History of right liver lobe mass. s/p large VHR repair without mesh now with wound dehiscence, please eval for fascial integrity History: 52 yo M s/p emergent colectomy with primary anastomosis for perforated contained diverticulitis in 2009, c/b anastomotic leak, requiring several repeat operations including a diverting ileostomy now s/p VHR by Dr. Gottlieb on 5/12/2015 ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size. Demonstrated again is a large mass in the right hepatic lobe with lobular margins measuring up to 8.3 x 7.4 cm (series 901/385) compared to 8.1 x 7.4 cm previously, not significantly changed accounting for technical differences. The lesion is intrinsically peripherally hyperintense on T2-weighted imaging with central hypointensity. It demonstrates peripheral thick and internal thick enhancement. Centrally there is no obvious enhancement. No wash-out is evident. There is associated thrombosis of a right portal vein branch. No associated biliary ductal dilatation.SPLEEN: Splenomegaly measuring 15 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: As seen on the prior CT there are large para-esophageal and gastrohepatic and right cardiophrenic lymph nodes. For future reference a right cardiophrenic lymph node measures 1.7 x 1.0 cm (series 5 on 1/29).BOWEL, MESENTERY: No significant abnormality noted. Right lower quadrant colostomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
The right hepatic lobe mass is more suspicious for neoplasm as opposed to an abscess. Differential considerations include cholangiocarcinoma or metastases. Tissue sampling is recommended.Enlarged paraesophageal, gastrohepatic and right cardiophrenic lymph nodes.