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Click 46-year-old female presents with new large right upper quadrant abdominal pain.

TECHNIQUE: Helical (axial) CT scan examination of the abdomen and pelvis is performed from the domes of the diaphragm to the pubic symphysis with administration of intravenous contrast material. CONTRAST: 80 cc of Omnipaque 350 intravenous contrast. TOTAL DLP DOSE: 1267 mGy*cm

FINDINGS:
• The lung bases demonstrate subcentimeter pulmonary nodules, measuring up to 5 mm in right lower lobe.
• There is a large heterogeneously enhancing mass within the right upper quadrant, which measures 11.5 x 15.4 x 13.0 cm in greatest dimension. This mass demonstrates heterogeneous arterial enhancement with central areas of low attenuation, likely related to necrosis which is isointense on the venous and delayed phases to the liver. There is internal vascularity. There is significant mass effect on the adjacent structures including the liver, gallbladder, pancreas, IVC, and right kidney. The mass abuts the liver and mildly extends into the liver. There is occlusion of the IVC at the hepatic and suprahepatic portion which may be from tumor involving the inferior vena cava. Additionally, numerous enhancing masses are present throughout the liver, for example 1.0 cm arterial enhancing lesion within hepatic segment VII/IVA. There is heterogeneous enhancement throughout the liver. The portal veins are patent.
• The gallbladder is displaced without wall thickening or stones.
• There is no pancreatic ductal dilatation.
• The spleen is normal in size.
• The adrenals are symmetric and normal in caliber.
• The kidneys are normal in size and contour. No stones or hydronephrosis.
• No evidence of bowel obstruction or bowel wall thickening. Normal appendix.
• The aorta is normal in caliber. No pathologic lymphadenopathy. Small amount of ascites within the pelvis.
•The bladder is smooth in contour. The uterus is normal in appearance.
• Soft tissues appear normal. No acute osseous abnormality.



Click 46-year-old female presents with new large right upper quadrant abdominal pain.

TECHNIQUE: Helical (coronal reconstruction) CT scan examination of the abdomen and pelvis is performed from the domes of the diaphragm to the pubic symphysis with administration of intravenous contrast material. CONTRAST: 80 cc of Omnipaque 350 intravenous contrast. TOTAL DLP DOSE: 1267 mGy*cm

FINDINGS:
• The lung bases demonstrate subcentimeter pulmonary nodules, measuring up to 5 mm in right lower lobe.
• There is a large heterogeneously enhancing mass within the right upper quadrant, which measures 11.5 x 15.4 x 13.0 cm in greatest dimension. This mass demonstrates heterogeneous arterial enhancement with central areas of low attenuation, likely related to necrosis which is isointense on the venous and delayed phases to the liver. There is internal vascularity. There is significant mass effect on the adjacent structures including the liver, gallbladder, pancreas, IVC, and right kidney. The mass abuts the liver and mildly extends into the liver. There is occlusion of the IVC at the hepatic and suprahepatic portion which may be from tumor involving the inferior vena cava. Additionally, numerous enhancing masses are present throughout the liver, for example 1.0 cm arterial enhancing lesion within hepatic segment VII/IVA. There is heterogeneous enhancement throughout the liver. The portal veins are patent.
• The gallbladder is displaced without wall thickening or stones.
• There is no pancreatic ductal dilatation.
•The spleen is normal in size.
•The adrenals are symmetric and normal in caliber.
• The kidneys are normal in size and contour. No stones or hydronephrosis.
• No evidence of bowel obstruction or bowel wall thickening. Normal appendix.
• The aorta is normal in caliber. No pathologic lymphadenopathy. Small amount of ascites within the pelvis.
• The bladder is smooth in contour. The uterus is normal in appearance.
• Soft tissues appear normal. No acute osseous abnormality.



Click 46-year-old female presents with new large right upper quadrant abdominal pain.

