Date : 00.00.00
Name of the Patient : Abc Xyza Ramchanlmn / F / 73 yrs.
Referred by : Dr. Abc Xyzdeo. Examination : M.R.Cholangiogram.
CLINICAL PROFILE : Known C/O CA gall bladder. Operated in July 0000. Has received 25 sittings of radiotherapy.
Now C/O jaundice since 3-4 weeks.
MR Cholangiogram was performed. 7 mm thick T1 Weighted and T2 Weighted axial images. 8 mm thick T2 Weighted coronal images.OBSERVATION :
There is seen an approximately 4.0 cms diameter sized mass lesion at the porta hepatis. This lesion is iso to slightly hyperintense to the hepatic parenchyma on the T1 Weighted images and appears heterogeneously hyperintense on the T2 Weighted images. There is resultant obstruction of the biliary tree at the level of the porta hepatis. The common hepatic duct and the left and right hepatic ducts are not well differentiated on this study. There is mild dilatation of the intrahepatic biliary radicles upto the level of the mass lesion at the porta hepatis. A stricture lesion is noted of the descending right hepatic duct more towards the mass lesion at the porta hepatis. The common bile duct and the pancreatic duct are not dilated. The gall bladder is not visualized, the result of previous surgery.
There is mild to moderate hepatomegaly. Probable infiltration of the mass lesion into the hepatic parenchyma near the porta hepatis is noted.
Mild splenomegaly is noted. The spleen shows a relatively hypointense on all the pulse sequences ? due to increased iron deposition. Splenunculi are noted along the medial margin of the spleen.
A small renal parenchymal cyst is noted on the left side. Both the kidneys are otherwise unremarkable.
The pancreas and both adrenal glands are unremarkable.
There is no free fluid in the abdomen. No obvious enlarged lymph nodes are noted.
In a known C/O Ca gall bladder, the patient is status post-operative and post-radiotherapy.
An approximately 4.0 cms diameter sized mass lesion in the porta hepatis would represent a recurrent lesion. Probable infiltration into the liver is noted in the region of the porta hepatis. Resultant mild dilatation of the intrahepatic biliary radicles upto the level of the porta hepatis is noted. The left and right hepatic duct and common hepatic ducts are not visualized. A stricturous lesion is noted in one of the right hepatic ducts as described. The common bile duct and pancreatic ducts are unremarkable.