Presentation
Right flank pain, history of nephrolithiasis - impacted urinary calculus?
Patient Data
No evidence of nephrolithiasis or ureteral calculus.
Retrocrural lymphadenopathy.
Several enlarged retroperitoneal lymph nodes.
The gallbladder contains two small calcified gallstones, no sign of cholecystitis.
Right adrenal adenoma measuring 12x15 mm.
Small left kidney.
Bulky fecal matter along ascending, transverse, and descending colon.
3.5 months later, presents with constipation and abdominal pain. Bowel obstruction?
Large amount of gas and bulky feces in non-dilated colon.
Sizable portion of colon superimposed on liver.
Post-sternotomy wires, CABG staples along expected course of LAD.
No sign of bowel obstruction. Bulky fecal matter along ascending, transverse, and descending colon.
Compared to the previous CT study:
New right paravertebral mass at L2 level, merging with the psoas major muscle and eroding the vertebral body. One right retrocrural lymph node has enlarged significantly, now measuring 18 mm in thickness.
The liver is now rotated in the sagittal plane and shifted to the left.
Extremely long dolichosigma located in the right abdomen, better visible on this study; no evidence of sigmoid volvulus.
Huge prostate gland, has enlarged markedly.
Case Discussion
This is a curious case, for several reasons:
- wandering liver 1-4, which returned to the normal anatomical position on a repeat CT abdomen done several days after the second study shown here
- paravertebral mass which appeared in the interval
- huge prostate, having enlarged to several times its original volume in just a few months
- extremely long dolichosigma
The liver must have had long attachments (ligaments) that enabled it to move and rotate.
As for the paravertebral mass, it was biopsied - histopathology report as follows:
Metastatic carcinoma, clear cell type, most probably of renal origin 5.
Immunostains: Positive: CA-9, EMA, CK7 (focally). Negative: CK20.