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RADIOLOGY: ABDOMEN: Case# 109: ?HEPATIC INFARCTION, S/P RESECTION FOR PANCREATIC CA. 53-year-old female with pancreatic cancer, status post hepaticojejunostomy and gastrojejunostomy ten days ago, with a postoperative course complicated by anastomotic bleed at the gastrojejunostomy site requiring sclerotherapy by EGD. The patient now complains of back pain after the removal of the left-sided drainage catheter in the region of the splenectomy bed. Comparison is made to a prior abdominal CT scan from six weeks ago. Also new is the development of hyperdense and hypodense regions within the right hepatic lobe, mainly in a peripheral location which are felt to represent perfusion abnormalities within the liver. The more central hypodense region may actually represent infarction. The intrahepatic portion of the portal vein can be easily identified but cannot completely be identified in its extrahepatic location. The superior mesenteric vein is not identified at all. Only a small portion of the splenic vein is identified proximally. The gallbladder and spleen have both been surgically removed, and there has been interval creation of a hepaticojejunostomy and a gastrojejunostomy. In the region of the site of the gastrojejunostomy, there is a hypodense fluid collection in an intramural location along the posterior wall of the greater curve of the stomach, felt to be a postoperative fluid collection. The duodenum is patent, and its walls are diffusely mildly thickened. A T-tube is identified within the region of the porta, and a drainage catheter is seen extending just inferior to the liver. There are mild inflammatory changes in the region of the splenectomy bed, but no fluid collection or abscess is identified in this region. A large pancreatic mass is identified in the region of the pancreatic head which is abutting the duodenum. This does not appear significantly different than on the outside CT scan. There is dilatation of the pancreatic duct. No bowel obstruction is identified.

Peter Anderson
abdomen, radiology