These are two contrast-enhanced CT images obtained in the portal venous phase. In the first image, we see what appears to be a partially calcified metastasis occupying most of the right hepatic lobe, probably involving all segments of the right lobe. We can see that sporadically in colorectal cancer. It’s also something we see more commonly in mucinous colorectal cancer and something that may develop in patients who’ve been treated. So all of those would be considerations for calcification within a colorectal metastasis.
Postchemotherapy scan:
The second image shows that partial response has occurred with shrinkage of this lesion, which, however, remains quite substantial. The additional images show left-lobe lesions that have not decreased much in size.
Lung CT:
The CT through the lungs shows a 1.5-cm nodule in the mid-left lung. This is suspicious for metastasis in someone with a known advanced primary lesion. One could certainly obtain a PET scan here, if you wanted further confirmation. Obviously, one would also want to examine the remaining images of the lungs to see if additional lesions were present.
This lesion is slightly less speculated than one would expect with a primary lung cancer, but you would certainly have to keep that in mind as a possibility. It would be unlucky for the patient to have both.
