Figure 4a. Progressive abdominal pain and distention in a 12-year-old girl. (a) Contrast-enhanced CT scan shows hepatomegaly and innumerable hepatic metastases (arrows). Also note the hypoattenuating portal lymphadenopathy (arrowheads). Desmoplastic small round cell tumor was diagnosed with US-guided hepatic biopsy. (b) More caudal section through the pelvis shows ascites (short arrow) and a heterogeneous retrovesical mass (arrowheads) with areas of low attenuation and foci of punctate calcification (long arrow). Two additional peritoneal masses were present at higher levels. Areas of calcification became densely confluent on CT scans obtained after chemotherapy (not shown).