CT Neck, Chest, Adbomen, Pelvis with Contrast (March 26th, 2010)
4 year old child with abdominal mass. Multiple lymph nodes and spinal metastasis.
Axial images of the neck, chest, abdomen, pelvis were acquired after IV contrast administration.
There are a few small sized lymph nodes in both the jugular chains. The largest on the right side measures 11×12 mm while that on the left side measures 7×7 mm.
An oval heterogeneously enhancing nodule is seen in the right cardiophrenic recess abutting the IVC – RA junction. It measures 16×13 mm in transverse dimension. There is no significantly enlarged lymph node or mass in the mediastinum. Both axillae are clear.
There are bilateral pleural effusions; left more than right. Patchy opacities are seen on the posterior aspects of both lower lobes, left upper lobe, hilar and perihilar regions. The opacities likely to represent atelectatic changes. There are more nodular air-space opacities in the left lingula anteriorly. A small irregular nodule (3 mm) is seen in the right apex (Series 4/ima 17). It is difficult to exclude any nodular densities in the areas of patchy opacities. A small pleural nodule is seen in the posterior recess on the right on image 43 of Series 2.
A large heterogeneously enhancing mass is seen in the right suprarenal region. Craniocaudally, this mass extends from the diaphragm up to the mid pole of right kidney. It is seen extending into the right lobe of the liver. Medially it extends across the midline displacing the head of the pancreas and vessels to the left side. Anteromedially, it extends up to the porta and surrounds the portal vein. Inferolaterally, it invades the hilum of the right kidney and upper pole. Direct invasion of the liver and right kidney cannot be excluded. In fact, there are areas very suspicious for direct invasion. The kidney is displaced inferolaterally. It encases right renal artery and vein. It encases IVC and lifts it anteriorly. It shows a few specks of calcification in the center. It measures approximately 8.6×7.6×9.1 cm in RL by AP by SI dimensions respectively. Multiple nodular masses are seen, suggestive of metastatic lymph nodes, in the retroperitoneum and retrocrural region. The largest retrocrural lymph node measures 14 x 22 mm, the largest lymph node at the left renal hilum measures 26 x 38 mm and the largest in the left para-aortic region at the aortic bifurcation measures 21 x 29 mm. Some of these enlarged lymph nodes show specks of calcification within them. Lymph node masses encase the left renal artery and vein, IVC, aorta and displace pancreas anteriorly. A short segment of the left renal vein in the midline is not clearly opacified. A small lymph node is also seen in the right phrenic region measuring 10×5 mm.
A small hypodense area is seen in the cortex of upper pole of the left kidney (Series 2, image 53). This likely represent a tiny cyst rather than invasion from adjacent enlarged lymph nodes. Ultrasound is recommended for further evaluation. A small splenule measuring 17mm is seen at the splenic hilum. Spleen, pancreas and gallbladder are grossly normal. The left adrenal gland is not well seen but may be thickend. Bowel loops and urinary bladder are unremarkable. There is trace of free fluid in the pelvis and right flank.
Multiple ill defined lytic areas are seen involving the entire spine, pelvic bones and scapulae. There are also subtle areas in the sternum. There is multi-level reduction in the height of vertebral bodies. The maximum reduction is seen in the T5 vertebral body.
- A large heterogeneously enhancing mass in the right suprarenal region with multiple enlarged retroperitoneal lymph nodes. The mass is most likely to represent neuroblastoma. Morphology and extent are described above.
- A nodular metastatic deposit in the right cardiophrenic recess. Multiple patchy opacities in the lungs that could represent atelectatic changes limiting the detection of any discrete nodular density. A single 3 mm nonspecific nodule is seen in the right apex.
- Multiple lytic lesions in the vertebral column, pelvic bones and scapulae in keeping with metastatic bone disease. Multilevel reduction in the vertebral bodies with maximum reduction at T5 level.