PMC4996584_01
Axial view of CT urogram demonstrates a 1.5 cm filling defect in the right renal pelvis.
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A CT urogram delineated a 1.5 cm right renal pelvic lesion with no evidence of local advancement or LAD in the abdomen or pelvis (Fig. 1).
(a) CT scan demonstrating 3.3 cm right external iliac node (vertical arrow), right external iliac vein (asterisk), and right external iliac artery (horizontal arrow). (b) CT scan showing 3.2 cm right obturator lymph node enlargement (vertical arrow).
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A CT scan of the chest, abdomen, and pelvis demonstrated new onset of right-sided pelvic LAD with a 3.3 cm right external iliac node (Fig. 2a), 1.6 cm right common iliac node, and 3.2 cm right obturator node (Fig. 2b).
PMC4996584_02
(a) Coronal views on CT urogram show 2.6 cm right distal ureteral defect (red arrow). (b) Simultaneous 1.5 cm left renal pelvic filling defect (red arrow).
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A CT urogram demonstrated a 1.5 cm left renal pelvic filling defect and a 2.5 cm right distal ureteral filling defect, but no evidence of locally advanced or metastatic disease was present (Fig. 3a, b).
MRI of the abdomen demonstrates an enlarged 2.0 cm left para-aortic lymph node with enhancement after gadolinium (red arrow).
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Periodic cross-sectional imaging had been performed regularly but a new 2.0 cm left para-aortic lymph node concerning for metastatic disease was discovered on an MRI, 20 months after initial presentation (Fig. 4).