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Abdomen/pelvis: The liver has a 6 mm hypodense lesion in the segment 5/6, too small to characterise on CT; Otherwise, normal liver enhancement. The gallbladder, pancreas, adrenal glands, spleen, and kidneys are normal. Note is made to two small simple renal cortical cysts on the left.
The rectum is abnormal with bulky thickened walls. Also, there is extensive mesorectal, bilateral pelvic sidewall, retroperitoneal, and mesenteric lymphadenopathy. Small amount of free fluid in the peritoneal cavity, but no free gas. Features in keeping right hemicolectomy, end-ileostomy, and mucous fistula. Bilateral iliac fossa region ileostomies, on the right with a small parastomal hernia but no incarceration.
No suspicious osseous lesions.
Conclusion:
- Extensive abdominal/pelvic lymphadenopathy is highly suggestive of lymphoma recurrence.
- The bulkiness of the rectal wall in a mass-like appearance is favoured lymphoma involvement rather than primary colorectal malignancy.
- The non-specific small liver lesion in seg V/VI is indeterminate (cyst? other?) - targeted ultrasound or correlation with old scans recommended.
- Small right-sided pleural effusion, no nodal disease above the diaphragm.