TECHNIQUE: Helical (sagittal reconstruction) CT scan examination of the abdomen and pelvis is performed from the domes of the diaphragm to the pubic symphysis with administration of intravenous contrast material. CONTRAST: 80 cc of Omnipaque 350 intravenous contrast. TOTAL DLP DOSE: 1267 mGy*cm

FINDINGS:
• The lung bases demonstrate subcentimeter pulmonary nodules, measuring up to 5 mm in right lower lobe.
• There is a large heterogeneously enhancing mass within the right upper quadrant, which measures 11.5 x 15.4 x 13.0 cm in greatest dimension. This mass demonstrates heterogeneous arterial enhancement with central areas of low attenuation, likely related to necrosis which is isointense on the venous and delayed phases to the liver. There is internal vascularity. There is significant mass effect on the adjacent structures including the liver, gallbladder, pancreas, IVC, and right kidney. The mass abuts the liver and mildly extends into the liver. There is occlusion of the IVC at the hepatic and suprahepatic portion which may be from tumor involving the inferior vena cava. Additionally, numerous enhancing masses are present throughout the liver, for example 1.0 cm arterial enhancing lesion within hepatic segment VII/IVA. There is heterogeneous enhancement throughout the liver. The portal veins are patent.
• The gallbladder is displaced without wall thickening or stones.
• There is no pancreatic ductal dilatation.
• The spleen is normal in size.
• The adrenals are symmetric and normal in caliber.
• The kidneys are normal in size and contour. No stones or hydronephrosis.
• No evidence of bowel obstruction or bowel wall thickening. Normal appendix.
• The aorta is normal in caliber. No pathologic lymphadenopathy. Small amount of ascites within the pelvis.
• The bladder is smooth in contour. The uterus is normal in appearance.
• Soft tissues appear normal. No acute osseous abnormality.



Click 46-year-old female presents with new large right upper quadrant abdominal pain.

TECHNIQUE: Multiple contiguous axial CT images of the chest were obtained following the administration of intravenous contrast.
CONTRAST: 70 cc Omnipaque 350 intravenous contrast. TOTAL DLP DOSE: 220 mGy*cm

FINDINGS:
• Medical Devices: None.
• Thyroid and Neck Base: Visualized thyroid gland is normal. No pathologically enlarged lymph nodes are identified.
• Aorta: Aorta is normal in caliber and contour. No atherosclerosis is identified.
• Pulmonary Arteries: Central pulmonary arteries are normal in size.
• Heart: Heart is normal in size. No coronary artery atherosclerosis is identified. No pericardial effusion is present.
• Mediastinum and Hila: No pathologically enlarged lymph nodes are identified. The esophagus is normal.
• Pleura and Diaphragm: No pleural effusion is present. Right and left hemidiaphragms are normal in position. No pneumothorax is identified.
• Chest Wall and Axilla: No abnormality of the chest wall is demonstrated. No pathologically enlarged lymph nodes are identified.
• Lungs and Airways: Trachea and main bronchi are patent. Lungs are well aerated. There are numerous well-defined nodules seen throughout the lungs. For example, a 7 mm nodule within the apicoposterior segment of the left lower lobe, and a 6 mm nodule within the lateral basal segment of the left lower lobe. Within the right lung, a 5 mm nodule within the anterior segment of the right upper lobe, and a 4 mm nodule at the right hilum. There is trace dependent atelectasis.
• Musculoskeletal: No acute osseous abnormalities. No suspicious osteoblastic or osteolytic lesions.


Click 46-year-old female presents with new large right upper quadrant abdominal pain.

TECHNIQUE: Coronal reconstruction from axial CT images of the chest were obtained following the administration of intravenous contrast.
CONTRAST: 70 cc Omnipaque 350 intravenous contrast. TOTAL DLP DOSE: 220 mGy*cm

