There is a large hypodense and hypovascular mass lesion arising from the pancreatic head/uncinate process measuring approximately 8.2 x 6.0 x 7.2 cm (longitudinal x AP x transverse). It completely encases but not obstructs the proximal portal vein and the right hepatic artery (which is replaced to the SMA - anatomical variant). It also involves in less than 180+ the left hepatic and left gastric arteries (also anatomical variant, with the left hepatic artery replaced to the left gastric artery) and abuts and compresses the left renal vein and IVC. There is compression against the distal CBD with mild upstream dilatation of the biliary tree (CBD measuring up to 10 mm in calibre). Multiple prominent retroperitoneal lymph nodes at this level measuring up to 1.5 cm in their short axis are noted.
The liver has otherwise unremarkable appearances, with no focal lesions. The left adrenal gland demonstrates a well-defined 2.3 cm nodule that has average attenuation of 12 HU; although it is nonspecific, this is more likely to represents a lipid poor adenoma. The right adrenal glands, spleen, and kidneys appear normal. The bowel has unremarkable appearances, no free fluid or free gas in the peritoneal cavity. No suspicious bone lesions. The imaged lung and pleural bases are clear.