PMC2635124_01
Axial CT of upper chest demonstrating axillary lymphadenopathy.
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F1
CT revealed a one cm left anterior axillary node, subcentimetre nodes in both axilla, multiple subcentimetre mediastinal nodes, the largest one measuring 9 mm in the pre-carina. (Figures 1, 2 and 3) In the abdomen, there was a 3 cm x 2 cm soft tissue mass located inferior to the left hemi-diaphragm, which most likely represented lymph nodal mass.
Axial CT of upper chest shows mildly enlarged axillary and mediastinal lymph nodes.
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F2
CT revealed a one cm left anterior axillary node, subcentimetre nodes in both axilla, multiple subcentimetre mediastinal nodes, the largest one measuring 9 mm in the pre-carina. (Figures 1, 2 and 3) In the abdomen, there was a 3 cm x 2 cm soft tissue mass located inferior to the left hemi-diaphragm, which most likely represented lymph nodal mass.
Axial CT of lung hila shows hilar lymphadenopathy.
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F3
CT revealed a one cm left anterior axillary node, subcentimetre nodes in both axilla, multiple subcentimetre mediastinal nodes, the largest one measuring 9 mm in the pre-carina. (Figures 1, 2 and 3) In the abdomen, there was a 3 cm x 2 cm soft tissue mass located inferior to the left hemi-diaphragm, which most likely represented lymph nodal mass.
Axial CT of upper abdomen demonstrates mildly enlarged para-aortic and portal lymph nodes.
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F4
There was a 12 mm node in the aorta-caval region; further subcentimetre nodes were seen in the celiac region around the lesser curvature, paraortic area, and the mesentery. (Figure 4) Lymph nodes were seen in the inguinal region bilaterally measuring 9 mm in the left inguinal area.
Axial CT of chest shows embolus in the right lower lobar artery.
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F5
CT with contrast was performed the next day. Computerised tomography with contrast revealed thrombus in the right main lobar branch of pulmonary artery extending into the segmental branch of the lower lobe. (Figure 5) Thrombus was also seen in the segmental branch of right upper lobe, left lower lobe and middle lobe.
Axial CT through the liver during arterial phase shows peripheral enhancement of the 6 x 5 cm haemangioma in segment 7. There is a 3 cm splenunculus on the left side.
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F6
In the arterial phase, there was peripheral enhancement (Figure 6); the lesion became homogenous with the liver parenchyma in delayed phase. (Figure 7) and increased enhancement was seen in the portal venous phase. (Figure 8) Further, the soft tissue mass located under left hemidiaphragm, which was initially reported as lymph nodes, represented splenunculus. (Figures 6 and 7) The mass received blood supply from splenic artery and venous drainage was by splenic vein.
Axial CT 5 minutes post-contrast demonstrates complete homogenous enhancement of the haemangioma, now being of the same density as normal surrounding liver. There is a 3 cm splenunculus on the left side.
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F7
In the arterial phase, there was peripheral enhancement (Figure 6); the lesion became homogenous with the liver parenchyma in delayed phase. (Figure 7) and increased enhancement was seen in the portal venous phase. (Figure 8) Further, the soft tissue mass located under left hemidiaphragm, which was initially reported as lymph nodes, represented splenunculus. (Figures 6 and 7) The mass received blood supply from splenic artery and venous drainage was by splenic vein.
Axial CT - portal venous phase shows increased enhancement of the haemangioma.
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F8