Evaluate the biliary system. History of metastatic renal cell carcinoma and rising bilirubinemia. The examination is limited by respiratory motion.ABDOMEN:LIVER, BILIARY TRACT: Moderate volume perihepatic ascites. At the junction of the right and left hepatic ducts there is an ill-defined intermediate T2-weighted signal intensity lesion measuring approximately 2.8 x 2.6 cm (series 501/26). The signal abnormality appears to extend along the portal branches. This is associated with moderate intrahepatic biliary ductal dilatation.There are additional intermediate T2-weighted signal foci in the liver suspicious for metastatic disease (series 401/11). The common bile duct is minimally prominent but tapers smoothly to the level of the ampulla without a discrete filling defect.Gallbladder sludge. The vessels are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst. Post-surgical changes of a partial left nephrectomy. RETROPERITONEUM, LYMPH NODES: Periaortic lymphadenopathy, see reference measurements from prior CT.BOWEL, MESENTERY: Moderate volume ascites.BONES, SOFT TISSUES: Extensive body wall edema/anasarca. Numerous enhancing osseous metastases most prominently involving the pelvis.OTHER: Large right greater than left pleural effusion. There appears to be loculation/complexity of the left pleural effusion. Adjacent consolidation/atelectasis. A left lateral chest tube is noted.
1. Interval increase in the metastatic lesion involving the junction of the right and left hepatic ducts with worsening now moderate intrahepatic biliary ductal dilatation. No choledocholithiasis. Additional liver metastases are noted.2. Extensive osseous metastases and retroperitoneal metastatic lymphadenopathy.3. Large right greater than left loculated pleural effusions with associated consolidation and/or atelectasis.