History of questionable peritoneal carcinomatosis on CT. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size and signal intensity. A few small cysts are again noted in the right hepatic lobe and in segment 1.No suspicious liver lesion.Normally distended gallbladder.No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is normal in morphology, signal intensity and enhancement. Mild prominence of the main pancreatic duct up to 5 mm, unchanged. No obstructing lesion is evident.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small aortocaval lymph node measuring 1.0 x 0.7 cm (series 1902/45).BOWEL, MESENTERY: Demonstrated again are small mesenteric lymph nodes as well as enhancing nodularity of the peritoneum within the left lower quadrant.BONES, SOFT TISSUES: New small pleural effusions.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus is normal in size and contains a heterogeneously enhancing left posterior subserosal 4.2 x 2.6 cm fibroid. Additional right body pedunculated fibroid measuring 1.4 cm. The endometrium is normal in thickness. The inner myometrial/junctional zone is unremarkable..The adnexa are atrophic and difficult to visualize. No adnexal mass lesion is evident.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small volume pelvic ascites.BONES, SOFT TISSUES: Heterogeneous enhancement of the pelvis is compatible with known Paget's disease. Focal osseous enhancing foci are also noted. No cortical disruption is evident. OTHER: No significant abnormality noted.
Enhancing peritoneal nodularity is again noted. No adnexal mass lesion is seen. Malignancy of unknown primary is still suspected. PET/CT or tissue sampling of a peritoneal soft tissue nodule should be considered. New small pleural effusions and ascites. 