Evaluate for metastatic liver lesion in patient with known RCC and acute LFTs elevation ABDOMEN:LIVER, BILIARY TRACT: T2 hyperintense, nonenhancing hepatic foci, appearance consistent with cysts, largest measures 1.5 x 1.2 cm located in hepatic segment 4B, image 20 series 701. No biliary duct dilatation.SPLEEN: Near spleen subcentimeter soft tissue signal foci, most likely splenules.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy, no definite enhancing soft tissue attenuation seen to suggest local tumor recurrence. Heterogeneous right mid pole renal mass with associated restricted diffusion, suspicious for renal cell carcinoma, measures 6.9 x 5.4 cm x 5.5 cm in craniocaudal dimension on image 10 series 701, extends to level of right psoas muscle but no underlying associated invasion seen at this time as boundaries appear preserved. Internal T1 hyperintense areas likely reflect hemorrhagic/proteinaceous material. Although comparison to earlier CT difficult due to differences in modality and technique, mass appears larger than on earlier study, when measured 6 x 4.9 cm. Mild right-sided hydronephrosis secondary to mass effect from aforementioned right renal mass and possible tumor extension into collecting system, image 13 series 701 and coronal image 26 series 801. Adjacent fat stranding. Present on prior study is additional ill-defined rounded masslesion in lower pole of right kidney (versus tumoral extension/infiltration related to previously described dominant lesion), incompletely imaged on transaxial imaging, measuring approximately 5.9 x 4.8 x 6 cm in craniocaudal dimension, image 2 series 701. Additional sites of right renal parenchymal heterogeneity including midpole hypoenhancing wedge-shaped area on image 173 series 1007, evolving infarct not excluded, and additional subcentimeter renal T2 hyperintense foci, these likely cysts although small size makes definitive characterization difficult. Another T2 hypointense subcentimeter focus is seen in the right kidney and T1 iso to decreased signal seen, measuring 1.2 x 1 cm, image 13 series 501, this does not demonstrate restricted diffusion, may be a hemorrhagic cyst but is indeterminant. Visualized main right renal vein and artery appear patent.RETROPERITONEUM, LYMPH NODES: Mildly prominent retroperitoneal lymph nodes, submitted for reference aortocaval node measuring 3.6 x 1.4 cm and right perirenal lymph node measuring 1.8 x 1.3 cm, image 97 series 1006, without significant change.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Avidly enhancing left lower lobe lung lesion, measuring 2.4 x 1.9 cm, image 447 series 1006, compatible with metastatic disease, not present on earlier study. Only seen on coronal image 32 series 801 is ovoid focus in region of left lung apex, while not well assessed on this nondedicated exam and may be related to volume averaging artifact, but suspicious for additional metastatic lesion. Partially imaged pleural-based nodular thickening in anterolateral right middle lobe, measuring up to 1.2 cm. Trace pleural effusions.
1. No suspicious liver lesion.2. Right renal neoplasm(s), see discussion above, dominant mass likely mildly increased in size from prior exam. Mild right-sided hydronephrosis secondary to mass effect from aforementioned right renal mass and possible tumoral extension into collecting system. Additional wedgeshaped hypoenhancing area in midpole of right kidney suspicious for superimposed infarct versus neoplastic extension, present on prior CT study.3. Pulmonary metastatic disease, trace pleural effusions.4. Stable mild retroperitoneal lymphadenopathy, nonspecific.