Female 50 years old; Reason: history metastatic renal cancer. presumed RT induced esophageal ulcer, with esophageal stent, assess for cancer progression History: epigastric pain CHEST:LUNGS AND PLEURA: Interval development of a small left pleural effusion.MEDIASTINUM AND HILA: Reference left para-aortic lymph node measures 1.2 x 0 .9 cm, previously 1.3 x 1.3 cm (image 687/series 2102). CHEST WALL: Surgical changes above the xiphoid process.ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There are postsurgical changes in the caudate. The reference poorly enhancing lesion within the right hepatic lobe measures 1.0 cm, previously 0.8 cm (image 533; series 2103), suspicious for metastatic disease. There is mild intrahepatic biliary ductal dilatation, unchanged. The hepatic and portal veins are patent.SPLEEN: The spleen is absent.PANCREAS: The pancreatic body and tail are severely atrophic. This is possibly due to radiation. Pancreatic duct is mildly prominent but not dilated, unchanged.ADRENAL GLANDS: Right adrenal gland is unremarkable. Left adrenal gland has been resected.KIDNEYS, URETERS: Status post left nephrectomy. Right kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: There postsurgical changes near the gastroesophageal junction. There is interval development of gastrohepatic lymphadenopathy (image 102: Series 2201).BOWEL, MESENTERY: Again seen is diffuse circumferential wall thickening of the distal esophagus near the GE junction. There is also thickening of the gastroesophageal junction, unchanged. This is in the region of prior nodal tumor. There is focal soft tissue thickening involving the gastric wall near the fundus about the gastroesophageal junction measuring 2.5 x 2.4 cm, previously 2.3 x 2.1 cm (image 593 series 2201). BONES, SOFT TISSUES: Postsurgical changes in the intra-abdominal wall and chest wall.OTHER: No upper abdominal fluid collections.
1.Persistent diffuse distal esophageal wall thickening with a soft tissue nodule in the adjacent gastric wall. This is located in the site of prior nodal disease and may represent recurrent disease.2.Persistent right hepatic lobe lesion.3.Persistent periaortic lymphadenopathy with interval development of gastrohepatic lymphadenopathy. 