Vague abdominal discomfort and fullness.
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Multiple organ systems are markedly abnormal: There is diffuse enlargement and low-attenuation infiltration of the kidneys, low attenuation splenic lesions, thickening of the proximal small bowel, retroperitoneal adenopathy, diffuse enlargement and irregularity of the inferior rectus abdominus musculature, and inguinal and pelvic adenopathy.
The non-contrast images were included for educational benefit, particularly how the renal abnormalities can still be appreciated (though subtle).
The patient went on to have a inguinal mass biopsy
GROSS DESCRIPTION: Received in formalin labelled left inguinal mass biopsy are tan needle core biopsies up to 1.5 cm which are entirely submitted in a single cassette.
FINAL DIAGNOSIS: Follicular lymphoma, Grade 1-2 of 3.
This case is characterized by lymphomatous infiltration throughout the abdomen and pelvis. The most striking manifestations of disease is the symmetric renal involvement and infiltration of the rectus abdominus musculature. Given the extensive nature of the disease (renal, spleen, probable small bowel, muscular, lymphoid), it would be difficult to plausibly suggest any other diagnosis than lymphoma. If you had a case with the renal findings alone, a reasonable differential would include lymphoma, IgG4 deposition disease, amyloid, and Erdheim-Chester disease.
When reporting, it is most appropriate to suggest a potential target for biopsy, so that the clinician does not have to call the radiologist and ask: in this case, the large left inguinal lymph node is superficial and safe for ultrasound-guided biopsy.