64-year-old male with cachexia and bright red blood per rectum. Evaluate for malignancy and also for pancreatic pseudocyst; patient has experienced weight loss. ABDOMEN: LUNG BASES: New small bilateral pleural effusions with associated lower lobe volume loss bilaterally. Cachexia.LIVER, BILIARY TRACT: Hepatomegaly, the liver measures more than 20 cm craniocaudally. Diffuse fatty infiltration throughout the liver. The presence of fat limits the ability to see liver masses. If liver masses are of concern, MRI examination would be recommended. Heterogeneous soft tissue density is seen in the lateral segment of left lobe and in the right lobe described on the previous examination are most likely due to focal sparing from fat deposition due to lack of displacement of vessels.Gallstones and biliary sludge are present. No gallbladder wall thickening. No intrahepatic or extrahepatic biliary duct dilatation. Multiple subcentimeter hepatic hypodensities are too small to characterize.SPLEEN: No significant abnormality notedPANCREAS: Punctate focal calcification in the head of the pancreas. These were not present on 2008 examination and may be the sequela of pancreatitis. Pancreatic parenchyma otherwise appears normal with no mass is identified. No pancreatic ductal dilatation is seen.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No hydronephrosis. Subcentimeter left lower pole renal cortical hypodensity is most likely due to a simple cyst..RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse osteopenia without focal mass. Degenerative changes throughout the lumbar spine.OTHER: Small amount of ascites is new.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: A large soft tissue mass protrudes from the anus measuring 3 cm in diameter at coronal image 16/74. This may be due to rectal prolapse or prominent external hemorrhoids or both. The marked contrast enhancement most likely represents inflammatory change and possible bleeding focus in this mass.BONES, SOFT TISSUES: Bony ankylosis of the sacroiliac joints. Degenerative changes in the lumbosacral spine and pelvis.OTHER: Small amount of ascites is present.
1. Hepatomegaly. Diffuse fatty infiltration of the liver. 2. Gallstones and biliary sludge without acute cholecystitis. 3. New bilateral pleural effusions and small amount of ascites have developed since the prior exam. 4. Rectal prolapse and/or external hemorrhoids are probable source of melena. See above. 