RADIOLOGY: HEPATOBILIARY: Case# 34074: ? GALLBLADDER CARCINOMA. Patient is an 84 year old female with jaundice found to have common bile duct obstruction in the suprapancreatic region on ERCP. Only prior study available was CT from 1/12/93 but this was a chest CT that did not go all the way through the liver and pancreas. Images through the lung bases show no pulmonary nodules or focal pulmonary opacities or effusions. There is enlargement of suprapancreatic and portal lymph nodes. Stent is placed into the upper common duct with mild to moderate residual biliary dilatation. The stent extends into the duodenum. Low attenuation at the ampulla in the head of the pancreas may be secondary to recent sphincterotomy versus a small mass lesion. The remainder of the pancreas is normal and no stricture or mass was seen in this area on ERCP. There is gallbladder wall thickening in the fundus with adjacent liver metastatic lesions as well as gallstones within the remainder of the gallbladder. These findings were not appreciable on prior scan from 93 except for gallstones. Index lesions in the liver include left medial segment lesion measuring 3.7 x 2.3 cm (image 25) and a right anterior segment lesion measuring 1.1 x 0.9 cm (image 28). The right anterior segment lesion is not well defined. There are a few shotty retroperitoneal lymph nodes that are not definitely pathologically enlarged. No other metastatic lesions seen. Review of bone images shows no skeletal lesion suspicious for metastasis. The kidneys, adrenals, small and large bowel, uterus and urinary bladder are unremarkable except for diverticulosis and tiny wedge-shaped defect in the posterior spleen most consistent with an infarct. No abnormal masses or fluid collection seen elsewhere in the abdomen or pelvis.