No pulmonary arterial filling defect was identified in a good-quality CTPA. No right ventricular strain. The heart is normal with no pericardial effusion. Normal opacification and caliber of the thoracic aorta. No mediastinal lymphadenopathy.
The lungs are clear. No pleural effusion or pneumothorax.
Moderate left perinephric and subsplenic fluid with density of 28 HU extending around the pancreatic tail. Bulky appearance of the left kidney with focal cortical hypoenhancement of the anterior aspect. Left renal exophytic partially imaged rounded mass approximately 4 cm in diameter arising from the upper pole. No arterial contrast extravasation evident.
No fracture or destructive osseous lesions.
Impression
No PE identified to the level of the subsegmental arteries.
Left retroperitoneal hemorrhage centered on an exophytic (partially imaged) rounded mass arising from the upper pole of the left kidney. No arterial contrast extravasation evident. DDx included tumor (AML, RCC) and abscess complicated with hemorrhage. CT abdomen is advised.