/00002 Date : 19/00.00.00

Name of the Patient : Abc Xyz lmn / M / 68 yrs.
Referred by : Dr. Abc Xyz Shah.
Examination : M.R. Cholangiogram.

CLINICAL PROFILE :

C/O pain in the abdomen and vomiting since 8 days.

EXAMINATION :

The upper abdomen was scanned with 7 mm thick T1 Weighted and T2 Weighted axial images and 8 mm thick T2 Weighted coronal images.

MR cholangiogram was also obtained.

OBSERVATION :

The evidence of the eventration of the dome of the diaphragm on the right. The liver is placed at a much higher level than a normal. The bowel loops and fat are placed between the right dome of the diaphragm and the liver and this is suggestive of Chileaditi syndrome. There is no focal area of altered signal in the liver parenchyma. There is no dilatation of the intrahepatic radicles.

The gall bladder is small and contracted.

The tail of the pancreas is slightly ill-defined and bulky. Streaking of the peripancreatic fat plane is noted in the region of the pancreatic tail. A pocket of fluid is noted at the inferior pole of the spleen in the region of the tail of the pancreas. The head and body of the pancreas appear unremarkable. The pancreatic duct is not dilated.

Multiple renal cortical and parenchymal cysts are noted.






The spleen is normal in size and signal characteristics.

There are no abnormally enlarged abdominal lymph nodes noted.

The visualized adrenal glands are unremarkable.

A small left basal pleural effusion is noted with left basal atelectasis.

The MRCP reveals mild fullness of the common bile duct which measures approximately 1.0 cm in its maximum transverse dimensions. Mild concentric narrowing of the terminal CBD is noted without intrinsic lesion in the terminal CBD.

A focal hypointensity along the posterior wall of the common bile duct in its mid-segment is suspicious for a calculus (scan 102.10). There is no dilatation of the hepatic ducts or the intrahepatic biliary radicles. The cystic duct is not well-identified.

IMPRESSION :

1. Eventration of the dome of the diaphragm on the right.

2. Ill-defined and bulky tail of the pancreas with streaking of the peripancreatic fat in that region and a fluid collection at the inferior margin of the spleen as described may suggest focal pancreatitis. Small left basal pleural effusion and left basal atelectasis.
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- 3 - Scan-00005


3. Small and contracted gall bladder.

4. CBD measures 1.0 cm in its maximum transverse dimension. Concentratic narrowing of the terminal CBD is noted, without obvious intrinsic lesion in terminal CBD.

5. Suspicious calculus in the mid-segment of the CBD along its posterior wall. Terminal CBD and pancreatic ducts are unremarkable.

6. Multiple renal cortical and parenchymal cysts.

7. Chileaditi syndrome.