Name of the Patient : Abc Xyzen lmn / F / 76 yrs.
Referred by : Dr. Abc Xyztankar. Examination : M.R.Cholangiogram.
CLINICAL PROFILE : C/O Ca head of pancreas. CBD stenting done twice before, last on
Now C/O backpain.
MR Cholangiogram was performed. 7 mm thick T1 Weighted and T2 Weighted axial images. 6 mm thick T2 Weighted coronal images.OBSERVATION :
There is seen an approximately 2.5 cms diameter sized intermediate signal intensity mass lesion on the T1 Weighted images in the region of the head of pancreas/terminal CBD. This lesion appears relatively hypointense on the T2 Weighted images. There is resultant dilatation of the pancreatic duct, common bile duct, cystic duct and the intrahepatic biliary radicles. The gall bladder is also distended. The common bile duct measures approximately 2.5 cms in its maximum transverse dimensions and the pancreatic duct measures approximately 8.0 mms in diameter. There is a cut off at the level of the terminal CBD and pancreatic duct. A stent is noted within the CBD.
There is a small, subcentimeter, hypointense lesion on the T1 Weighted images in the right lobe of the liver, postero-superiorly. This lesion appears hyperintense on the T2 Weighted images (scans 108.2, 102.4). The rest of the liver parenchyma shows no focal abnormal lesion, though mild hepatomegaly is noted.
The intrahepatic venous architecture is normal.Both the adrenal glands, spleen and the right kidney are unremarkable. A parenchymal cyst is noted in the left kidney.
The gall bladder shows no obvious intrinsic lesion.
There are no abnormally enlarged abdominal lymph nodes on this study. There is no free fluid.
In a known C/O CA head pancreas, the MRCP suggest :
1. A moderately dilated biliary tree and pancreatic duct with obstruction at the level of the terminal CBD and pancreatic duct. A shunt tube is noted in the CBD which is most likely non-functioning, in view of the dilated biliary tree.
2. Mild hepatomegaly with a focal lesion in the right lobe of the liver, postero-superiorly, which is a ? hepatic cyst, ?? metastasis (less likely to represent a focally dilated biliary radicle).