CT Abdomen & Pelvis Multiphase

Name : Basim Mohd Abdlh Albalawi

MRN : 5388621
Date : 06 June 2022

</TECHNIQUE/>:Routine enhancing scan of the chest abdomen and pelvis was obtained as multiphasic liver
protocol and compared to the previous CT of March 2, 2022.

</FINDINGS/>:Interval increase in the size of the metastatic mediastinal and bilateral hilar lymph nodes, for
example wall of the pretracheal lymph nodes used to measure approximately 1.6 cm while currently measures
approximately 2.4 cm. When of the left hilar lymphadenopathy is used to measure approximately 1.1 cm while
currently measures approximately 1.9 cm. The right retrocrural lymph node used to measure approximately 1.7 cm
while currently measures approximately 2 cm. The bilateral hilar lymph nodes are compressing the branches of the
pulmonary artery. However the major mediastinal vascular structures are all patent. Small pericardial effusion is
seen. No suspicious pulmonary nodule. Interval development of a small bilateral pleural effusions with no gross
pleural nodules.There are multiple hypervascular hepatic lesions representing the known metastatic fibrolamellar
hepatoma, many of them are stable while some have slightly increased in size, for example one of the lesions in
segment seven used to measure approximately 1.7 cm while currently measures approximately 2.8 cm. When of
the lesions in segment six used to measure approximately 1.2 cm while currently measures approximately 2.1 cm.
There is mild interval increase in the size of the multiple metastatic porta hepatics, retroperitoneal, perigastric,
peripancreatic and pelvic lymph nodes, for example one of the left para-aortic lymph nodes used to measure
approximately 4.5 cm while currently measures approximately 5 cm. All of the perigastric lymph nodes used to
measure approximately 1.5 cm while currently measures approximately 2 cm.The multiple porta hepatics lymph
nodes are causing severe compression on the main portal vein which is still patent. Hepatic veins are patent as well.
Gallbladder is partially distended. No significant biliary dilatation. The spleen, pancreas and adrenals are within
normal. There is interval development of bilateral moderate hydroureternephrosis with delayed excretion of
contrast in the left kidney due to obstruction by the multiple large retroperitoneal lymph nodes.Stable peritoneal
nodules which are most obvious in the pelvis with mild progression of the ascites. Signs of progression of the
metastatic skeletal lesions which are most obvious in the lumbar spine, the used to be very faint while currently,
they are more obvious, one of them at the level of L3 used to measure approximately 1.4 cm while currently
measures approximately 2.5 cm.

</CONCLUSION/>:The patient is a known case of metastatic fibrolamellar hepatic cellular carcinoma with signs
of disease progression manifested by enlargement of the lymph nodes in the chest, abdomen and pelvis with
increase in the size of the metastatic liver lesions and metastatic skeletal lesions.Interval development of a new
bilateral small pleural effusions with progression of the ascites. Stable peritoneal metastatic nodules. The metastatic
retroperitoneal lymph nodes are causing a newly developed bilateral moderate hydroureternephrosis with delayed
excretion of contrast in the left kidney. They are causing compression on the main portal vein which is still patent.