FINDINGS:
• Medical Devices: None.
• Thyroid and Neck Base: Visualized thyroid gland is normal. No pathologically enlarged lymph nodes are identified.
• Aorta: Aorta is normal in caliber and contour. No atherosclerosis is identified.
• Pulmonary Arteries: Central pulmonary arteries are normal in size.
• Heart: Heart is normal in size. No coronary artery atherosclerosis is identified. No pericardial effusion is present.
• Mediastinum and Hila: No pathologically enlarged lymph nodes are identified. The esophagus is normal.
• Pleura and Diaphragm: No pleural effusion is present. Right and left hemidiaphragms are normal in position. No pneumothorax is identified.
• Chest Wall and Axilla: No abnormality of the chest wall is demonstrated. No pathologically enlarged lymph nodes are identified.
• Lungs and Airways: Trachea and main bronchi are patent. Lungs are well aerated. There are numerous well-defined nodules seen throughout the lungs. For example, a 7 mm nodule within the apicoposterior segment of the left lower lobe, and a 6 mm nodule within the lateral basal segment of the left lower lobe. Within the right lung, a 5 mm nodule within the anterior segment of the right upper lobe, and a 4 mm nodule at the right hilum. There is trace dependent atelectasis.
• Musculoskeletal: No acute osseous abnormalities. No suspicious osteoblastic or osteolytic lesions.


Click 46-year-old female presents with new large right upper quadrant abdominal pain.

TECHNIQUE: Sagittal reconstruction from axial CT images of the chest were obtained following the administration of intravenous contrast.
CONTRAST: 70 cc Omnipaque 350 intravenous contrast. TOTAL DLP DOSE: 220 mGy*cm

FINDINGS:
• Medical Devices: None.
• Thyroid and Neck Base: Visualized thyroid gland is normal. No pathologically enlarged lymph nodes are identified.
• Aorta: Aorta is normal in caliber and contour. No atherosclerosis is identified.
• Pulmonary Arteries: Central pulmonary arteries are normal in size.
• Heart: Heart is normal in size. No coronary artery atherosclerosis is identified. No pericardial effusion is present.
• Mediastinum and Hila: No pathologically enlarged lymph nodes are identified. The esophagus is normal.
• Pleura and Diaphragm: No pleural effusion is present. Right and left hemidiaphragms are normal in position. No pneumothorax is identified.
• Chest Wall and Axilla: No abnormality of the chest wall is demonstrated. No pathologically enlarged lymph nodes are identified.
• Lungs and Airways: Trachea and main bronchi are patent. Lungs are well aerated. There are numerous well-defined nodules seen throughout the lungs. For example, a 7 mm nodule within the apicoposterior segment of the left lower lobe, and a 6 mm nodule within the lateral basal segment of the left lower lobe. Within the right lung, a 5 mm nodule within the anterior segment of the right upper lobe, and a 4 mm nodule at the right hilum. There is trace dependent atelectasis.
• Musculoskeletal: No acute osseous abnormalities. No suspicious osteoblastic or osteolytic lesions.


Click 48-year-old female with history of leiomyosarcoma. Follow up scan.

TECHNIQUE: Helical CT scan examination of the chest, abdomen and pelvis is performed from the domes of the diaphragm to the pubic symphysis with administration of oral contrast and intravenous contrast material in the arterial and venous phases.
CONTRAST: 80 mL Omnipaque 350 intravenous contrast. 300 mL of Gastroview oral contrast. TOTAL DLP DOSE: 835 mGy*cm

FINDINGS:

• Liver: Multiple heterogeneous masses are present throughout the entire liver and are increased in size from initial examination. The largest is centered about the hepatic segment 4A and measures 9 cm. No intrahepatic biliary ductal dilatation. The portal vein is patent.
• Bile ducts: Normal caliber.
• Gallbladder: Mildly distended. No stones, wall thickening, or pericholecystic fluid.
• Pancreas: Normal appearance without focal lesion.
• Spleen: Normal in size and contour.
• Adrenals: Normal configuration of the left adrenal gland. Right adrenal nodule is now measuring 1.2 cm is increased in size from initial exam.
• Kidneys and ureters: Normal size. No hydronephrosis. Mass effect on the right kidney secondary to the large IVC mass.
• Bladder: Normal in appearance.
• Vessels: Large heterogeneously enhancing mass arising from the inferior vena cava measures approximately 19 x 20 x 17 cm. This exerts mass effect on the surrounding organs including the liver, stomach, bowel, right kidney, pancreas, and right adrenal gland.
• Reproductive organs: normal.
• Bowel: Loops of bowel without wall thickening or obstruction. Normal appendix.
• Lymph nodes: No enlarged mesenteric or retroperitoneal lymph nodes.
• Peritoneum: Small amount of fluid in the abdomen and pelvis.
• Retroperitoneum: No mass or hemorrhage.
• Abdominal wall: No hernia or mass.
• Bones: No acute abnormality or suspicious bony lesion.


