Presentation
Upper abdominal discomfort. Hepar on examination. Cause?
Patient Data
CT CHEST
Multiple small nodules throughout both lungs, the largest 4mm.
Extensive lymphadenopathy at multiple mediastinal nodal stations, the largest 2.1cm in the AP window. Small left supraclavicular nodes.
CT ABDOMEN
Innumerable liver metastases.
Extensive para-aortic and portacaval lymphadenopathy upto 2.5cm.
The remainder of the solid organs are normal.
Short segment of apparent thickening of the proximal transervse colon just distal to the hepatic flexure.
No focal bone lesions.
Comment: Diffuse metastatic disease
The only potential primary may be colonic. Endoscopy recommended.
NB. Both the 1mm and 5mm CT Abdomen stacks after provided to demonstrate that the 'thinner' data may be of some value in identifying more sutble colonic pathology.
The blue arrows indicate the site of the primary colonic tumor. Short and pretty subtle in this collapsed underprepaed bowel.
Case Discussion
Colonic cancer is not an uncommon pathology. Presentation with metastatic disease is observed not infrequently.
This case is presented to illustrate how on occasion profound metastatic disease is evident on imaging, but the primary source can be difficult or impossible to identify.
In this case there is a pretty subtle short segment of thickening in the proximal transverse colon (unprepared bowel). Large bowel on CT can be difficult to distinguish normal collapsed loop from real mural thickening.
The role of the clinical radiologist is to direct the referrer to a potential site for investigtion and advise how to get the safest most reliably tissue diagnosis.
Argueably in this case endoscopy with biopsy is a better and safter method than liver biopsy.
A colonic adenocarcinoma was identify in the proximal transverse colon at endoscopy.
NB. Both the 1mm and 5mm CT Abdomen stacks after provided to demonstrate that the 'thinner' data may be of some value in identifying more sutble colonic pathology.
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