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No evidence of chronic or acute pancreatitis. There is a 3.9 cm x 3.2 cm x 3.2 cm well defined - almost encapsulated appearing - solid enhancing pancreatic head mass demonstrating quite vivid arterial enhancement with persistent hyper enhancement relative to pancreatic parenchyma on portal venous phase. Small non-enhancing cystic spaces are shown, which may represent small areas of necrosis. The mass does not cause main pancreatic duct dilatation or biliary dilatation. The mass is closely associated with the proximal portal vein. The portal vein is slightly displaced and deformed but has a smooth margin where there is contact with the mass. There is a short distance of central superior mesenteric vein in contact with the mass. Contact points at portal vein and superior veins are less than
Coeliac axis, hepatic artery, superior mesenteric artery are clear. No lymphadenopathy.
Within segment 5 of the liver, there is a wedge-shaped area of arterial hyper enhancement, without washout of seen on prior exam. Within segment 8, there is a small focus of arterial hyperenhancement without washout, which may represent a similar phenomenon.
Left renal cyst. While both kidneys, adrenal glands, spleen are normal in appearance. Visible bones are normal in appearance.
Conclusion: Pancreatic head mass, abutting the proximal portal vein without clear evidence of invasion. Differential diagnosis includes neuroendocrine tumour; appearances are not typical for adenocarcinoma. Seg. VIII hypervascular liver lesion is indeterminate. Seg. V hypervascular liver area may represent a THID/THAD.
Suggest consider correlation with EUS/FNA.