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CT Abd Lymphoma, Carcinomatosis

Findings: There is a large, enhancing mass within the central abdomen that encases without displacing the central vasculature and displaces bowel loops peripherally. There are multiple internal, low density, nonenhancing regions within the mass, compatible with necrosis. There is significant mass effect on the colon with questionable invasion of or origination from the rectum. The mass is not significantly changed in size as compared to prior, however there is significantly more ascites throughout the abdomen in the pelvis. There is thickening and enhancement of the intra-abdominal peritoneum. There is nodular thickening and enhancement of the or intrapelvic peritoneum. The inferior vena cava is compressed however does not appear occluded or invaded by the mass lesion at this time. The bladder is decompressed and not well visualized. The liver, spleen, kidneys, and adrenal glands are unremarkable. There are large layering bilateral pleural effusions, significantly increased as compared to prior. The lung bases are assembly atelectatic. Degenerative changes are seen at the L5-S1 level. Conclusion: Large intra-abdominal mass with diffuse peritoneal carcinomatosis, worsening ascites, and worsening pleural effusions. Differential considerations include lymphoma, gastrointestinal neoplasms, testicular carcinoma, as well as additional neoplastic processes. Tissue diagnosis is suggested. Findings: There are bilateral pleural effusions, more significant on the left, both increased in volume since the prior CT chest. There is new bilateral lower lobe airspace disease with air bronchograms, likely secondary to compressive atelectasis, however bilateral lobar pneumonia cannot be excluded. The right pigtail catheter is curled up in the posterior subcutaneous tissues, outside of the thoracic cage. The heart and great vessels are normal in appearance. There is a right-sided PICC line, with the catheter tip terminating in the right atrium. There is no significant mediastinal or axillary lymphadenopathy. The structures of the neck base are unremarkable. There continues to be a large intra-abdominal mass without significant interval change in size or appearance since the prior study. The mass continues to encase the SMA, SMV and splenic vein. There is diffuse moderate ascites, without significant worsening since the comparison studies. The ascites is more prominent in the lower abdomen and pelvis with enhancing thickened peritoneum, suggestive of peritoneal carcinomatosis. There is also free intraperitoneal fluid in the pericolic gutters bilaterally and surrounding spleen and liver. The liver, spleen, adrenals, and kidneys are unremarkable. Minimal enteric contrast is seen only within the stomach. The hollow viscera are without evidence for wall thickening, mass, or obstruction. No evidence of free air in the peritoneal cavity. The bladder is normal. The osseous structures are unremarkable. The soft tissues are remarkable for diffuse subcutaneous edema. IMPRESSION: 1. Worsening bilateral pleural effusions more prominent on left, with bilateral lower lobe airspace disease. 2. Large intra-abdominal mass without significant interval change in size and appearance, as described above. 3. Persistent stable ascites with evidence of peritoneal carcinomatosis. 4. Malposition in the right pigtail catheter as described above.