86-year-old female history of HCV cirrhosis. ABDOMEN:LUNG BASES: Large right pleural effusion with layering cellularity and associated atelectasis. Masslike restricted diffusion in the right perihilar region may represent a primary lung malignancy.LIVER, BILIARY TRACT: Interval development of innumerable lesions scattered throughout the liver parenchyma demonstrating increased T2 signal abnormality with no appreciable enhancement. These lesions are compatible with metastatic disease.Cirrhotic liver morphology. Cholelithiasis. No intra or extra hepatic biliary ductal dilatation. The portal vein, hepatic vein, and hepatic arteries are patent.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is not well visualized due to motion artifact.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: There are retroperitoneal nodules present bilaterally with reference right retroperitoneal lesion measuring 18 x 12 mm (image 21 series 601).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Innumerable osseous metastases.OTHER: Moderate volume ascites.
Interval development of innumerable hepatic, osseous, and retroperitoneal lesions, most likely metastatic in etiology. Given the presence of a right perihilar masslike area of restricted diffusion and large right pleural effusion, the constellation of findings suggest a primary lung malignancy, probably adenocarcinoma. Dedicated chest CT is recommended.The liver lesions would be amenable to ultrasound guided biopsy.