History of vague abdominal pain and weight loss for the past couple months. A CT scan was requested as part of the study of the symptoms.
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Portal venous phase abdominal CT scan shows a massive right retroperitoneal heterogeneous solid mass. The mass has no macroscopic fat or calcifications. It also occupies the lumen of the hepatic and infrahepatic inferior vena cava, and displaces the right kidney inferiorly. The lower pulmonary lobes had multiple nodules, suspicious for metastasic dissemination.
The location and size of the mass, along with the pulmonary nodules, made us consider the diagnosis of sarcoma. An ultrasound-guided biopsy of the mass was performed, which confirmed a retroperitoneal leiomyosarcoma. Because of the size of the mass, surgery was rejected and the patient has undergone treatment with chemotherapy.