Clinical History: Liver Neoplasm, Followup

Technique: CT of chest, abdomen, and pelvis is performed following limited oral as well as IV contrast. The patient did vomit some of oral contrast. The patient was injected with 100 CC of Optiray. Correlation with a chest only CT of 12/30/2008

Findings: Again there is a large mass in the right posterior mediastinum measuring 8.6 x 5.3 CM. This has enlarged slightly. This does cause some deformity on the right lower lobe bronchus. This abuts the carina. There may be a small precarinal node but otherwise no other definite mediastinal areas of adenopathy are seen. There is also small nodule in the left lower paraspinal region, grossly unchanged.

The lung parenohyma demonstrates bilateral nodules. Some of these have increased slightly in size including in the left upper lobe and right lower lobe. A larger right lower lobe nodule just above the diaphragm is grossly unchanged.

In the upper abdomen there is a large heterogeneous mass in the right lobe of the liver. This measures 8 CM in diameter and does appear somewhat more heterogeneous than before. There is increased ascites within the upper abdomen and pelvis. While only limited amounts of the abdomen are included in the previous study these peritoneal masses have markedly increased. Findings are compatible with extensive peritoneal carcinomatosis.

The spleen, pancreas and left adrenal gland is grossly unremarkable. The right adrenal is somewhat difficult to visualize and may be thickened. Both kidneys do excretecontrast without definite mass. I suspect that there is a necrotic appearing lymph node in the peripancreatic region 2 CM in diameter. Otherwise no obvious bowel distension is clearly identified. No suspicious bony lesions are seen.

Impression: Extensive peritoneal carcinomatosis and ascites which I believe has worsened from the CT of last December. Large posterior mediastinal mass grossly unchanged. Slight progression of lung nodules. Large liver mass which appears somewhat more heterogeneous than before although grossly unchanged in size.