Demographics:
55 years old, Male
Indication:
Abdominal pain, fever
Findings
Lower chest
- Mild dependent atelectasis
Abdomen/Pelvis
- Marked intrahepatic and extrahepatic biliary duct dilation with the common bile duct measuring up to 23 mm in diameter
- Abrupt tapering of the common bile duct in the region of the ampulla with a likely ampullary mass
- Diffuse dilation of the main pancreatic duct, measuring up to 10 mm in diameter, also with abrupt tapering in the region of the ampulla
- Gallbladder is distended without wall thickening, radiopaque calculi, or pericholecystic inflammatory changes
- Enlarged anterior periportal lymph node measuring 13 mm in short axis
- Bilateral renal cysts measuring up to 4 cm on the right and 2.8 cm on the left. The exophytic left renal cyst contains minimal layering high attenuation material
- Colonic diverticulosis
- Mild circumferential mural thickening of the urinary bladder
- Replaced right hepatic artery from the SMA
- Minimal atherosclerotic calcification of the abdominal aorta and branch vessels without aneurysm
MSK
- No acute findings
- Ankylosis of the right greater than left sacroiliac joints
- Bilateral L5 pars defects with grade 1 anterolisthesis of L5 on S1
Diagnosis
Obstructing ampullary mass (proven ampullary adenocarcinoma on subsequent biopsy)
Sample Report
Biliary and pancreatic duct dilation with findings concerning for an obstructing ampullary mass. Recommend gastroenterology evaluation.
Gallbladder distension is favored to relate to distal biliary obstruction without additional CT findings to suggest acute cholecystitis.
Nonspecific enlarged anterior periportal lymph node, which could represent a nodal metastasis.
Mild circumferential mural thickening of the urinary bladder. Recommend correlation with urinalysis for signs of cystitis.
Discussion