Presentation
Right renal neoplasm.
Patient Data
Multiple pleural-based masses are noted, with soft tissue density, largest 2.8 x 1.8 cm in the apicoposterior segment of left upper lobe, likely represents pleural metastases.
Multiple pulmonary nodules and masses involving nearly all segments of both lungs, largest of the right middle lobe measuring 3.2 x 2.5 cm, in keeping with diffuse pulmonary metastases.
Bilateral hilar lymphadenopathies, largest 2.1 x 2.3 cm at right hilum. Multiple mediastinal lymphadenopathies, largest 3.2 x 2.1 cm at aortopulmonary window. In view of disseminated metastatic disease, these likely represent metastatic hilar and mediastinal lymphadenopathies.
Bilateral diffuse faint ground-glass densities with fibrotic changes and thickened interstitum.
Multiple hypodense (osteolytic) bone lesions are noted along the scanned vertebrae, suggestive of skeletal metastases.
Scans through the upper abdomen revealed:
- oval-shaped hyperdense gallstone measuring 2 x 1.4 cm, this is calcular gallbladder disease
- right renal mass with renal hilar and para-aortic lymph nodes, representing metastatic renal neoplasm
Case Discussion
Pulmonary and pleural nodules are likely representing diffuse pulmonary and pleural metastases. Metastatic hilar and mediastinal lymphadenopathy as well as vertebral metastases are also seen.
Interstitial lung changes, may be as sequels of previous pulmonary infection or interstitial lung process as lymphangitic carcinomatosis.