Reference is made to the trauma CT examination. A 7.8 cm x 6.3 cm x 6.3 cm rounded mass is again identified located in the right side of the abdomen, closely associated with segments V3 at the duodenum and retroperitoneal in location. The mass is also immediately adjacent to the pancreatic head from which it is felt to be separate. There is mass-effect with compression of the inferior vena cava. The mass itself appears encapsulated. It is heterogeneously T2 vividly hyperintense and T1 hypointense. No fat content. The lesion vividly and heterogeneously enhances with relatively rapid washout. Prominent intralesional flow voids and large draining veins are seen immediately inferior to the mass. The vasculature returns to the IVC.
Other structures are abutted by the mass are the non-dilated right ureter, right psoas major muscle, distal aorta and right colon all of which appear unremarkable.
There is no duodenal or gastric outlet obstruction.
Pancreas is normal in appearance with no focal pancreatic lesion identified. The main pancreatic duct is non-dilated. No peripancreatic fluid collection.
The biliary tree is normal in calibre and appearance. There is no evidence of gallstone disease. The gallbladder is unremarkable.
Within segment 2 of the liver, there is a statically T2 hyperintense lesion measuring 1.9 centimetres. This is not visible on T1 weighted imaging. There is arterial hyper enhancement ( but not nearly as avidly as the abdominal mass ) without washout, and persistent mild hyper enhancement on later phases.
7.8cm retroperitoneal tumour adjacent to the third part of the duodenum and IVC, but felt to be separate from pancreas. The most likely diagnosis is of a paraganglioma, with the main differential being a gastrointestinal stromal tumour (do not typically enhance so vividly). Other forms of sarcoma remain in the differential. Clinical markers and nuclear scan exclusion of a phaeo/paraganglioma strongly suggested before biopsy (via EUS) is contemplated.1.9 cm segment 2 liver lesion is ill-defined. Correlation with contrast enhanced US suggested to confirm this is a real lesion and if so, possible nature.