Large right pleural effusion with right lower lobe atelectasis. Subpleural left apical nodule measures 3 mm, stable. Left hilar lymph node measures 12 x 15 mm, stable. No pericardial effusion. No mediastinal or axillary enlarged lymph nodes.
Numerous liver hypodensities appear stable in size and number. Those imaged on the chest CT demonstrate peripheral arterial phase enhancement in keeping with metastasis. Adrenal glands, kidneys, spleen, gallbladder and pancreas have a normal appearance. The large bowel, especially the right colon is distended with faeces. Appearances of a stricture within the distal colon (Se 8 Im 56) with no faecal material distal to this point. Bladder is massively distended and contains a few locules of gas. Left para-aortic lymph node (Se 8 Im 35) measures 21 x 7 mm, previously 16 x 7 mm. No other enlarged lymph nodes are identified but sensitivity is reduced by the lack of intra-abdominal fat. Abdominal drain and laparotomy staples noted.No suspicious bone lesion identified.
Conclusion: Multiple liver hypodensities are in keeping with metastasis. Left hilar lymph node and left para-aortic lymph node suspicious for metastases. No peritoneal fluid collection identified. Prominent soft tissue within the distal colon is mild swelling at the anastomosis not causing obstruction. There is minor colonic faecal loading. Massively distended bladder is noted. Locules of gas would be in keeping with recent instrumentation but this has not occurred infection should be considered. Large right pleural effusion has developed since the prior CT.