56-year-old male who presents for renal cell cancer surveillance monitoring. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology without evidence of a focal lesion or biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy. Again noted is several enhancing soft tissue nodules in the dorsal lateral retroperitoneal space.The largest nodule measures 3.0 x 1.4 cm (series 1002, image 437), previously remeasured as 3.0 x 1.4 cm.Another discrete nodule more inferiorly measures 0.8 cm (series 1002, image 362), unchanged.Additional discrete perisplenic implant on the left lateral transversalis fascia is unchanged (series 1002, image 552).RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a new rim-enhancing lesion anterior to the spleen in left upper abdomen (series 1002, image 527).BONES, SOFT TISSUES: In the lower left lateral abdominal wall musculature, there is a 1.8 x 1.0 cm enhancing nodule (series 1002, image 162) not significantly changed.OTHER: No significant abnormality noted.
1.Status post left nephrectomy with enhancing soft tissue nodularity in the left retroperitoneum suspicious for residual/recurrent disease, which is not significantly changed.2.Additional nonspecific enhancing soft tissue nodule in the left lateral abdominal wall musculature is not significantly changed and may represent another site of metastatic disease.3.New mesenteric rim-enhancing lesion anterior to the spleen highly suspicious for necrotic metastatic focus.4.Near complete resolution of enhancing lesion in the left gluteal maximus muscle, likely prior site of inflammation.