Ultrasound Case 048

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.

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.