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17 July 2011

Report: CT Chest/Abdo/Pelvis With IV Cont
Date: 17/07/11 14:13

CT CHEST, ABDOMEN AND PELVIS

INDICATION:
Presents with abdominal mass. Ultrasound shows left retroperitoneal tumour. Quey neuroblastoma or Wilms tumour.

TECHNIQUE:
Multiaxial image acquisition through the chest, abdomen and pelvis following uncomplicated IV and oral contrast. The patient is studied under general anaesthesia.

FINDINGS:
No previous imaging available for comparison.

CHEST:
Multiple prominent lymph nodes are detected in the left aXilia, witb the largest node's short axis measuring 7 mm. No size significant mediastinal or hilar or right axillary lymphadenopathy. Lungs and pleural spaces are normal. No pulmonary nodules or mass lesions

ABDOMEN AND PELVIS:
Thers is a large, predominantly hypodense, heterogeneous mass identified in the left flank, which appears to arise from the postero superior aspect of the left kidney. A thin rim of renal cortex remains external to the mass, in a 'claw' configuration. The normally enhancing portion of the left kidney is displaced inferiorly. The mass measures 9.3 x 8.1 x 11.3 cm . (AP x TV x CC) and contains a 5 mm calcific density in the centre of the mass. This lesion extends across the midline, with extensive para-aortic and pelvic lymphadenopathy. In particular, a large nodal mass is identified anterior to left iliac artery and measures 2.6 x 2.6 x 3cm (AP x TV x CC). The splenic vein is displaced anteriorly, and draped across the anterior aspect of the mass. Left renal vein, is displaced inferiorly. No evidence of vascular invasion.

Appearances of the liver, spleen, pancreas, gallbladder, right adrenal gland and right kidney are within normal limits. Left adrenal gland can not be identified. Oral contrast has passed to tbe distal transverse colon. No evidence of bowel obstruction. Large bowel and small bowel are normal in calibre.

No suspicious bony lesions identified.

IMPRESSION:
1. Large heterogeneous, predominantly hypodense mass, arising from the left kidney posterosuperiorly . The appearance is suggestive of Wilm's tumour.

2. Extensive para aortic and left pelvic lymphadenopathy with a few prominent lymph nodes identified in left axilla. In particular, a large left pelvic lymph node is amenable for biopsy.

3. No suspicious bony, hepatic or pulmonary lesions identified.

Reported by Dr. (Radiology fellow)
Co-report by Dr. (Radiology consultant)
Acknowledge by Dr.

 

25 August 2011

Report: CT Abdomen/Pelvis With IV Contrast
Date: 25/08/11 15:15

CT ABDOMEN/PELVIS

CLINICAL HISTORY:
Neuroblastoma follow-up after 2 courses of chemotherapy.

TECHNIQUE:
Portal venous phase scan with oral contrast.

FINDINGS:
The left suprarenal mass has reduced in size in the interval period, measuring approximately 55 mm (trans) 55 mm (AP) by a 68 mm (cranio-caudal) compared with 80 x 90 x 105 mm previously. Internally it is of lower density, suggesting internal necrosis. The extensive retroperitoneal adenopathy, extending along the left external iliac vessels, has mostly resolved. There is residual 9 mm x 7 mm node located anterior to the left external iliac vessels, but this has reduced in size, having measured 27 mm x 25 mm previously.

The liver, gallbladder, biliary tree, spleen and pancreas are unremarkable. The right kidney has normal appearance.

The upper pole of the left kidney is indented by the suprarenal mass but the kidney is otherwise unremarkable.

No free fluid.

The long bases demonstrate minimal atelectasis only.

There is a linear lucency with some surrounding sclerosis adjacent to the costochondral junction of the right 9th rib. If anything, it is a little less prominent than on the previous scan. An 8 mm by 3 mm lucent area with sclerotic margins is noted in the left proximal femoral metaphysis. This is unchanged from the previous scan.

CONCLUSION:
The left suprarenal mass and retroperitoneal/left iliac adenopathy have shown a good response to treatment as described. I note no abnormality was seen on the previous bone scan in the region of the ninth rib abnormality. It's CT appearance is non-specific but a metastatic lesion cannot be excluded. The lesion in the left proximal femoral metaphysis has a benign appearance.

Reported by Dr (Radiology Fellow)
Supervised by Dr (Consultant Radiologist)
Acknowledged by Dr