78-year-old man with history of bladder cancer status post cystectomy, now with left renal mass on CT. ABDOMEN:LIVER, BILIARY TRACT: There is slight loss of parenchymal signal on opposed phase imaging. Multiple hepatic cysts are noted. The gallbladder is normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: Spleen appears normal.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: There is new, nodular thickening of the lateral limb of the left adrenal gland (series 13, image 40) measuring 18 x 12 mm. The signal characteristics of this nodule are similar to those of the left renal mass described below.KIDNEYS, URETERS: In the inferior pole of the left kidney, there is a 38 x 24 mm lesion extending from the renal collecting system to the posterior cortex (series 13, image 32). The hilar portion of this lesion has a rim of high T1 signal on precontrast images (series 12, image 32) and the remainder of the lesion demonstrates only mild enhancement.A punctate T1 hyperintense cyst is seen in the inferior pole of the left kidney, likely hemorrhagic.There is a right inferior pole renal cyst, otherwise the right kidney is normal.RETROPERITONEUM, LYMPH NODES: There is a 14 x 11 mm left para-aortic lymph node (series 12, image 39) with diffusion restriction.BOWEL, MESENTERY: There is at least a small hiatal hernia. Postoperative findings are noted with a right lower abdominal ostomy.BONES, SOFT TISSUES: Probable hemangiomas in L1 and L2.OTHER: Partially imaged right-sided ostomy (patient status post cystectomy).
1.Tumor involving left inferior pole renal collecting system and cortex. Imaging appearance suspicious for papillary urothelial carcinoma arising from collecting system and extending into renal parenchyma, with internal hemorrhage.2.Present on 10/6/15 CT imaging left adrenal nodule and retroperitoneal lymph node suspicious for metastatic disease.