Female 53 years old Reason: suspected rectovaginal fistula, advanced stage fallopian tube cancer History: stool through vagina PELVIS:UTERUS, ADNEXA: Status post hysterectomy. There is masslike thickening of the vaginal vault measuring 5.5 x 4.3 cm (series 1302, image 417). There is fistulation between this mass and the right lateral wall of the rectosigmoid colon. The neck of the fistula measures 1.2 cm (series 501, image 43). There is loss of the normal fat plane between the mass and the posterior wall of the bladder suggesting focal invasion.BLADDER: Please see above.LYMPH NODES: Multiple necrotic lower aortocaval, common iliac, bilateral internal and external iliac lymph nodes are identified. An enlarged aortocaval lymph node measures 2.1 x 1.4 cm (series 1302, image 812). A reference left common iliac node measures 1.9 x 2.8 cm (series 1302, image 672). These demonstrate diffusion restriction and are suspicious for malignant involvement.BOWEL, MESENTERY: Please see above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is mass effect on the right external iliac vein by enlarged right pelvic sidewall lymph nodes. Nonocclusive organized filling defect within the right common femoral vein most likely representing chronic deep venous thrombosis.
Necrotic mass in the vaginal vault suspicious for tumor recurrence with fistulation to the adjacent rectosigmoid colon. Multiple necrotic lymph nodes are suspicious for malignant involvement. There is also suspicion for focal invasion of the bladder wall.Findings discussed with Dr. Jean Rudnicki by myself Dr. Ward at time of dictation 03/31/15.