Age: 70.0
Sex: M
Vaccine: COVID19, TDAP
Symptoms: Gastrointestinal wall thickening, Hepatic cyst, Hepatic lesion, Inguinal hernia, Lung infiltration
Clinical narrative: Document Type: CT Abd/Pelvis W/IV Contrast Document Subject: CT Abd/Pelvis W/IV Contrast Performed By: October 05, 2022 11:06 EDT Verified By: October 05, 2022 12:22 EDT Encounter Info: Hospital, Outpatient, 10/05/22 - 10/05/22  * Final Report *  Reason For Exam weight loss, abd. pain  Report EXAM:  CT Abd/Pelvis W/IV Contrast  COMPARISON:  None available.  HISTORY:  Weight loss abdominal pain  TECHNIQUE:  Axial CT scanning of the abdomen and pelvis was performed with 100 cc's of iopamidol 76%.  The patient did not receive positive enteric contrast.  Dose reduction/iterative reconstruction technique was utilized.  FINDINGS:   Lung bases: Chronic emphysema and patchy infiltrates identified in the lung bases. Irregular nodules identified in the lung bases measuring up to 1.5 cm, these are indeterminate.  Organs: 5 mm low-attenuation lesion in the left hepatic lobe is likely a cyst. A subtle 1 cm lesion in the right hepatic lobe, segment 8 image 47 series 2 is indeterminate. Portal venous system is patent. Gallbladder is not visualized. Normal pancreas spleen and adrenals. 5 cm simple cyst inferior pole right kidney. No nephrolithiasis or hydronephrosis and kidneys. Ureters are nondilated.  GI: Moderate distal gastric wall thickening noted.  The small bowel is not obstructed. Multiple soft tissue nodularity and ascites fluid surrounding the small bowel suspicious for peritoneal metastasis.  The right colon, the transverse colon and the left colon are not very well visualized likely diffusely coated with peritoneal metastasis.  3 cm long moderate wall thickening of the mid sigmoid colon noted.  Diffuse severe malignant ascites strongly suspected with peritoneal metastasis. Intermediate density peritoneal thickening over the right hepatic lobe, 6.5 x 5 cm soft tissue mass left upper peritoneum and 7 x 4 cm soft tissue mass in the pelvis, suspicious for peritoneal metastasis. Additional soft tissue nodularity throughout abdomen.  Pelvis: Unremarkable urinary bladder. Mildly enlarged prostate.  7 x 4 cm Heterogenous soft tissue noted in the pelvis suspicious for peritoneal metastasis.  Retroperitoneum: Normal size abdominal aorta. No retroperitoneal adenopathy noted.  Bones/soft tissues: Osteoporotic changes identified with compression fractures of L1 L3 L4 without to 50% loss of vertebral body height. No retropulsion. No focal bony lesions identified.  IMPRESSION: 1. Diffuse severe malignant ascites strongly suspected with diffuse widespread peritoneal metastasis. Intermediate density peritoneal thickening over the right hepatic lobe, 6.5 x 5 cm soft tissue mass left upper peritoneum and 7 x 4 cm soft tissue mass in the pelvis, suspicious for peritoneal metastasis.   2. 3.5 cm long segmental wall thickening involving the mid sigmoid colon. Colonic malignancy needs to be excluded. The right colon, the transverse colon and the left colon are not very well visualized likely diffusely coated with peritoneal metastasis.  3. Moderate distal gastric wall thickening is indeterminate.   4. 2 cm right cardiophrenic adenopathy suspicious for being malignant.  5. 1 cm right hepatic lobe lesion, hepatic metastatic disease needs to be excluded.  6. Patchy infiltrates and irregular nodules in the visualized lower lungs, lung metastatic disease needs to be excluded.  Recommendation: Further evaluation with PET/CT is advised.  Electronically Signed by:  Dictated on: 10/5/2022 11:54 AM    Signature Line This examination and reported findings have been reviewed and confirmed by the undersigned.   Read By:     I authorize my name to be Electronically affixed by using my unique signature access code.   Click VIEW IMAGE icon to Display Image This document has an image