68 year old male with metastatic renal cell cancer and known mets to lung and liver. Rule out biliary tree obstruction. Jaundice, elevated LFTs This examination is limited by absence of IV contrast. CHEST:LUNGS AND PLEURA: Large right and moderate left pleural effusions with associated compressive atelectasis. Mild cardiomegaly. Pulmonary nodules are suspicious for diffuse metastases. MEDIASTINUM AND HILA: Cardiomegaly. CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Questionable hypoechoic lesion in the inferior right hepatic lobe. The lesion measures 7.5 cm in diameter at axial image 103 of series 3. MRI, even an exam without contrast, may be helpful for further evaluation. Hepatomegaly. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post left nephrectomy. Large amount of metal streak artifact in the left perirenal region due to numerous large surgical clips in that area obscures local details. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of ascites. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
Bilateral pleural effusions. Lung nodules are suspicious for metastases. Ascites. Questionable large lesion in right hepatic lobe, may be further evaluated with MRI/MRCP, if indicated. 