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CT CAP Super

TECHNIQUE: Helical CT of the chest/abdomen/pelvis after administration of IV and oral contrast. Standard 5 mm axial images were obtained with coronal and sagittal reformations. Renal delay images were also obtained. FINDINGS: The lungs demonstrate dependent atelectasis and are otherwise clear without evidence of mass, consolidation, or pleural effusion. The heart and great vessels demonstrate normal morphology. There is no pathologically enlarged mediastinal, hilar, or axillary lymph nodes. There is no penumothorax. There has been significant interval decrease in the size of the previously described paraortic and aortocaval lymph node conglomeration extending from renal vasculature to the iliac bifurcation. Retroperitoneal adenopathy results in significant narrowing of the IVC inferior to the renal vessels. Previously described left paracolic gutter soft tissue mass has significantly decreased in size and now measures 1.3 x 1.3 cm (previously 2.6 x 1.9 cm). The 7 mm hypoattenuating lesion in the right lobe of the liver is unchanged from prior. There is unchanged large concentrically calcified gallstone. Gallbladder is markedly distended measuring 9.5 cm in greatest dimension. There is no intra or extrahepatic biliary ductal dilatation. There is significant fatty atrophy of the pancreas. The spleen and adrenals demonstrate normal morphology and enhancement without mass lesions. The bilateral kidneys are atrophic. There has been interval placement of a right ureteral stent with the tip extending from the right renal collecting system to the bladder. This results in interval resolution of the previous described right hydronephrosis. Enteric contrast extends to the level of the rectum. No dilated loops of bowel or evidence for obstruction identified. There is no definite bowel wall thickening or associated inflammatory changes identified. The appendix is normal in appearance and caliber. A Foley catheter is present within the urinary bladder resulting in bladder decompression. Prostate has decreased in size. There is a lytic destruction of the anterior vertebral body of L5 with associated anterior soft tissue mass. This is increased in severity when compared with prior studies. Significant degenerative changes are also noted throughout the thoracolumbar spine, most severe at the L5-S1 level. There is faint sclerosis seen within the L5 and S1 vertebral bodies. There is a low attenuation filling defect within the right common iliac vein extending into the common femoral vein with associated expansion of the vessel. Low-attenuation filling defect is also noted within the left common femoral vein. Imaged body wall soft tissues are remarkable for left fat-containing inguinal hernia. There is a focus of subcutaneous air as well as phlegmonous mass within the right inguinal region measuring 3.8 x 2.7 cm. This is likely secondary to prior right inguinal lymph node dissection. IMPRESSION: 1. Improvement in size of paraortic and aortocaval retroperitoneal lymph node conglomeration and soft tissue mass in the left paracolic gutter consistent with response to prostate carcinoma therapy. 2. Bilateral deep venous thromboses involving the common femoral veins with extension to the common iliac vein on the right. Significant narrowing and mass effect on the infrarenal IVC secondary to the retroperitoneal lymphadenopathy. 3. Sclerotic mets involving L5 and S1 vertebral bodies with lytic destructive process of the anterior vertebral body of L5 with associated anterior soft tissue. This demonstrates increased severity when compared with prior examination. 4. Post surgical changes in the right inguinal region secondary to prior lymph node dissection. 5. Markedly distended gallbladder measuring 9.5 cm.