? MRCP or MRI abdomen w/wo


Best answers
Order states MRCP w/ contrast.

Not sure if S8037/A9579 x 20 or 74183/A9579 x 20 would be appropriate.


INDICATION: Pancreatic mass.

TECHNIQUE: Multiplanar, multisequence MRI performed prior to and following 20 ml intravenous Magnevist. MRCP sequences performed. Comparison made to CT scan performed 01/19/09 Franklin Regional Medical Center.

FINDINGS: There is a complex fluid collection approximately 14 x 9 mm in size seen in the pancreatic body without significant enhancement, findings consistent with pseudocyst. Immediately anterior to this, there is a focal gas and fluid collection which appears to be within the stomach, associated with some gastric contour change here suggesting that this may represent a site for prior surgical intervention of pseudocyst. There is no suspicious pancreatic lesion. There is pancreatic ductal dilatation upstream from this pseudocyst. The distal pancreatic duct is unremarkable. There is mild intra and extrahepatic biliary ductal ectasia with pneumobilia. Small lesion seen inferiorly in the right lobe of the liver is signal void and presumably is an additional focus of pneumobilia. There is no suspicious hepatic lesion. There splenomegaly, spleen approximately 16 x 5 x 14 cm in size. No lesion is seen. There are varices seen at the gastroesophageal junction. There is no clear portal vein although serpiginous structures seen in the porta hepatis, findings consistent with cavernous transformation of the portal vein. Adrenals unremarkable. There is a 14 x 9 mm exophytic lesion arising from the anterior surface of the interpolar region right kidney demonstrating extrinsically bright T1 signal with no enhancement, findings consistent with hemorrhagic cyst. Adrenals and left kidney unremarkable. There is wedge-shaped peripheral abnormality seen in the left lower lobe with no corresponding abnormality on the CT scan several months ago.

IMPRESSION: Lesion in the mid pancreas exhibits signal characteristics with no enhancement, findings consistent with old pseudocyst. There is upstream pancreatic ductal dilatation with side branch dilatation suggesting chronic pancreatitis. There are changes suggesting portal hypertension with mild splenomegaly, gastroesophageal varices, and cavernous transformation of the portal vein. Mild biliary ductal ectasia with pneumobilia. Left basilar pulmonary abnormality, normal here on CT scan several months ago. The abnormality could result from infarction or pneumonic infiltrate.


Kimberley Tober, CPC
Franklin, TN