0:00

So another challenging case here.

0:02

On T2 weighted images, as we scroll through,

0:04

we can see a lesion in the pancreatic tail,

0:07

which is expanding the entire parenchyma.

0:11

It is showing some kind of heterogeneous

0:13

T2 weighted intermediate to

0:16

hyperintensity scattered here and there.

0:18

It is well-defined, well-circumscribed, uh, within

0:22

the parenchymal outline of the pancreas, but it

0:26

is. And as we scroll further, we can see another

0:30

deposits in the left paracolic gutter, which has

0:33

some tortuous vessels along with the periphery.

0:35

And if we follow these vessels, some of

0:37

these vessels are actually traversing

0:40

towards the same area in the pancreatic

0:41

tail, uh, which we have seen earlier.

0:44

And then, um, in the right adrenal

0:47

gland, we can see a cystic lesion, uh,

0:53

surrounded by a rim of soft tissue.

0:55

In addition to that, we can see some

0:57

of the lesions in the right kidney,

0:59

for example, this one in the right upper pole.

1:01

And there are some scattered areas of

1:03

heterogeneous intensity on T2 weighted

1:05

images, those look very concerning.

1:08

So once we have this kind of broad picture

1:11

in our mind, we can quickly move to the

1:13

coronal images and see how they look here.

1:16

On T2 weighted coronal images,

1:18

we can see the lesions once again,

1:21

they are looking suspicious, right?

1:23

Lower pole, lower pole.

1:24

Right upper pole looks more complex.

1:26

Cystic lesion in the right adrenal gland,

1:28

a lesion in the pancreatic tail, which is closely

1:32

abutting the surface of the stomach, and the left

1:34

upper quadrant lesion, uh, in the paracolic

1:37

gutter with tortuous vessels, those are draining

1:39

towards the lesion in the pancreatic tail.

1:42

And we can quickly confirm these

1:44

findings on post-contrast images.

1:46

And we can see this lesion is hyper-enhancing.

1:48

There are a few deposits along with

1:50

the periphery of the pancreas.

1:52

Outside the anticipated outline,

1:54

those tortuous vessels can be

1:56

easily seen on post-contrast images.

1:57

They are connecting these two lesions together.

2:00

So that is very obvious that that

2:02

deposit actually came from this place.

2:04

And then we can see this hyper-enhancing region

2:07

in the right lower pole, uh, which extends

2:10

up to the mid-pole, uh, or interpolar region.

2:14

And as soon as we reach the upper pole, we can

2:16

see that enhancing lesion looks very suspicious.

2:19

But in addition to that, we can find some of

2:21

the other areas, those who are not seen on

2:23

T2-weighted images, are those that happen enhancing

2:25

and they look separate from the parenchyma.

2:28

It looks like this right kidney

2:29

is developing multifocal RCCs.

2:31

And the left kidney is missing,

2:32

likely due to prior surgery because of the RCC.

2:35

Now, a patient presenting with multiple

2:37

deposits in the pancreatic tail, left

2:39

paracolic gutter, and the right adrenal gland.

2:42

In addition to that, there are

2:43

multiple RCCs in the right kidney.