- Marked intra and extrahepatic biliary distension is identified associated with upstream pancreatic duct enlargement.
- There is a mass in the pancreatic head with loss of T1 signal, restricted diffusion and late enhancement present surrounding the common hepatic duct. This is associated with extension back into the pancreatic neck with ill-defined appearances leading to occlusion of the main pancreatic duct and the appearances would support a lesion of at least 2.4 cm in size with likely localised invasion outside the pancreatic head and around the common hepatic duct in the porta.
- There are prominent surrounding lymph nodes which are concerning for involvement and there is narrowing of the portal veins slightly probably less than 180 degrees.
- The left hepatic artery appears to be arising from the left gastric as a variant.
- The hepatic artery proper appears to be encased along with the origin of the right hepatic artery and encasement of the GDA.
- The SMA is clear, SMV is likely involved at the attachment to form the portal vein.
- Patchy oedema through the liver consistent with biliary obstruction is identified with no features supportive of metastatic deposits slightly prominent peri coeliac nodes superiorly, no retroperitoneal deposits.
- Appearances are likely a locally invasive 2.5 cm pancreatic head primary adenocarcinoma with double duct obstruction.
- There is involvement of the right hepatic artery, hepatic artery proper and GDA with the left hepatic artery appearing to be replaced arising from the left gastric.
- SMV and portal vein contact less than 180 degrees.
- Small lymph nodes around the porta caval window are possibly just reactive.
- Ill-defined tissues about the pancreatic head suggest an may be peripancreatic invasion into the adjacent lesser omentum and fat.
- At this stage it is likely that this mass is status unresectable.