William Santis, M.D.
Michelle M. McNicholas, M.D.
William DeWolf, M.D.
Beth Israel Hospital, Harvard Medical School
Boston, Massachusetts

A 74 year-old man status post sigmoid colectomy for Dukes stage B colon carcinoma presented with a one week history of left lower quadrant pain, nausea, and malaise. He was found to have a rising CEA, and underwent abdominal CT which revealed multiple retroperitoneal soft tissue lesions. One mass was overlying the left ureter and causing mild hydronephrosis (Figure1). Serum creatinine was 1.5 ml/dl. The patient was treated as an outpatient, and returned ten days later with complaints of intermittent left flank pain and worsening abdominal pain. A repeat CT was obtained.

Physical Examination: Revealed mild left lower quadrant pain with minimal left costovertebral angle tenderness.

Laboratory Values:Creatinine: 2.0 ml/dl

Initial Abdominal CT

Followup Abdominal CT

DIAGNOSIS and DISCUSSION

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