History of liver transplant with recurrent hepatocellular carcinoma and extensive retroperitoneal metastatic lymphadenopathy. The study is limited by extensive susceptibility artifact from the patient's surgical hardware.ABDOMEN:LIVER, BILIARY TRACT: Orthotopic liver transplant. A large portion of the liver cannot be evaluated due to susceptibility artifact from patient's stent.Multiple new liver lesions are noted. Many of these are intrinsically T1-weighted hyperintense. Of these, several demonstrate arterial enhancement and washout, compatible with multifocal HCC in additional to multiple dysplastic nodules.For future reference a segment 5/6 lesion measures approximately 1 cm (series 100/50 and series 102/50). SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Bilateral heterogeneous periaortic masses. The right-sided mass measures 9.6 x 7.2 cm (series 3/17) compared to 11.7 x 10.2 cm previously. The left-sided mass measures 9.3 x 10.2 cm (series 3/17), compared to 10.2 x 9.4 cm previously. The masses displace loops of small bowel.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Incisional fat-containing hernia.OTHER: Large right-sided pleural effusion with right lower lobe compressive atelectasis. Enhancing pleural nodule (series 1 102/84) measures 1.6 x 1.2 cm, unchanged.
1.Mild interval decrease in the large bilateral periaortic lymph node masses.2.Multiple new liver lesions some of which meet imaging criteria for multifocal HCC. Others may represent dysplastic nodules and/or early-HCC. Consider CT evaluation to evaluate for the central aspect of the liver which is obscured by artifact.3.Large right-sided pleural effusion with a 1.6 cm enhancing pleural nodule. 