23 year old male with a history of testicular cancer and EtOH abuse with liver lesion on recent CT examination. Evaluate for metastasis versus focal fatty liver. ABDOMEN:LIVER, BILIARY TRACT: Note is made of a wedge shaped area in the posterior right hepatic lobe with associated decreased enhancement relative to the liver parenchyma on arterial weighted post contrast sequences. However, there is also delayed enhancement in this area. These findings appear most consistent with a perfusion abnormality of the liver. No focal mass lesions are identified. No evidence of intra-or extrahepatic biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a 1.9 cm nodule with increased T2 signal abnormality in the left lower lobe, which is incompletely visualized/characterized on this examination, but is suspicious for metastatic disease. There is also a focus of fluid signal intensity in the retrocrural region anterior to L1 vertebral body measuring 1.8 x 1.3 cm (13; series 3). There is no associated enhancement on post contrast enhanced sequences.
1.Focal area in the posterior right hepatic lobe with imaging characteristics most consistent with a perfusion abnormality. No convincing evidence of metastatic disease involving the liver.2.Left lower lobe nodule is incompletely visualized/characterized but consistent with the stated history of metastatic disease. 3.Nonspecific retrocrural cystic lesion along the anterior L1 vertebral body which appears slightly increased in size when compared to the prior CT examinations, and may be postoperative in nature, although metastatic adenopathy cannot be entirely excluded. 