There is diffuse intra- and extrahepatic ductal dilatation. The common bile duct measures up to 19 mm in AP diameter. The gallbladder is distended. The main pancreatic duct is dilated, measuring up to 8 mm.
There is an abrupt tapering of the common bile duct and hepatic ducts at the pancreatic head. There is the impression of a slightly T2 hyperintense mass in the pancreatic head/uncinate process, measuring approximately 2.4 x 3.4 x 2.7 cm. Enlarged lymph node with a short-axis diameter of 14 mm is identified in the coeliac axis, superior to the pancreatic neck. This demonstrates mildly increased diffusion restriction. The pancreatic body and tail are mildly atrophic.
There are no filling defects anywhere within the biliary tree to suggest calculi. No calculi or sludge in the gallbladder.
No focal liver lesion. Normal appearance of the spleen.
Loss of corticomedullary differentiation in both kidneys. Small T2 hyperintense lesions in the right kidney are in keeping with cysts. Normal adrenal glands.
Conclusion: Pancreatic head mass/uncinate process is very suspicious for pancreatic malignancy. Associated biliary and pancreatic ductal obstruction with an enlarged lymph node. No evidence of biliary calculi.