Heterogeneous soft tissue density surrounding the superior mesenteric artery, measuring up to 6.5 x 5.2 cm in transaxial dimensions, and 5.3 cm in craniocaudal dimension. The artery appears displaced and the mass is predominantly anterior to the artery. The third/fourth part of the duodenum abuts the inferior aspect of the mass, the duodenum is not frankly invaded. On delayed phase imaging the mass demonstrates progressive enhancement suggesting it may be fibrous.
The superior mesenteric vein, and the confluence of the splenic vein and superior mesenteric vein are partially compressed by the soft tissue mass however they remain patent.
Extensive colonic diverticulosis, moderate in the sigmoid and mild elsewhere, otherwise normal large bowel appearances with no significant colonic mass lesion or polyp.
The gallbladder appears very small and collapsed. Intra and extrahepatic biliary dilatation, common bile duct diameter 16 mm. Abrupt transition point at the ampulla. Minimal pancreatic duct dilatation, diameter 5 mm in the head of the pancreas.
Hypoattenuating focus in the central liver has benign appearances. Smaller subcapsular focus of hypoattenuation in segment 6 is slightly less well-defined and considered indeterminate. Liver otherwise normal.
Small bilateral renal cysts, the kidneys otherwise normal. Normal adrenals and spleen.
Severe calcified atherosclerotic disease of the abdominal aorta but no aneurysm.
Large hiatus hernia.
Bibasal atelectasis, the imaged lung bases are otherwise clear.
Severe degenerative changes of the right hip joint with likely small fluid-filled bursa at the superior posterior aspect.
Severe degenerative changes of the imaged spine. No destructive bony abnormality identified.
Comments:
Soft tissue mass surrounding the superior mesenteric artery, the exact nature is unclear but the enhancement suggests a fibrous tumour. Marked biliary dilatation is also demonstrated, this is more likely incidental however an ampullary mass cannot be excluded.
Colonic diverticulosis but no colonic mass lesion or polyps.
Percutaneous biopsy will be challenging although may be possible via a left sided retroperitoneal approach. Alternatively it may be accessible to EUS from the distal duodenum.