Table 2: Imaging Studies

Imaging Study Finding
Electrocardiogram Atrial fibrillation with a heart rate of 110/minute, T wave inversions in the lateral leads which was unchanged from prior ECG
Chest x-ray Enlarged cardiac silhouette, bilateral interstitial edema, blunting of the left costophrenic angle consistent with pleural thickening or pleural effusion.
Abdominal x-ray (Fig. 1) Multiple moderately dilated, gas filled loops of colon noted in the upper abdomen suggesting a possible distal colonic obstruction.
Renal ultrasound Renal cysts without evidence of obstructive uropathy, a very large cystic mass in the right mid-abdomen possibly due to a very large exophytic right renal cyst versus a peritoneal inclusion cyst or cystic retroperitoneal neoplasm or intraperitoneal neoplasm.
CT abdomen and pelvis without contrast (Figs. 2-5) Bilateral pleural effusions, coronary calcifications, bladder distention, a large cystic mass that is believed to be renal in origin measuring 27 cm possibly originating from the right kidney
MRI abdomen without contrast (Fig. 6) Multiple renal lesions some of which appear to represent cysts though they cannot be completely characterized without contrast, very large cystic lesion in the right abdomen of indeterminate significance, tiny pancreas fluid signal intensity lesions, evidence of iron deposition in the liver and spleen, T2 bright lesions in the liver possibly reflective of hemangiomas or cysts though not completely characterized, and cardiomegaly