 Compared to examination from 5 days prior, there are interval postsurgical changes of decompression of the thoracic spinal canal from T5 to T8 and tumor debulking. Previously seen cord deformity is improved. There remains epidural tumor involving the left ventrolateral aspect of the spinal canal including with minimal cord deformity at the T7 level involving its left lateral aspect. Dorsal thecal sac effacement is much improved. There is subtle T2 hyperintensity within the thoracic cord from T5 to T7 which is suspected and probably present on prior although difficult to appreciate on prior due to the compressed cord.Multifocal osseous metastatic disease is again seen including the T1, T6-T8, and L1 vertebrae. Again noted is extensive involvement of the posterior elements on the left from T6 to T8 and narrowing of the left T6-T7, T7-T8, and T8-T9 neural foramina due to tumor. Enhancing tumor involving the neural foramina at the right C7-T1, right T1-T2, right T2-T3, right T12-L1, and right L1-L2 neural foramina also again seen. Tumor involving the left chest wall from approximately T7-T9, moderate left-sided pleural effusion, and para-aortic lymphadenopathy also again seen.The thoracic spine is in normal alignment, with a normal thoracic kyphosis. Vertebral body heights are maintained. Mild degenerative changes are seen including small central disc protrusion at T6-T7 and T7-T8.There is a fluid collection in the surgical bed which is mostly in the posterior midline paraspinous soft tissues and may represent a seroma or pseudomeningocele. Small amount of the fluid extends into the left lateral epidural space extending from T6 to the T7-T8 levels.
Compared to MRI examination from 5 days prior, interval posterior decompression of the spinal canal from T5 to T8 is seen with laminectomies and tumor debulking. Previously seen cord deformity is improved. Dorsal thecal sac effacement is significantly improved. There however remains rightward displacement of the cord and mild cord deformity at the T7 level related to epidural tumor involving the left ventrolateral aspect of the spinal canal. Paraspinous fluid collection which has mild extension into the left lateral epidural space from the T6 to the T7-T8 levels also mildly contributes to the mass effect. There is subtle T2 hyperintensity within the thoracic cord from T5 to T7 which may have been present on prior study although difficult to appreciate due to the compressed cord.Please see above and recent report from 12/5/2015 regarding additional foci of metastatic disease including involvement of multiple neural foramina.