History of tuberous sclerosis with pancreatic neuroendocrine tumor and renal angiomyolipoma status post partial nephrectomy and distal pancreatectomy. Status post prior splenectomy. ABDOMEN:LIVER, BILIARY TRACT: Demonstrated again are multiple small hepatic T2 hyperintense lesions which demonstrate signal dropout on fat-suppressed imaging compatible with small hepatic angiomyolipomas, unchanged. No suspicious liver lesion. No intra or extrahepatic biliary ductal dilatation.SPLEEN: Status post splenectomy.PANCREAS: Postsurgical changes from a distal pancreatectomy without specific evidence of residual or recurrent tumor.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal masses are again seen and mostly demonstrate partial or complete macroscopic fat signal intensity and avid contrast enhancement compatible with angiomyolipomas. Status post partial nephrectomy of the previously seen left lower pole angiomyolipoma. The dominant right angiomyolipoma involves the anterior cortex measuring 4.9 x 4.0 cm, minimally increased in size from 4.4 x 3.9 cm previously. There is a T2-weighted hypointense right posterior cortex superior pole lesion demonstrating avid enhancement which is unchanged measuring 2.5 x 1.9 cm and is more compatible with an angiomyolipoma. None of the larger lesions demonstrate typical signal characteristics of a renal cell carcinoma.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: A fatty lesion adjacent to the left ventricle is again seen and is unchanged.
1.Postsurgical changes from partial left nephrectomy, distal pancreatectomy and splenectomy.2.Bilateral renal masses are again noted and are most compatible with angiomyolipomas including a 4.9 cm right renal angiomyolipoma which is slightly increased in size from the prior.3.Stable multiple hepatic lesions are compatible with angiomyolipomas.