Presentation
Right upper quadrant pain.
Patient Data
Triple phase liver CT
The comparison is made to previous scans.
There is a large circumferential mass at the hepatic flexure that extends for a distance of approximately 10 cm and demonstrates shouldering at its proximal margin and some internal gas locules possibly suggesting ulceration. No proximal bowel obstruction. There is an adjacent cluster of abnormal mesenteric lymph nodes that measure up to 14 mm in short axis. More medially within the mesentery, however, there is an extremely large 7 cm mesenteric mass with a tail of abnormal tissue extending into the superior mesenteric vein with approximately 50% stenosis of the vessel at this point. No thrombus within the main portal vein.
There are multiple masses throughout both lobes of the liver that remain hypodense to parenchyma on early phases. The most prominent of which measures 7.2 cm and arises from segment 5 of the liver with an exophytic inferior growth pattern. No invasion of the proximal portal vein branches and the liver contour is smooth. Right hepatic artery arises directly from the celiac trunk. Cholelithiasis. Trace fluid around the gallbladder. No other colonic mass identified.
Submucosal hypodensity within the rectum and distal sigmoid in keeping with chronic inflammation and the known history of ulcerative colitis. Normal appendix. Trace free fluid within the pelvis only. The pancreas, adrenals, spleen and kidneys are within normal limits. The imaged lung bases are clear. No suspicious bony lesions.
Case Discussion
The findings are most in keeping with a primary colonic cancer at the hepatic flexure with multiple mesenteric metastases including one with vascular invasion into the SMV as well as innumerable liver metastases.
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