.1 cm in diameter immediately proximal to an ill-defined mass in the pancreatic head. This ill-defined mass in the pancreatic head is not significantly changed in size measuring 4.3 x 3.3 cm (15/47), previously 4.2 x 3.2 cm on remeasurement.There is fatty atrophy within the majority of the body and neck of the pancreas. There is ill-defined tissue at the pancreatic head surrounding the common bile duct which demonstrates enhancement diffusion restrictionADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Enlarged portacaval node is unchanged measuring 2.6 x 1.6 cm (15/58), previously 2.5 x 1.7 cm. Enlarged periaortic lymph nodes are unchanged.BOWEL, MESENTERY: 8 x 6 mm peritoneal nodule is stable (13/255).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Minimal perihepatic and perisplenic ascites is slightly increased. Small right pleural effusion with thickened adjacent pleura is unchanged.
1.Common bile duct stent is likely obstructed with increased moderate intrahepatic biliary ductal dilatation.2.Increased dilatation of the main pancreatic duct, likely due to obstruction from pancreatic head mass.3.Soft tissue in the porta hepatis is slightly increased. Hepatic metastases are unchanged.4.Pancreatic head mass is unchanged.5.Peritoneal nodularity is unchanged.6.Small right pleural effusion with thickened pleura suggestive of an empyema is unchanged.