What do you think is the most likely diagnosis?
Nodular pleural disease is suspicious for pleural metastases.
What incidental finding is partially imaged in the upper abdomen? What could this represent?
Left upper quadrant cystic mass appears to be the kidney. This could be a hydronephrotic kidney, a cystic renal mass or a multicystic dysplastic kidney. The patient is known to have a non-functioning kidney.
If this was a multicystic dysplastic kidney, would it be a relevant finding?
Controversy exists over the need for prophylactic surgical excision of a MCDK, justified on the grounds of a small risk of malignant transformation, more commonly in adults with a persistent MCDK (i.e. has not spontaneously resolved). More recently, conservative management with follow up has been recommended. In either case further imaging is required.
Left sided ICC noted. Left sided effusion has almost entirely been drained with residual associated left basal atelectasis. The pleura demonstrates multiple soft tissue nodules (especially medially along the mediastinum) with the largest region located abutting the descending aorta and spinal column measuring 12 x 28 x 75 mm. Nodules are also seen in the fissures. A number of enlarged nodes are also present, the largest of which is in the aortopulmonary window measuring 16 x 24 x 12 millimetres.
No mediastinal haematoma. The heart and the great vessels are unremarkable. No rib, sternal or scapula fractures are seen. No suspicious bone lesions identified.
A cystic mass is located in the left upper quadrant, probably representing the kidney.