50 year-old male with history of pancreatic adenocarcinoma CHEST:LUNGS AND PLEURA: Large left-sided pleural effusion which has significantly increased in size compared to previous study. Scattered micronodules are unchanged.MEDIASTINUM AND HILA: Small mediastinal lymph nodes are unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Again noted no static lesions in the liver. Index lesion in segment 6 now measures 9 x 10 mm image number 105, series number 4, not significantly changed from previous study. Second index lesion in the left lobe is slightly smaller measuring 8-mm in diameter image number 104, series number 4.SPLEEN: Small hypodense lesion in the lower pole of the spleen is unchanged and most likely benign.PANCREAS: Patient's known pancreatic mass is slightly smaller measuring 4.9 by 4.9 cm on image number 110, series number 4 when measured in a similar fashion to the prior exam. This cystic component in the tail of the pancreas has increased in size now measuring 2.7 x 4 cm on image number 113, series number 4. Vascular encasement of retroperitoneal vessels are again noted. Splenic vein is thrombosed.Solid mass anterior to the cystic component of patient's known pancreatic carcinoma is also slightly smaller.ADRENAL GLANDS: The mass in the left adrenal gland has increased in size and now measures 2.9 x 3.4 cm in image number 107, series number 4. Right adrenal gland is unremarkable.KIDNEYS, URETERS: Interval development of left-sided hydronephrosis. Right kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: Retroperitoneal adenopathy is unchanged. Index left para-aortic node measures 1.9 x 1.1 cm on image number 127, series number 4.Left psoas muscle is asymmetrically and heterogeneously enlarged compared to the right side suspicious for infiltration by the patient's known cancer.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse increased density of the subcutaneous tissues of the anterior abdominal wall associate with small amount of air likely represents changes secondary to injection, new from previous study.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Ill-defined, and new soft tissue density along the right side of the pelvis is also suspicious for a peritoneal deposit and measures 2.6 x 1.9 cm in image number 176 on series number 4.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: New, small amount of ascites, associate with mild nodularity in the pelvis suspicious for peritoneal carcinomatosis.
Interval decrease in the size of the solid component of patient's known pancreatic cancer.Hepatic metastases are grossly unchanged.Interval increase in the amount of the left-sided pleural effusion.New peritoneal carcinomatosis, left adrenal metastases, hydronephrosis and enlargement of the left psoas muscle suspicious for metastatic disease.