The lungs and pleural spaces are clear apart from atelectasis in the left lower lobe and dependent atelectasis in bothcostophrenic angles. No consolidation,suspicious pulmonary nodules, pleural effusions or pneumothorax.
There is a large slightly heterogeneous enhancing mass lesion in the right axilla. The lesion measures 13 mm in maximal short axis diameter and is consistent with nodal metastatic disease. No left axillary, hilar or mediastinal lymphadenopathy. There is degenerative disc disease throughout the thoracic spine. No destructive lesion demonstrated.
There is a large irregular ill-defined mass lesion on the serosal surfacel of the hepatic flexure in the right upper quadrant measuring 10 x 8.5 x 7 cm in maximum dimensions with surrounding fat stranding. The lesion is extending into the lumen of the colon and there is no dilatation to suggestion obstruction. Medially, the mass is in contact with, and is possibly adherent to, loops of non-distended small bowel.
There is para-aortic lymphadenopathy measuring 15 mm in maximal short axis diameter consistent with nodal metastatic disease. Free fluid in the upper abdomen surrounds the liver and spleen. No free gas.
The liver contains no focal lesions. The portal and hepatic veins are opacified. The gallbladder is contracted. The pancreas, spleen, and right adrenal gland are normal.There is an abnormal irregular soft tissue density in the left upper quadrant that appears to communicate with the left adrenal gland and may represent adrenal or nodal metastatic disease. There are cortical cysts in both kidneys measuring up to 35 mm in maximum diameter.
There is abnormal soft tissue density in the right retroperitoneum inferior to the kidney measuring 19 mm maximal diameter. It may represent nodal or distant metastatic disease. There are bilateral inguinal herniae containing fat, larger on the left. Mild distal colonic diverticulosis noted.
Left buttock subcutaneous metastasis.
There is slight superior endplate deformities in the lumbar spine probably due degenerative change. No destructive skeletal lesion is detected.
The bowel lesion does not have the appearance for primary colonic malignancy. Multiple lesions and cranial findings in keeping with metastatic disease, with melanoma the favoured diagnoses given the peritoneal and subcutaneous distribution of lesions.