Date : 00.00.00
Name of the Patient : Abc Xyz Tilmn / F / 53 yrs.
Referred by : Dr. Abc Xyzdeo. Examination : M.R.Cholangiogram.
CLINICAL PROFILE :
H/O laproscopic cholecystectomy 2 years back. Detected to have Ca gall bladder in January 0000 with recurrence at site. Received Chemotherapy (3 cycles). FNAC from right axillary lymphnode was s/o adenocarcinoma.
C/O pain in the abdomen with jaundice since 2-3 months. Knonw diabetic/hypertensive.
MR Cholangiogram was performed. 7 mm thick T1 Weighted and T2 Weighted axial images. 8 mm thick T2 Weighted coronal images.OBSERVATION :
The gall bladder is not visualized, the sequelae of previous surgery. There is mild to moderate dilatation of the intrahepatic biliary radicles, right and left hepatic ducts and the common bile duct upto the level of the head of the pancreas. The distal pancreatic duct is also dilated. The uncinate process of the pancreas is slightly bulky. The body and tail of the pancreas are otherwise unremarkable.
There is mild hepatomegaly.
There is no focal or diffuse area of altered signal intensity within the liver per se. The intrahepatic venous architecture is normal.Both the visualized kidneys and adrenals are normal.
The spleen shows a relatively hypointense signal on the T2 Weighted images.
There are no abnormally enlarged abdominal lymphnodes identified. There is no free fluid in abdomen.
A small, right sided pleural effusion is noted.
Ill-defined hyperintense signal on the T2 Weighted images is noted in the subcutaneous fat along the right lateral chest wall and right lateral abdominal wall. Site of the previous surgery is noted in the subcutaneous tissue in the right hypochondrium.
Suspicious hypointense areas on the T1 Weighted images are noted in the lower lumbar vertebrae and in the left iliac bone in the acetabular region (localizer image).
1. Post-cholecystectomy status.
2. Mild to moderate dilatation of the intrahepatic biliary radicles, right and left hepatic ducts and the common bile duct upto the level of the head of the pancreas with mild dilatation of the distal pancreatic duct as described. The uncinate process of the pancreas appears slightly bulky. In view of the above findings, a carcinoma of the uncinate process of pancreas/periampullary carcinoma should be ruled out. Patient is a known C/O ? Ca gall bladder.
3. Small right sided pleural effusion.
4. Altered signal in the subcutaneous fat along the right lateral chest wall and right lateral abdominal wall may represent cellulitis. 4. Altered signal in the lower lumbar vertebrae and in the left iliac bone in the acetabular region may represent metastasis in the given clinical setting. These areas of signal change however need to be confirm by dedicated studies of the lumbar spine and the pelvis.