Click 48-year-old female with history of leiomyosarcoma. Follow up scan.

TECHNIQUE: Helical (coronal reconstruction) CT scan examination of the abdomen and pelvis is performed from the domes of the diaphragm to the pubic symphysis with administration of oral contrast and intravenous contrast material in the arterial and venous phases.
CONTRAST: 80 mL Omnipaque 350 intravenous contrast. 300 mL of Gastroview oral contrast. TOTAL DLP DOSE: 835 mGy*cm

FINDINGS:

• Liver: Multiple heterogeneous masses are present throughout the entire liver and are increased in size from initial examination. The largest is centered about the hepatic segment 4A and measures 9 cm. No intrahepatic biliary ductal dilatation. The portal vein is patent.
• Bile ducts: Normal caliber.
• Gallbladder: Mildly distended. No stones, wall thickening, or pericholecystic fluid.
• Pancreas: Normal appearance without focal lesion.
• Spleen: Normal in size and contour.
• Adrenals: Normal configuration of the left adrenal gland. Right adrenal nodule is now measuring 1.2 cm is increased in size from initial exam.
• Kidneys and ureters: Normal size. No hydronephrosis. Mass effect on the right kidney secondary to the large IVC mass.
• Bladder: Normal in appearance.
• Vessels: Large heterogeneously enhancing mass arising from the inferior vena cava measures approximately 19 x 20 x 17 cm. This exerts mass effect on the surrounding organs including the liver, stomach, bowel, right kidney, pancreas, and right adrenal gland.
• Reproductive organs: normal.
• Bowel: Loops of bowel without wall thickening or obstruction. Normal appendix.
• Lymph nodes: No enlarged mesenteric or retroperitoneal lymph nodes.
• Peritoneum: Small amount of fluid in the abdomen and pelvis.
• Retroperitoneum: No mass or hemorrhage.
• Abdominal wall: No hernia or mass.
• Bones: No acute abnormality or suspicious bony lesion.


Click 48-year-old female with history of leiomyosarcoma. Follow up scan.

TECHNIQUE: Helical (sagittal reconstruction) CT scan examination of the abdomen and pelvis is performed from the domes of the diaphragm to the pubic symphysis with administration of oral contrast and intravenous contrast material in the arterial and venous phases.
CONTRAST: 80 mL Omnipaque 350 intravenous contrast. 300 mL of Gastroview oral contrast. TOTAL DLP DOSE: 835 mGy*cm

FINDINGS:

• Liver: Multiple heterogeneous masses are present throughout the entire liver and are increased in size from initial examination. The largest is centered about the hepatic segment 4A and measures 9 cm. No intrahepatic biliary ductal dilatation. The portal vein is patent.
• Bile ducts: Normal caliber.
• Gallbladder: Mildly distended. No stones, wall thickening, or pericholecystic fluid.
• Pancreas: Normal appearance without focal lesion.
• Spleen: Normal in size and contour.
• Adrenals: Normal configuration of the left adrenal gland. Right adrenal nodule is now measuring 1.2 cm is increased in size from initial exam.
• Kidneys and ureters: Normal size. No hydronephrosis. Mass effect on the right kidney secondary to the large IVC mass.
• Bladder: Normal in appearance.
• Vessels: Large heterogeneously enhancing mass arising from the inferior vena cava measures approximately 19 x 20 x 17 cm. This exerts mass effect on the surrounding organs including the liver, stomach, bowel, right kidney, pancreas, and right adrenal gland.
• Reproductive organs: normal.
• Bowel: Loops of bowel without wall thickening or obstruction. Normal appendix.
• Lymph nodes: No enlarged mesenteric or retroperitoneal lymph nodes.
• Peritoneum: Small amount of fluid in the abdomen and pelvis.
• Retroperitoneum: No mass or hemorrhage.
• Abdominal wall: No hernia or mass.
• Bones: No acute abnormality or suspicious bony lesion.


