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The proximal small bowel is dilated measuring up to 4 cm, with a transition point in the mid-small bowel. The transition point has the appearance of intussusception, with collapsed bowel distal. No definite mass is identified, although at the apex of the intussusception there is the impression of rounded enhancing nodule *2.5cm diameter (best seen on coronal images) which presumably represents the lead point. There is no intraperitoneal free air. There is a small amount of free fluid within the mesentery. Numerous enlarged lymph nodes are present within the mesentery.
Bilateral large, necrotic / septated cystic adrenal masses are identified. The right is larger than the left measuring 7.4 x 6.5 x 10.7 cm with a solid component inferiorly measuring 3.1 x 1.7 x 2.2 cm. The mass displaces the adjacent liver and kidney. There is some compressive effect on the IVC, although above the mass the IVC fills normally. The left adrenal mass measures 6.4 x 4.1 x 5.1 cm.
There is a large hypodense lesion in the right kidney measuring 6.4 x 5.2 cm, with the characteristics of a simple cyst. The left kidney, spleen, pancreas, stomach and colon are unremarkable. No suspicious osseous lesions identified.
Intussusception of the small bowel with probable nodular lead point.
Bilateral large adrenal cystic / necrotic masses. Differentials for the adrenal masses include bilateral phaeochromocytomas / adrenal carcinomas or much more likely large adrenal metastases.
It is likely that these findings all represent the same malignancy, most likely metastatic.