65-year-old man with history of orthotopic liver transplant, evaluate for HCC. Please note that this study is markedly limited due to susceptibility artifact from the IVC/porta hepatis.ABDOMEN:LIVER, BILIARY TRACT: The partially visualized liver has nodular contour and widened fissures suggestive of cirrhosis. There is a geographic area of increased T2 signal in the right hepatic lobe along with delayed enhancement of this region. There is an approximately 16 x 14 mm round focus of arterial enhancement with washout on delayed phase images (series 103, image 51) in segment 6 of the liver. Restricted diffusion suggested by this focus. Additionally, there is a 10 x 10 mm focus of arterial enhancement with washout on delayed phase images (series 13, image 23) in the dome of the liver.SPLEEN: The spleen appears normal.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: The left adrenal gland appears normal. The right adrenal gland is not visualized.KIDNEYS, URETERS: The left kidney has uniformly increased T2 signal and diffusion restriction. There is no hydronephrosis. The right kidney appears normal. The kidneys enhance symmetrically with normal nephrograms bilaterally.RETROPERITONEUM, LYMPH NODES: There are two large para-aortic masses which are heterogeneous in appearance but predominantly isointense to liver on T1 and T2 sequences. The left-sided mesenteric mass (series 4, image 27) measures 102 x 94 mm. This mass appears nodular, has small areas of high T1 signal suggesting hemorrhage, nonenhancing areas suggestive of necrosis, and peripheral enhancement. The right-sided mesenteric mass (series 4, image 27) measures 117 by 102 mm. This mass also appears nodular with nonenhancing areas suggestive of necrosis and demonstrates peripheral enhancement.The superiormost intrahepatic IVC and the intrahepatic IVC are not visualized.BOWEL, MESENTERY: Loops of small bowel are displaced by the retroperitoneal masses, otherwise the partially visualized small bowel and colon appear normal. The SMV courses anterior to the right retroperitoneal mass and is attenuated in caliber.BONES, SOFT TISSUES: There are multiple small ventral hernias, most of which contain fat, although one of which contains a portion of the transverse colon without evidence of obstruction. The patient is status post median sternotomy.OTHER: Right lung base pleural nodule (series 3, image 6) measures 12 x 11 mm.
1.Examination markedly limited by susceptibility artifact as described above, patient motion artifact noted on several sequences as well. Given the findings below, a contrast-enhanced liver protocol CT should be considered.2.Cirrhotic morphology of the liver with geographic increased T2 signal and delayed enhancement of the right lobe which may represent fibrosis or may be perfusional.3.Foci of enhancement in segments 6 and 8 of the liver as described suspicious for HCC.4.Large retroperitoneal masses which may represent necrotic nodal metastatic disease or PTLD or lymphoma (however these latter conditions considered less likely given the heterogeneous appearance).5.Abnormal signal of the left kidney nonspecific but may be related to an early obstructive process. No hydronephrosis.6.Nonspecific right pleural based lung nodule.