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RADIOLOGY: HEPATOBILIARY: Case# 33153: LIVER METASTASIS. LARGE TUMOR IMPLANT SUSPICIOUS FOR EROSION INTO THE STOMACH. 37 year old man with history of metastatic rhabdomyosarcoma, initially discovered at cholecystectomy. He now presents with fever, elevated white count, abdominal pain. 1) Large complex mass located between loops of bowel in the pelvis, with adjacent inflammatory changes. There is air and fluid contained within the center of this mass. This mass is highly suspicious for an abscess, probably secondary to bowel perforation. Alternatively this could represent necrotic tumor implant with or without infection. Abscess or infected mass seems most likely considering the adjacent peritoneal enhancement and diffuse inflammatory change of adjacent colon.2) There is a large tumor implant in the left upper quadrant that contains a small amount of air. This appears suspicious for erosion into the stomach, though this could represent simple necrosis or infection of the mass. There are multiple other peritoneal/mesenteric implants, some containing small amounts of air. 3) Multiple lesions within the liver, consistent with metastasis.

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Peter Anderson
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