Click 48-year-old female with history of leiomyosarcoma. Follow up scan.

TECHNIQUE: Multiple contiguous axial CT images of the chest were obtained following the administration of intravenous contrast.
CONTRAST: 80 cc Omnipaque 350 intravenous contrast. TOTAL DLP DOSE: 824 mGy-cm.

FINDINGS:

• Right chest wall MediPort with distal tip terminating in the region of the cavoatrial junction. No axillary, supraclavicular, mediastinal, or hilar lymphadenopathy by CT size criteria.
• Visualized portions of the thyroid appear within normal limits.
• No chest wall masses. Soft tissues within normal limits.
• Heart size is normal. No pericardial effusion. No significant coronary artery atherosclerotic calcifications.
• Normal anatomic variant two-vessel aortic arch branch pattern with shared common origin of the right brachiocephalic and left common carotid arteries. No thoracic aortic aneurysm.
• No significant thoracic aortic atherosclerotic calcifications. Central pulmonary arteries are normal in size. There is no large central pulmonary embolus.
• Intrathoracic esophagus appears within normal limits.
• Multiple bilateral pulmonary nodules measuring up to 1.0 cm in the left lower lobe.
• No pleural effusion. No pneumothorax.
• Osseous structures are intact. No suspicious lytic or blastic bony lesions.


Click 48-year-old female with history of leiomyosarcoma. Follow up scan.

TECHNIQUE: Coronal reconstruction from axial CT images of the chest were obtained following the administration of intravenous contrast.
CONTRAST: 80 cc Omnipaque 350 intravenous contrast. TOTAL DLP DOSE: 824 mGy-cm.

FINDINGS:

• Right chest wall MediPort with distal tip terminating in the region of the cavoatrial junction. No axillary, supraclavicular, mediastinal, or hilar lymphadenopathy by CT size criteria.
• Visualized portions of the thyroid appear within normal limits.
• No chest wall masses. Soft tissues within normal limits.
• Heart size is normal. No pericardial effusion. No significant coronary artery atherosclerotic calcifications.
• Normal anatomic variant two-vessel aortic arch branch pattern with shared common origin of the right brachiocephalic and left common carotid arteries. No thoracic aortic aneurysm.
• No significant thoracic aortic atherosclerotic calcifications. Central pulmonary arteries are normal in size. There is no large central pulmonary embolus.
• Intrathoracic esophagus appears within normal limits.
• Multiple bilateral pulmonary nodules measuring up to 1.0 cm in the left lower lobe.
• No pleural effusion. No pneumothorax.
• Osseous structures are intact. No suspicious lytic or blastic bony lesions.


Click 48-year-old female with history of leiomyosarcoma. Follow up scan.

TECHNIQUE: Coronal reconstruction from axial CT images of the chest were obtained following the administration of intravenous contrast.
CONTRAST: 80 cc Omnipaque 350 intravenous contrast. TOTAL DLP DOSE: 824 mGy-cm.

FINDINGS:

• Right chest wall MediPort with distal tip terminating in the region of the cavoatrial junction. No axillary, supraclavicular, mediastinal, or hilar lymphadenopathy by CT size criteria.
• Visualized portions of the thyroid appear within normal limits.
• No chest wall masses. Soft tissues within normal limits.
• Heart size is normal. No pericardial effusion. No significant coronary artery atherosclerotic calcifications.
• Normal anatomic variant two-vessel aortic arch branch pattern with shared common origin of the right brachiocephalic and left common carotid arteries. No thoracic aortic aneurysm.
• No significant thoracic aortic atherosclerotic calcifications. Central pulmonary arteries are normal in size. There is no large central pulmonary embolus.
• Intrathoracic esophagus appears within normal limits.
• Multiple bilateral pulmonary nodules measuring up to 1.0 cm in the left lower lobe.
• No pleural effusion. No pneumothorax.
• Osseous structures are intact. No suspicious lytic or blastic bony lesions.