History of hepatocellular carcinoma in transplanted liver. ABDOMEN: The study is limited by extensive susceptibility artifact from the patient's surgical hardware.LIVER, BILIARY TRACT: Orthotopic liver transplant.A large portion of the liver cannot be evaluated due to susceptibility artifact from the patient's stent.Multiple small liver lesions are again noted some of which demonstrate intrinsic T1 weighted intensity and/or arterial enhancement, some with washout, again suspicious for dysplastic nodules and/or multifocal HCC. The reference segment 5 lesion measures approximately 1 cm (series 12/64). No definite new lesion although evaluation is markedly limited.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: Demonstrated again are bilateral heterogeneous periaortic masses.The right periaortic mass measures approximately 9.8 x 7.4 cm, compared to 9.6 x 7.2 cm previously.The left periaortic mass measures approximately 10.1 x 9.4 cm, compared to 10.2 x 9.3 cm previously.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Ventral midline incisional fat-containing hernia.OTHER: Large right-sided pleural effusion with right lower lobe compressive atelectasis with an enhancing pleural-based nodule measuring approximately 1.6 cm (series 11/29), unchanged.
1.Essentially stable large masses of periaortic lymphadenopathy.2.The multiple liver lesions are not significantly changed in size or number, and again are suspicious for multiple dysplastic nodules and/or multifocal HCC. Please note evaluation is limited by extensive susceptibility artifact from the patient's IVC stent. Consider CT evaluation on follow-up examinations if more optimal visualization of liver parenchyma, portal veins, and/or hepatic veins would be helpful for clinical care.3.Stable large right-sided pleural effusion and 1.6 cm enhancing pleural nodule.