Findings
Lower chest
- Left lower lobe collapse with volume loss in the left hemithorax, incompletely evaluated
- Mild patchy groundglass opacities in the right lower lobe
- Small left pleural effusion
- Mild cardiomegaly
- Small pericardial effusion
Abdomen/Pelvis
- Numerous soft tissue nodules and masses in the expected location of the urinary bladder, with the largest measuring 8 x 5 x 8 cm in the suprapubic region
- Nodularity extends anteriorly into the prevesical soft tissues, posteriorly into the anterior perirectal fascia, and inferiorly into the perineum with extensive nodularity along the anterior aspect of the anus and involving the penile crura
- The urinary bladder is not confidently identified, and given the presence of multiple surgical clips in the anatomic pelvis, may have been previously removed
- Moderate dilation of both ureters with multifocal intraluminal enhancing soft tissue nodules throughout both ureters
- Enhancing soft tissue nodules in the dilated renal pelvis bilaterally
- Severe bilateral renal atrophy with moderate bilateral hydronephrosis and multiple subcentimeter hypoattenuating lesions, which are too small to characterize
- Multiple enlarged retroperitoneal lymph nodes including a retrocaval node measuring 1.7 cm in short axis and a left para-aortic node measuring 1.2 cm in short axis
- Bilateral enlarged inguinal lymph nodes measuring up to 3.6 cm in short axis on the right and 1.5 cm in short axis on the left
- Endograft repair of an infrarenal abdominal aorta aneurysm and bilateral common iliac artery aneurysms with the maximum diameter of the excluded aortic aneurysm sac measuring 7.5 x 7 cm
- Contrast attenuation is noted external to the opacified lumen along the left posterior aspect of the aorta near the proximal margin of the graft and near the proximal aspect of the common iliac artery grafts
- High grade stenosis of the proximal right internal iliac artery
- Heterogeneous hepatic parenchymal enhancement with multiple small hypoattenuating lesions measuring up to 1.4 cm in the right hepatic lobe
- Splenomegaly
- Punctate calcification in the pancreatic uncinate process
- Peritoneal dialysis catheter terminates in the ventral right lower quadrant with expected small volume abdominopelvic ascites
MSK
- Sclerotic lesions in the right iliac bone, bilateral femoral heads, left inferior pubic ramus, and left ischium without aggressive features
- Lucent lesion in the posterior aspect of the L4 vertebral body
- Transitional lumbosacral anatomy
- Multilevel degenerative changes of the spine with mild stepwise retrolisthesis from L2-L4
Diagnosis
Multifocal transitional cell carcinoma
Aortic endoleak
Sample Report
Findings concerning for multifocal transitional cell carcinoma with involvement of both renal collecting systems and ureters and extensive masses in the expected location of the urinary bladder. Contiguous disease spread anteriorly into the prevesical soft tissues, posteriorly into the perirectal fascia, and inferiorly into the perineum along the anterior aspect of the anus and involving the penile crura.
Extensive metastatic adenopathy involving bilateral inguinal, internal and external iliac, and retroperitoneal nodal chains.
Multiple hepatic hypoattenuating lesions and a lytic L4 osseous lesion are nonspecific, but concerning for metastatic disease given the above findings.
Endograft repair of the abdominal aorta and bilateral common iliac arteries with findings concerning for endoleak at the proximal margins of the aortic and common iliac grafts. The aortic aneurysm sac measures up to 7.5 x 7 cm.
Moderate bilateral obstructive hydroureteronephrosis.
Left lower lobe collapse with volume loss in the left hemithorax and a small left pleural effusion. A central obstructing lesion is not excluded. Recommend nonemergent chest CT for further evaluation.
Mild patchy groundglass opacities in the right lower lobe, which may relate to microatelectasis or aspiration/pneumonia.
Discussion