Head of pancreas mass with invasion of the superior mesenteric artery

There is a large, hypoenhancing head of pancreas tumor that measures 2.6 x 4.4 x 4.6 cm. The tumor extends into the uncinate process as well as invading the base of the small bowel mesentery, and jejunal vessels. The tumor also incompletely encases the superior mesenteric artery. The portal, splenic and superior mesenteric veins opacify normally. The common bile duct is dilated up to 15 mm and there is also presence of intrahepatic duct dilatation. The main pancreatic duct is also dilated to 6 mm.

Within segment 3 of the liver, there is a rounded 6 mm hypodensity that demonstrates fluid attenuation and likely represents a liver cyst. No other focal liver lesions identified. Multiple bilateral rounded hypodensities in the kidneys are also in keeping with simple renal cysts. A larger more irregular shaped 22 mm lesion within the midpole left kidney does not demonstrate enhancement and is likely a collapsed hemorrhagic cyst. Bilateral adrenal glands, spleen and imaged portion of the bowel have an unremarkable appearance. Small hiatus hernia. There are multiple subcentimeter azygo-esophageal, celiac axis, left gastric, para-aortic and mesenteric lymph nodes. No peritoneal metastases identified.

Conclusion:

Large head of pancreas tumor that invades the superior mesenteric artery, small bowel mesentery and jejunal vessels. The tumor causes obstruction of the common bile duct and main pancreatic duct. Although no definite evidence of metastatic disease, there are multiple subcentimeter posterior mediastinal, celiac trunk, para-aortic and mesenteric lymph nodes.