Date : 00.00.00
Name of the Patient : Abc Xyzlya Slmn / F / 60 yrs.
Referred by : Dr. Abc Xyzdeo Examination : M.R.Cholangiogram.
CLINICAL PROFILE :
Known C/O Ca gall bladder. Cholecystectomy done 1 year back.
C/O abdominal pain and detected to have jaundice since 00.00.00. EXAMINATION :
MR Cholangiogram was performed. 8 mm thick T1 Weighted and T2 Weighted axial images. 8 mm thick T2 Weighted coronal images.OBSERVATION :
There is seen a fairly large, lobulated intermediate signal intensity mass lesion on the T1 Weighted images in the preaortic region around the coeliac and superior mesenteric axis and in the region of the porta hepatis. This lesion appears hyperintense on the T2 Weighted images. Similar signal intensity but smaller lesions are noted in the left paraaortic region, peripancreatic region and in the region of the lesser curvature of the stomach. The pancreas is displaced, slightly anteriorly by the lesion around the coeliac and superior mesenteric axis.
There is resultant obstruction of the biliary tree at the level of the porta hepatis with mild dilatation of the intrahepatic biliary radicles and the right and left hepatic ducts. Small signal voids in the biliary tree on the right may represent calculi/intraductal tumor tissue. Multiple small strictures are noted in the intrahepatic biliary tree which may be due to intraductal/periductal tumor tissue. The gall bladder is not visualized, the result of previous surgery. The common bile duct is also not well-visualized proximally. Distally, the CBD measures approximately 6 to 7 mms in its maximum transverse dimension at the level of the head of the pancreas.
Diffuse, ill-defined hyperintense signal on the T2 Weighted images in the right and left lobe of liver along the inferior surface (periportal region) is of ? etiology (?? tumor infiltration).
The intrahepatic venous architecture is normal.Both the visualized kidneys, pancreas, adrenals and spleen are normal in size and signal characteristics.
There is no free fluid in abdomen.
Susceptibility artifacts in the anterior abdominal wall may be due to previous surgery.
1. Post-cholecystectomy status.
2. A fairly large, lobulated mass lesion in the preaortic region around the coeliac and superior mesenteric axis and in the region of the porta hepatis as described most likely represents a lymphnodal mass, probably metastatic in etiology, in a known C/O Ca gall bladder. Multiple smaller lymphnodes are noted in the left paraaortic region, peripancreatic region and in the region of the lesser curvature of the stomach.
3. Obstruction of the biliary tree at the level of the porta hepatis with multiple intrahepatic strictures in the biliary tree, ? due to intraductal/periductal tumor tissue. Inclusions in the biliary ducts on the right may represent calculi/tumor tissue.