Wk 4, Case 2 - Review

EXAM: CT Chest, Abdomen, and Pelvis W/ IV Contrast

INDICATION: Renal mass incidentally noted on right upper quadrant ultrasound.

TECHNIQUE: Axial CT images of the chest, abdomen, and pelvis were obtained after the administration of IV contrast. Coronal and sagittal reformats were obtained for greater anatomic detail.

FINDINGS:

In the chest, and lower neck, the visualized portion of the thyroid gland appear normal. There is no supraclavicular or axillary lymphadenopathy.

The soft tissue density in the anterior mediastinum is consistent with normal thymic tissue. There is no mediastinal or hilar lymphadenopathy. The thoracic esophagus is unremarkable.

The heart is moderately dilated, predominantly at the left ventricle. The thoracic aorta is normal in course and caliber. Pulmonary artery is nondilated.

The central airways are patent. There is mosaic attenuation of the lungs suggestive of air-trapping or prior bronchiolitis. There are bandlike opacities in the lung bases, likely atelectasis. There is no focal consolidation, pleural effusion, or pneumothorax. There are no suspicious pulmonary nodules or masses.

Soft tissues of the chest wall are normal. Bones are normal for developmental age. Negative for lytic or blastic lesions.

In the abdomen and pelvis, the liver enhances homogeneously. Liver size is within normal limits. Punctate calcifications are noted adjacent to the falciform ligament. No intra or extrahepatic biliary dilatation.

A gastrostomy tube is present with balloon inflated inside the gastric lumen. There is fluid within the distended stomach. The proximal small bowel is unremarkable. Dense stool is present throughout the colon. The appendix is not clearly visualized and there are no secondary signs of acute appendicitis.

The pancreas enhances homogeneously. The spleen is within normal limits for size. Calcification of the bilateral adrenal glands is consistent with prior adrenal hemorrhage.

There is a right renal mass measuring 4.5 x 4 x 4.5 cm. The mass is well-circumscribed, without extrarenal extension. There is no extension into the renal vein or IVC. The portal veins are patent.

The left kidney is normal. The bladder is distended and unremarkable in appearance. The abdominal aorta is normal in course and caliber. There are scattered calcifications within the IVC, stable from prior ultrasound. There is no abdominal or pelvic adenopathy. The mesentery appears unremarkable.

The soft tissues of the abdominal wall are within normal limits. There is a partially visualized right inguinal testicle. Fluid within the left inguinal canal may represent hydrocele. Bony structures are normal for developmental age. No lytic or sclerotic lesions.

IMPRESSIONS:

1. Right renal mass measuring 4.5 cm, with imaging features suggestive of Wilms tumor. There is no vascular invasion or extrarenal extension.
2. No evidence of metastatic disease in the chest, abdomen, or pelvis.
3. Cardiomegaly.
4. Hepatic, bilateral adrenal, and small scattered IVC calcifications are unchanged and related to old injury/hemorrhage.