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RADIOLOGY: ABDOMEN: Case# 32860: RECTAL CA. WITH URETERAL OBSTRUCYION. This is a 54 year old female being followed for left sided colon cancer diagnosed three years ago. She is status post colectomy. G.I. Findings: Multiple small hypodense lesions are noted in the liver involving the posterior of right lobe and medial segment of left hepatic lobe. One 8 mm subcapsular lesion at the junction of medial segment of left lobe and anterior segment of right lobe shows possible enhancement. No other focal lesion is noted in the liver. A heterogeneous 3x2cm soft tissue mass is noted just above the level of the vagina anterolateral to the rectal stump with clips in it. This may either represent a mass in the cervix or exophytic rectal tumor. Part of the left descending colon is surgically missing. A left lower quadrant colostomy is seen with a small parastomal hernia without any evidence of obstruction. There is no retroperitoneal lymph node enlargement. Moderate left hydroureteronephrosis with dilated ureter traced into the pelvis after the soft tissue mass in the cervical region. The cortical thickness of the left kidney is decreased suggesting long-standing hydronephrosis and secondary atrophy. The right kidney is normal in size, shape and excretory function. The urinary bladder is normal in distension and outline. A well-defined fat plane is demonstrated between the posterior wall of the bladder and the mass located near the vault of the vagina. G.U. Gindings: A heterogeneous 3x2cm soft tissue mass is noted just above the level of the vagina anterolateral to the rectal stump with clips in it. This may either represent a mass in the cervix or exophytic rectal tumor. Part of the left descending colon is surgically missing. There is no retroperitoneal lymph node enlargement. Moderate left hydroureteronephrosis with dilated ureter traced into the pelvis to the soft tissue mass in the cervical region. The cortical thickness of the left kidney is decreased suggesting long-standing hydronephrosis and secondary atrophy. The right kidney is normal in size, shape and excretory function. The urinary bladder is normal. A well-defined fat plane is demonstrated between the posterior wall of the bladder and the mass located near the vault of the vagina. Colorectal cancer is the third most common cause of cancer death in the United States. It appears to be associated with diets high in animal fat and protein and low in fiber. Seventy percent of colorectal cancers occur in the rectosigmoid region. Rectal cancers may present with bleeding, change in bowel habits, perineal pain, and symptoms of invasion of adjacent organs including hematuria, urinary frequency, or vaginal fistulas. Surgical removal is the only effective therapy. Anterior resection with anastomosis to the rectal stump is performed for upper rectal tumors and a combined abdominal and perineal resection with a permanent colostomy for distal rectal lesions. On CT, rectal lesions may appear as focal lobulated soft tissue masses with asymmetrical or circumferential thickening of the bowel wall. Narrowing of the lumen and bowel obstruction may be evident. Extension into pericolonic fat or adjacent structures, regional adenopathy, adrenal or liver metastases, and hydronephrosis may also be visualized. Common sites of local extension include the pelvic musculature, bladder, prostate, ovaries, and seminal vesicles. Although CT is not as accurate in staging colorectal cancer, predicting local extension, or detecting spread to lymph nodes, it is the procedure of choice for detecting recurrence of carcinoma, particularly in patients who have undergone abdominoperineal resection.

Author
Peter Anderson
Keywords
abdomen, radiology
Visits
653

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