Left renal mass. Weight loss and anorexia. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size, morphology and signal intensity. No focal suspicious liver lesion or biliary ductal dilatation. The vessels appear patent. Minimally distended gallbladder.SPLEEN: The spleen measures 11.4 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: The left adrenal gland is mildly thickened without a discrete lesion.KIDNEYS, URETERS: There is a very large mass replacing a large portion of the left kidney with a large exophytic component, measuring approximately 16 x 15 cm maximal cross-section 20 cm in craniocaudal dimension. There are regions of reniform enhancement anteriorly and inferiorly with tumor infiltrating throughout the renal parenchyma. The mass is multilobulated and heterogeneous in signal intensity and demonstrates heterogeneous postcontrast enhancement with central and posterolateral regions of nonenhancement consistent with regions of necrosis. The mass causes mass effect on the spleen superiorly, the stomach pancreas, small bowel, duodenum and descending colon anteriorly. The mass abuts and displaces the pancrease and duodenum. There is mass affect on the left psoas muscle. The mass encases and narrows the left renal artery and abuts the anterior left lateral aspect of the aorta. The left renal vein is nondistended. A large feeding vessel off the anterior aspect of the distal abdominal aorta courses through an exophytic lobular component of the tumor inferiorly (series 1301, image 560) and gives off feeding vessels to the mass anteriorly.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small left pleural effusion. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The appendix is thickened up to 2.2 cm with nodular thickening at its base. Ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1. Large left renal mass resulting in extensive regional mass effect and adjacent organ abutment. No distal metastatic disease is evident.2. Thickened appendix up to 2.2 cm which nodular thickening at its base. This may represent a mucocele or a mucinous adenocarcinoma of the appendix. 2. Small left pleural effusion. 