Reason: Patient with large right renal mass concerning for extension into the IVC. Has new SOB and need MRI for surgical planning History: As above. ABDOMEN: Limited exam without the use of intravenous contrast.LUNG BASES: Bilateral small to moderate size pleural effusions, greater in the left. 1.1 x 1.2 cm left lower lobe pulmonary nodule (series 801 image 48) suspicious for metastases. Please see separately dictated MRI chest performed on the same day. Retrocrural lymph node measures 1.3 x 1.4 cm (series 801 image 32).LIVER, BILIARY TRACT: Several mildly T2 hyperintense intense, T1 hypointense lesions with restricted diffusion and ill-defined margins in the right lobe of the liver suspicious for metastases. The largest in segment 8 measures 2.0 x 1.9 cm (series 801 image 34). Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: In the expected location of the right adrenal gland, there is a 3.9 x 3.6 x 5.3 cm heterogeneous mass with restricted diffusion and signal characteristics similar to the separate right renal mass (series 801 image 31, series 701 image 22). The normal right adrenal gland is not visualized. The left adrenal gland is unremarkable.KIDNEYS, URETERS: In the right lower pole, there is a large heterogeneous mass with well-defined margins and restricted diffusion measuring 10.4 x 8.2 x 8.7 cm (series 801 image 16, series 701 image 22). There is extension of this mass into the left renal vein and IVC (series 801 image 23-28; series 701 image 14). The tumor extends superiorly just proximal to the level of the intrahepatic IVC and inferiorly to the level of L3. Moderate to severe left hydronephrosis that extends to the pelvis, outside the field of view. Nonspecific urothelial wall thickening of the proximal left ureter. RETROPERITONEUM, LYMPH NODES: Aortocaval lymph node measures 2.3 x 2.8 cm (series 801 image 21). BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scattered perineural or synovial cysts. Focal T2 hyperintense, T1 hypointense lesion in the left L1 posterior vertebral body with extension into the pedicle suspicious for metastasis. OTHER: No significant abnormality noted.
1.Large right renal mass suspicious for renal cell carcinoma with extension into the right renal vein and IVC. 2.Retroperitoneal lymphadenopathy. 3.Probable hepatic, pulmonary, and osseous metastases.4.Moderate to severe left hydroureteronephrosis that extends into the pelvis. No obstructive lesion identified within the abdomen, although the pelvis is not imaged. Nonspecific proximal ureteral wall thickening. 