CECT WHOLE ABDOMEN
Spiral axial sections were acquired through abdomen after oral opacofication of bowal before and after administration of I.V. contrast.
A large heterogenously enhancing lobulated mass with necrotic areas with it, is seen arising from the mid& upper poll of the right kidney(also involving the calyces in upper and mid pole) and extending to suprarenal region abulting the inferior surface of right lobe of liver, howerer the intervening fat plances with liver are maintained. The size of themass measures 11.0 x8.5x10.64cm (approx) in the superoinferior anteroposterior & transverse diamensions respectively. The right adrenal is the not seen separate from the mass. There is loss of intervening fat plances with right psosas muscle. The mass is extending to IVC, displacing it anteromedially with non visualization of right perirenal fascia with minimal fluid in Morrisonâ??s pouch.

Few enlargelymph nodes area are seen in upper retroperitoneum- in paraaortic, aortocaval & retocaval region, largest measuring 1.06x1.06cm (approx).

Lier is normal is outline, shape and attenuation. Intrahepatic billiary canaliculi and hepatic venous channels are normal.
Gall bladder is normal is outline and position. Gall bladder wall is uniform and normal in thickness.
Common bile duct is normal in caliber.
Pancreas is normal in size, outline and attenuation. Peripancreatic fat planes and vascular anatomy is normal.
Spleen is normal in outline, postion and shows normal attenuation value.
Left adrenal gland is normal in size, shape and attenuation.
Left kidney is normal in outline, size, position and attenuation. No hydronephrosis / calculus seen. Renal vascular pedicle is normal. Perirenal space and facial planes are normal. Left ureter is normal in course and calibre.
Urinary bladder is normal in outline and position. Uninary bladder wall is uniform. Perivesicle fat planes are normal.
Seminal vesicle angles are normal. Prostate is normal in outline and attenuation. Periprostatic fat planes are normal.
A well define lucent area is seen involving S1 vertebra? Metastatic.
Well define lucent area with fine vertical trabeculations is seen involving D12& L4 verterbral bodies suggestive of ? hemangioma.
Section through chest reveals moderate pleural effusion on left side with multiple enhancing soft tissue nodular lession involving pleure, likely to be metastatic deposits.
IMP: -Large lobulated soft tissue mass arising from mid and upper pole of right kidney & extending to suprarenal region abutting inferior surface of right lobe of liver with detailed extensions as described above. The etiology of these mass is likely to be a mitotic process(renal cell carcinoma).
-     Enlarged retroperitoneal lymph nodes.
-     Left sided moderate pleural effusion with nodular pleural deposits, likely to be metastatic.
-     The lucent area in S1 vertebra is suspicious for metastasis.