Metatstatic colorectal cancer

Case contributed by Dr Ian Bickle

Presentation

Upper abdominal discomfort. Hepar on examination. Cause?

Patient Data

Age: 45 years
Gender: Female
CT

CT CHEST

Multiple small nodules throughout both lungs, the largest 4mm.

Extensive lymphadenopathy at multiple mediastinal nodal stations, the largest 2.1cm in the AP window.  Small left supraclavicular nodes.

CT ABDOMEN

Innumerable liver metastases.

Extensive para-aortic and portacaval lymphadenopathy upto 2.5cm.

The remainder of the solid organs are normal.

Short segment of apparent thickening of the proximal transervse colon just distal to the hepatic flexure.

No focal bone lesions.

Comment: Diffuse metastatic disease

The only potential primary may be colonic.  Endoscopy recommended.

NB.  Both the 1mm and 5mm CT Abdomen stacks after provided to demonstrate that the 'thinner' data may be of some value in identifying more sutble colonic pathology.

Annotated image

The blue arrows indicate the site of the primary colonic tumor.  Short and pretty subtle in this collapsed underprepaed bowel.

Case Discussion

Colonic cancer is not an uncommon pathology.   Presentation with metastatic disease is observed not infrequently.

This case is presented to illustrate how on occasion profound metastatic disease is evident on imaging, but the primary source can be difficult or impossible to identify.

In this case there is a pretty subtle short segment of thickening in the proximal transverse colon (unprepared bowel).   Large bowel on CT can be difficult to distinguish normal collapsed loop from real mural thickening. 

The role of the clinical radiologist is to direct the referrer to a potential site for investigtion and advise how to get the safest most reliably tissue diagnosis.

Argueably in this case endoscopy with biopsy is a better and safter method than liver biopsy.

A colonic adenocarcinoma was identify in the proximal transverse colon at endoscopy.

NB.  Both the 1mm and 5mm CT Abdomen stacks after provided to demonstrate that the 'thinner' data may be of some value in identifying more sutble colonic pathology.

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Case information

rID: 59060
Published: 20th Mar 2018
Last edited: 1st May 2018
Tag: ripas2
Inclusion in quiz mode: Included

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