CT: WHOLE ABDOMEN (Plain  study)

CLINICAL BRIEF: Complain of abdominal pain since 6 months.

OBSERVATIONS:

There is a huge multilocular predominantly cystic mass measures approximately 31 x 23 x 21 cm in CC x TRA x AP dimension seen extending from left hypochondrium to pelvic region. The mass exhibit multiple solid areas and septal calcification. Left kidney is not separately visualized from the mass. The lesion is causing mass effect over adjacent bowel loops and pancreas.

Anteriorly mass is reaching up to anterior abdominal wall.

Medially mass is crossing the midline and reaching up to right iliac fossa.

CT features are suggestive of neoplastic lesion – ? multilocular renal cell carcinoma ? multilocular Cystic nephroma ? 

Liver is normal in size. Multiple varying sized hypodense lesions are seen in both lobe of liver- ? metastasis

Gall bladder is not well visualized – need clinical add USG correlation

Pancreas is normal in size. Margins are regular. Parenchyma shows normal and uniform density.  

Spleen is normal in size. Margins are regular with uniform parenchymal density.

Right kidney is normal in size and position. Margins are regular. Parenchymal thickness is adequate. No evidence of backpressure changes seen in the pelvicalyceal system. Right ureter is normal in course and calibre. 

Both adrenal appear normal. 

Large and small bowel loops are normal in calibre.

No significant retroperitoneal lymphadenopathy is observed. Retroperitoneal major vessels are normally visualized.

Urinary bladder is partially distended. No calculus and diverticulum is seen. Perivesical fat planes clear. 

Prostate is apparently normal with regular outline. 

No free fluid is seen in the peritoneal cavity. 

No lytic or sclerotic lesion is seen in visualised bone.

Visualised both lungs show innumerable varying sized soft tissue pulmonary nodule – likely metastatic.

IMPRESSION:

• CT finding reveal –

• A huge multilocular predominantly cystic mass with multiple solid areas and septal calcification is seen extending of left hypochondrium to pelvic region, likely arising from left kidney as described above- CT features are suggestive of neoplastic lesion ? multilocular renal cell carcinoma.

• Multiple hypodense lesions are seen in both lobe of liver – ? metastatic

• Innumerable soft tissue density nodule in both lung parenchyma – ? metastatic pulmonary nodule.