50-year-old female with metastatic colon cancer, left hydronephrosis, flank pain ABDOMEN:LIVER, BILIARY TRACT: T2 hyperintense segment 7/8 hepatic lesion is unchanged and compatible with a cyst. Reference right hepatic lesion is stable to slightly increased in size. There is a lesion in the caudate lobe with faint T2 hyperintensity. Restricted diffusion along the right liver lobe capsule is suspicious for metastatic seeding.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Grade 3 left hydroureteronephrosis with mild restriction of the left kidney parenchyma. The left ureter is dilated down to the level of a left periureteral lesion measuring 2.4 x 2.5 cm, slightly increased when compared to the prior examination measurement.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild tethering of colon and small bowel adjacent to a reference periureteral pelvic lesion without evidence of obstruction. Scattered left subcentimeter peritoneal nodularity.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: There is minimally heterogeneous solid, T1 hypointense, T2 isointense left adnexal mass measuring 4.8 x 5.1 cm, not present on the prior study. There is a heterogeneous right adnexal lesion measuring 2.3 x 2.4 cm, also not present on the prior study. Mild tethering of the vagina adjacent to the periureteral pelvis lesion.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Focus of enhancement along the sigmoid mesentery measuring 1.2 x 1.3 cm. Small amount of free fluid within the dependent portion of the pelvis. There is no evidence of obstruction.There is a right peritoneal nodule or abnormal lymph node measuring 9 x 9 mm (series 1304, image 463) and adjacent lymph nodes similar to the prior examination.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 11/30/2016 09:45:00)CAUDATE LIVER LESION: 1.7 x 0.9 cm (Image 37, Series 701); 1.5 x 1.0 cm on prior (12/3/2015) (Image 97, Series 5).L PERITONEAL FOCUS: NOT MEASURED OR NOT INCLUDED IN CURRENT EXAM; 0.6 x 0.9 cm on prior (11/4/2016) (Image 88, Series 201).L PERIURETERAL LESION: 2.5 x 2.4 cm (Image 255, Series 1306); 1.5 x 1.1 cm on prior (11/4/2016) (Image 132, Series 201).SEGMENT 8/7 LIVER LESION: 0.7 x 0.7 cm (Image 45, Series 701); 0.7 x 0.7 cm on prior (11/4/2016) (Image 62, Series 201).RIGHT HEPATIC LESION: 1.8 x 1.4 cm (Image 43, Series 701); 1.8 x 1.4 cm on prior (11/4/2016) (Image 63, Series 201).LEFT ADNEXAL LESION: 5.1 x 4.8 cm (Image 219, Series 1305).RIGHT ADNEXAL LESION: 2.3 x 2.4 cm (Image 249, Series 1305).SIGMOID MESENTERY LESION: 1.2 x 1.3 cm (Image 265, Series 1310).
1.Left periureteral lesion as described above resulting in unchanged left grade 3 hydroureteronephrosis and tethering of adjacent colon and bowel. Enhancing sigmoid mesentery nodularity as above.2.New bilateral, left greater than right, adnexal lesions as described above suspicious for metastases.3.Right liver lobe and caudate lesion compatible with metastatic disease. 4.Peritoneal nodularity and liver capsule seeding as described above.5.Other findings and reference measurements as above.