71 year old female with history of clear cell carcinoma of the uterus, status post chemotherapy. Metastatic uterine cancer with known enlarged retroperitoneal lymph nodes, presents with 3 weeks of progressive bilateral lower extremity edema. Evaluate for IVC clot/compression. CHEST:LUNGS AND PLEURA: Multiple small micronodules are unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodense focus in the dome the liver is unchanged. There are no other focal lesions. Gallstones are unchanged, but the gallbladder is contracted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Double-J stent in the left kidney collecting system is unchanged. Mild left caliectasis is unchanged. On axial image 58/165 of series 3, a 1.8 x 2 cm left midpole renal cortical mass is found. In retrospect this was present on the prior examination, but the timing of contrast bolus was inadequate to delineate the mass. This mass may represent a metastasis or primary renal neoplasm.RETROPERITONEUM, LYMPH NODES: Left para-aortic mass invading the L4 lumbar vertebral body now measures 4.6 x 4.1 cm image number 83, series number 3. The mass encases the left ureter. Adjacent retroperitoneal adenopathy is also slightly smaller. Increasing distraction of the L4 vertebral segment with compression deformity. Increasing periaortic and left mesenteric adenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Destruction of the L4 vertebral body is increased.OTHER: No IVC obstruction was found. The IVC is narrowed at the inferior hepatic margin, without change from the prior examination.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Increasing periaortic and mesenteric lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is increasing edema within the dependent portion of the lower extremities on this scan which extends to the proximal thighs bilaterally.OTHER: Periaortic/psoas/L4 vertebral body mass with direct invasion of the psoas and vertebral body is approximately unchanged in size. New compression deformity of the L4 vertebral segment. The spinal canal is difficult to evaluate in MRI may be helpful for further evaluation, if cord compression is a concern.
2-cm diameter left midpole renal mass may be metastasis versus renal cell cancer.Slight increase in the size of the left psoas/L4 mass and retroperitoneal adenopathy. Increased destruction of L4 vertebral body with compression deformity. No other significant change from previous CT.