Malignant neoplasm of unspecified part of unspecified bronchus or lung [C34.90], Reason for Study: ^Reason: h/o newly diagnosed small cell lung cancer; eval for mets prior to beginning urgent chemotherapy History: see above Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.There is no evidence of abnormal enhancement.Patchy scattered FLAIR/T2 high signal intensities on periventricular white matter and bilateral centrum semiovale indicate nonspecific small vessel ischemic disease.There are several lacunar infarcts seen on bilateral basal ganglia and left side anterior pons.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear. Left mastoid air cells show fluid collections.Cervical and Thoracic Spine MRIThere are multifocal vertebral body lesions which replacing normal fatty marrow on both cervical and thoracic vertebral bodies including C7, T1, T2, T3, T5, T10, T11 and T12 indicating multifocal metastatic lesions.Specifically, there are associated soft tissue mass left side neural foramen at the level of C7T1 and T12 with large paravertebral likely extrapleural soft tissue mass.There are also multilevel bilateral pleural thickening on thoracic vertebral levels as well as right posterior lobe of the liver indicating possible metastatic lesions.There is no evidence of vertebral body compression fracture on this scan. Cervical spine shows straightening with degenerative changes of cervical spine. In particular, there are disc dessication with disc height decrease at C45, C56 and C67.There is broad based a bit irregular disc protrusion which abuts thecal sac at the level of C34, however, no evidence of bilateral neuroforamen stenosis.Spinal cord signal intensity is normal.There is no evidence of spinal canal stenosis or neuroforaminal narrowing on thoracic spine.
1. No evidence of metastatic lesion intracranially.2. Multiple vertebral body metastatic lesions involving both cervical and thoracic vertebral bodies with paravertebral soft tissue mass formation at T1 and T2 level as described above.3. Multifocal extra vertebral metastatic lesions including bilateral extrapleural or pleural spaces and right lobe of the liver.4. Degenerative changes of cervical spine C45 to C67.