Report from Victoria Hospital
Prince Albert, Saskatchewan, Canada
Diagnostic Imaging Report
X-Ray #: 03-3645
Exam Date 2003 October 8

CT ABDOMEN and Pelvis (Plain, Dynamic and Delayed)

Axial 10mm cuts were obtained from the diaphragm down to the symphysis pubis, and these were repeated during the dynamic intravenous administration of 100 cc Isovue 300, with additional delayed liver images following that.

There are four hypodense, rounded liver lesions measuring between 8 and 15mm, and these are seen on the plain and the dynamic portions of the scan, but particularly well on the slightly delayed images. These are high in the right lobe (image 88), anteriorly in the left lobe (image 89), peripherally at the posterolateral aspect of the right lobe, half way down (image 92) and in the right lobe near the gallbladder (image 96). In reviewing the 28 March, 2003 plain and contrast scans, none of these was present.

There is also moderate hydronephrosis on the right, with hydroureter all the way down to about 2cm from the VU junction. I was not particularly using our urinary tract protocol with finer cuts, so it is a little bit difficult to trace the ureter, but the calibre changes seems to be at around the level of a 3cm, non specific mid density opacity (mass) just anteriorly to the recto-sigmoid junction, toward the right. Was this the site of the original primary? I do not see surgical clips here to confirm this. In addition the patient told me he had a second colonic cancer diagnosed at the colonoscopy this morning, so one also wonders if this might not be a second site. In any case, it is very suspicious of extrinsic neoplastic involvement of the distal ureter. I do not see any other specific bowel abnormality, but the patient is still quite full of gas from the morning coloscopy, and there is a variable collapse of certain segments of bowel, plus some oral contrast present, so CT is not really an optimal way of assessing this.

Slight heterogeneity of the spleen during dynamic contrast infusion is very probably just due to differential perfusion, and disappears on the delayed scan. No convincing nodularities seen in the portions of the lung bases caught on the upper most abdominal slices. No suspicious bony abnormalities identified.

INTERPRETATION

Given the new appearance of the four liver lesions since the 28 March scan, in the face of the suddenly elevated CEA, plus the additional history of a second colonic tumor, it is highly likely that these are liver metastases. Furthermore, moderate right hydronephrosis is very likely on the basis of local colonic tumor involvement, and I would be thinking more of actual invasion rather than simple extrinsic compression. I imagine a urological opinion will be needed in this regard as the hydronephrosis in only moderate, and there may well be some useful renal function here still.

Dr. Ian Waddell (Radiologist)

cc: Dr. R. Unsworth
cc: Saskatoon Cancer Center