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( Pelvic mass )
S.A. Rooholamini, M.D.*, P.K. Chen, M.D.†,
A.H. Au, M.D.*, J. Rahimian, Ph.D.*,
From Departments of Radiological Sciences* and Pathology† Olive View-UCLA Medical Center, Sylmar, CA
CASE SUMMARY A 42-year-old man with mild right lower quadrant abdominal pain. On physical examination a firm mass was palpable in the right lower quadrant. The mass was mildly tender to palpation. Routine laboratory data were normal
FIGURE 1. (A and B) Axial CT images of the lower abdomen and pelvis with intravenous administration of contrast material demonstrate a large multilobulated space-occupying infiltrating lesion in the right lower quadrant. The mass shows a heterogeneous attenuation with fatty component.
FIGURE 2. (A and B) Axial delayed CT images of the upper and lower pelvis demonstrate a partially opacified urinary bladder (white arrow) which is displaced by the mass anteriorly and toward the left side of the pelvis. The right ureter is displaced anteromedially (black arrow). The right iliac vessels (arrowheads) are displaced by the mass anteriorly.
RADIOLOGIC FINDINGS Computed tomography of the abdomen and pelvis reveals a large multilobulated and infiltrating mass arising from the retroperitoneum on the right side and extending cephalad into the mid abdomen, caudad into the pelvis, and medially into the abdominal cavity and pelvis. The mass measures 11x6x17 cm, and it has compressed and displaced the psoas muscle anteriorly. It has also surrounded the right psoas and extends laterally to the right iliacus muscle. The inferior vena cava is flattened and pushed anteromedially. The distal abdominal aorta, including the bifurcation. is displaced anteriorly. There is displacement of the common iliac arteries with deviation to the left. The right iliac artery and vein are stretched, displaced anteromedially, and draped over the mass, but they are all patent. The mass crosses the midline, extends toward the left side of the pelvis, and displaces the urinary bladder toward the left side. The urinary bladder is positioned right behind the left rectus abdominis muscle. Likewise, the right ureter is markedly displaced anteromedially, but it is patent, and there is no ureteral dilatation. Displacement of the colon and small bowel loops is also seen. The mass is heterogeneous in density, containing areas of fat and soft tissue densities. No calcifications are visible within the mass or in the wall. No other abnormalities are encountered in the abdomen and pelvis. No lymphadenopathy is present. Following intravenous administration of contrast material, heterogeneous enhancement of the mass is seen. The degree of enhancement is moderate.
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