Ultrasound Case 048

Presentation

A 69 year old man presents with altered bowel habit and some mild left loin pain. He has been feeling weak and tired recently. He has a microcytic anaemia.


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Describe and interpret these scans

IMAGE INTERPRETATION

Image 1: Longitudinal view left iliac fossa. There is a large disorganized heterogeneous mass. Some parts retain the appearance of bowel wall with a hypoechoic wall and gas is seen within the lumen.

Image 2: Longitudinal view right lobe of liver. Several large liver metastases are seen. These are metastases have a peripheral hypoechoic halo, then an echogenic ring and centrally they have stippled foci with posterior acoustic shadowing – which is typical of calcification within metastases.

Image 3: Longitudinal view of the left kidney. The kidney demonstrates mild to moderate hydronephrosis raising suspicion that the sigmoid mass was causing left ureteric obstruction. This was confirmed on CT scan.


CLINICAL CORRELATION

Sigmoid mucinous adenocarcinoma with calcified liver metastases and left ureteric obstruction

In a patient with weight loss, lethargy, altered bowel habit and microcytic anaemia the suspicion of a bowel malignancy is high. In this case the large disorganized bowel related mass in the left iliac fossa confirmed this.

Looking beyond the primary pathology and considering other possible complications in this case demonstrated two very significant issues.

  1. Multiple metastases in the liver. The central calcified areas are associated with gastrointestinal mucinous adenocarcinoma.
  2. Local invasion or pressure effects have caused at least some obstruction of the left sided ureter with resultant hydronephrosis.

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An Emergency physician based in Perth, Western Australia. Professionally my passion lies in integrating advanced diagnostic and procedural ultrasound into clinical assessment and management of the undifferentiated patient. Sharing hard fought knowledge with innovative educational techniques to ensure knowledge translation and dissemination is my goal. Family, wild coastlines, native forests, and tinkering in the shed fills the rest of my contented time. | SonoCPDUltrasound library | Top 100 | @thesonocave |

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