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CT Abd Pancreatic Cancer

Technique: Noncontrast CT of the pancreas was obtained. This was followed by intravenous contrast administration and imaging of the pancreas in the arterial, portal venous, and delayed phases. Coronal and sagittal reformations wereperformed.

Findings: There is an ill-defined hypodense mass within the head/uncinate of pancreas measuring 4.4 x 3.1 x 3.1 cm (Se: 5, Im: 13). No clear fat plane is seen between this mass and the celiac artery or portal venous confluence. However there is no evidence of invasion into these vascular structures. Also surrounding this mass, there are multiple small nodules that likely represent
pathologically involved lymph nodes. A duodenal diverticulum is present.

Again seen are multiple lung nodules better characterized on the prior CT aorta. Atherosclerotic vascular calcifications are seen throughout the tortuous aorta and its major branches.
There are unchanged bilateral renal cystic lesions. Hypodense lesion in the right adrenal gland represents an adrenal adenoma. The remaining upper abdominal viscera are unchanged from prior.
Degenerative changes are seen in the spine.

1. Findings above are consistent with pancreatic head carcinoma. Recommend GI or surgery consult and biopsy. There is probable regional lymph node spread of disease.
2. Multiple pulmonary lung nodules. Metastatic disease cannot be excluded.
3. Other chronic changes as above.
FINDINGS: The lungs are without evidence of mass, consolidation, or pleural effusion. Atherosclerotic vascular calcifications are seen throughout the tortuous aorta and its major branches. There are also cardiac valvular and coronary artery calcifications. There are no enlarged mediastinal, hilar, or axillary lymph nodes. A low density left-sided thyroid nodule is noted measuring 2.3 x 2.8 x 2.5 cm.

The liver demonstrates multiple branching air densities consistent with pneumobilia most likely due to recent ERCP. The gallbladder is contrast-filled. New biliary stent is seen with its proximal end in the common bile duct and distal end terminating within the second portion of the duodenum. Hypoattenuating pancreatic head mass measuring 4.1 x 3.6 cm is unchanged from prior. There is anterior peripancreatic fluid-density. Superior mesenteric vein, splenic vein, portosplenic confluence and portal vein are of normal caliber and without filling defect. There is no periaortic, pericaval or portal lymphadenopathy. The spleen is enlarged measuring 13 x 5 x 17 cm with splenic index 1105 cc (normal < 480). The adrenals are normal. Bilateral renal cysts, including a hemorrhagic cyst in the upper pole on the left, are noted. Enteric contrast extends to the rectum. The hollow viscera are without evidence for wall thickening, mass, or obstruction. No evidence of free fluid or free air in the peritoneal cavity. Moderate degenerative changes of the thoracolumbar spine are noted.

1. Pancreatic head mass, unchanged from prior.
2. No evidence of metastatic spread of pancreatic malignancy as queried. No evidence of involvement of SMV, splenic vein and the portal vein.
3. Peripancreatic fluid may represent mild pancreatitis.
4. Left thyroid nodule, recommend ultrasound for further characterization.
5. Splenomegaly.
6. Other chronic changes as above.