MDCT SCAN OF THE WHOLE ABDOMEN HIST

MDCT SCAN OF THE WHOLE ABDOMEN
HISTORY: CA stomach S/P surgery with back pain.

TECHNIQUES: Plain, venous and delayed axial scans of the whole abdomen were performed.

COMPARISON: 12/10/2015.
FINDINGS:
Lower thorax: A 4-mm pulmonary nodule at left basal lung. Small amount of left pleural effusion.
Liver and biliary: Slightly increased size of three cystic lesions at hepatic segment II, V and VIII, size 0.6-2.1 cm.
Increased size of necrotic mass at porta hepatis with caudate lobe invasion, now about 3.1x6.2x4.9 cm; causing intrahepatic duct dilatation (more degree in right hepatic lobe), severe narrowing of intrahepatic IVC and suspicious for right portal vein thrombosis with patchy perfusion abnormality at hepatic segment IV and VIII.
Gallbladder: No gallstone or mass.
Spleen: Increased size of necrotic mass abutting anterior aspect of spleen with presence of internal air bubble. Progression of splenic invasion, now seen as large rim enhancing cystic splenic lesion, about 7.8x4.4 cm in size. Associated irregularity of posterior splenic capsul, suspicious for concealed rupture of lesion. The lesion also extended to involved splenic flexure colon seen as short segmental wall thickening, about 3.0 cm in length. No evidence of obstruction.
Pancreas: Increased size of 3.2-cm necrotic mass at gastrohepatic region abutting pancreatic body.
Adrenals: No nodule.
Kidneys/ureters: Normal size and excretory function of the both kidneys. No stone, hydronephrosis or solid mass. A small right renal cortical cyst.
Bladder and pelvic organs: Unremarkable.
GI tract: Post total gastrectomy with patent esophagojejunostomy anastomosis.
Peritoneum/lymph nodes: Increased size of peritoneal nodules at the rectovesical pouch with possible rectal invasion and hepatorenal fossa with hepatic segment VI invasion. No free air or free fluid. Newly seen 0.9-cm peritoneal nodule attached to hepatic flexure colon.
No significant change in size of 3.0-cm mass at right-sided pararectal area without definite enhancement.
Bony structures: No suspicious lytic or blastic lesion.

IMPRESSION: Suggestive of progressive disease seen as
- Increased size of necrotic mass/node at anterior aspect of spleen with progressed splenic and splenic flexure colon invasion.
: Associated irregularity of splenic capsule; concerning for concealed rupture of lesion.
: Presence of air in necrotic mass could be due to superimposed gas forming infection or forming bowel fistula.
- Increased size of infiltrative mass/node at porta hepatis with caudate lobe invasion; causing intrahepatic duct dilatation.
- Increased size of 3.2-cm necrotic mass/node at gastrohepatic region abutting pancreatic body.
- Increased size of peritoneal metastatic nodules at hepatorenal fossa with liver invasion and rectoveical pouch with possible rectal invasion and a new peritoneal nodule abutting hepatic flexure colon.
- A 4-mm pulmonary nodule at left basal lung; lung metastasis should be considered.
- Small amount of left pleural effusion.