CHEST
Multiple different size small subpleural lung nodules with irregular nodular thickening of the pleura are seen on both sides highly suggestive of lung and pleural metastases.
No evidence of pleural effusion.
ABDOMEN AND PELVIS
There is a huge heterogeneous, well circumscribed, mass lesion seen arising from the mid and lower poles of the left kidney measuring about twelve centimeters in diameter, crossing the midline displacing the pancreas and bowel loops anteromedially and the aorta to the right side. It appears abutting the psoas muscle
No evidence that the previously described mass is seen invading the veins or evidence of renal vein thrombosis.
This mass lesion is typical for Wilms tumor.
There are multiple enlarged retroperitoneal and mesenteric lymph nodes noted. However no evidence of liver or splenic metastases.
The right kidney and pelvic organs appear normal.
On bone window, there is no evidence of lytic or blastic lesions.