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CT Abd Pancreatic Pseudocyst

Findings: There is bibasilar pulmonary parenchymal consolidation with adjacent left pleural effusion. The right-sided thoracostomy tube has been intervally removed. The heart, pericardium and large vessels are unremarkable. Atherosclerotic vascular calcifications are seen throughout the aorta and its major branches.

The liver demonstrates normal morphology and low attenuation. Surgical clips are noted within the gallbladder fossa consistent with prior cholecystectomy. There is a very large, multiloculated fluid collection, with the largest component measuring 8.3 x 18.8 x 22 cm in the pancreatic bed extending posteriorly into the posterior pararenal space, anteriorly into the small bowel mesentery, superiorly to the left hemidiaphragm and inseparable from the left basilar pleural effusion, and as far inferiorly as the pelvis. There is also complex fluid surrounding the rectum as seen on prior study. Minimal capsular enhancement is noted throughout this fluid collection.

The spleen demonstrates a single focus of calcification and is otherwise normal in size and morphology. Bilateral adrenal glands are normal. There are unchanged bilateral renal cysts. The enteric contrast extends to the rectum. The hollow viscera are otherwise without evidence of wall thickening, mass or obstruction. No evidence of free air within the peritoneal cavity.

There is no lymphadenopathy. Right total hip replacement hardware producing beam hardening artifact obscuring the majority of the bladder. A Foley catheter has been intervally removed. Mild degenerative changes of the lumbar spine are noted.

1. Very large multiloculated peripherally enhancing fluid collection with the majority of the fluid in the pancreatic bed but with extension throughout the abdomen and pelvis as described. This finding is much worse compared with 9/7/2013 exam. The peripheral enhancement is likely due to pseudocyst formation, however secondary infection cannot be fully excluded and should be clinically
correlated. Of note, this fluid collection is inseparable from the left hemidiaphragm and left basilar pleural effusion. The left basilar pleural effusion is likely a sympathetic effusion, however fistulous formation from the abdominal fluid collection cannot be excluded.
2. Bibasilar pulmonary atelectasis, left lower lobe pneumonia cannot be fully excluded.