Male 67 years old Reason: atypical renal cyst, hematuria History: hematuria The absence of intravenous and oral contrast limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made:ABDOMEN:LIVER, BILIARY TRACT: Multiple T2 hyperintense lesions within the liver. These are incompletely characterized in the absence of intravenous contrast but have a benign appearance may represent cysts/hemangiomas. A T2 hyperintense lesion at the hepatic dome (series 701, image 30) demonstrates thin internal septations and in the absence of intravenous contrast is indeterminate.Mild loss of signal on in phase images raising the possibility of iron deposition.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Scattered subcentimeter T2 hyperintensities within the left kidney which are most consistent with renal cysts. There is a 1.6 x 1.4 cm T2 hyperintensity within the mid/lower pole of the right kidney. This corresponds to the complex lesion identified on prior ultrasound. On axial and coronal T2 weighted images there is a suggestion of solid component on the medial wall (series 701, image 10; series 801, image 24). There is no diffusion restriction. Evaluation of this is limited however in the absence of intravenous contrast. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.
1. T2 hyperintense lesion within the right kidney with internal complexity as detailed above. This is stable in size compared to prior studies however remains indeterminate in the absence of evaluation with intravenous contrast. Further discussion with the referring service provides a history of allergy to iodinated contrast. As there is no cross-reactivity between iodinated and gadolinium-based contrast agents, if patient's eGFR supports it, this lesion would be more optimally imaged with additional postcontrast sequences. 2. A T2 hyperintense lesion at the hepatic dome demonstrates thin internal septations and in the absence of intravenous contrast is indeterminate. This could also be further evaluated with additional postcontrast sequences.3. Mild loss of signal on in phase images raising the possibility of iron deposition. 