. Scattered bilateral punctate micronodules. Normal size heart with no pericardial effusion. Small mediastinal lymph nodes which are not pathologic by CT size criteria. Status post partial right thyroidectomy. Enlarged left thyroid lobe containing multiple thyroid nodules with calcification. None. Bilateral breast calcifications. The right breast mass is not as pronounced in comparison to the prior outside hospital study with punctate foci of gas underlying the skin, correlate with procedural history. Multiple large right axillary lymph nodes are stable to slightly increased from prior study reference largest axillary lymph node measures 16 mm is unchanged. Additional smaller left axillary lymph nodes noted. Sclerotic lesion in the right scapula is unchanged. New and enlarging bilobar hypodense lesions compatible with metastatic disease with ill-defined borders making direct comparison difficult. However previously referenced mass in the right hepatic lobe measures 3.4 cm x 2.2 cm previously 3.0 cm x 2.1 cm. The majority appear of these lesions demonstrate ill-defined infiltrated borders and are clustered in appearance additionally there is mild perihepatic stranding. Although metastatic disease is favored, clinical correlation as well as correlation with the patients white blood cell count is recommended to exclude superimposed infection. No intra or extrahepatic biliary ductal dilatation. Cholelithiasis without evidence of cholecystitis. No significant abnormality noted. No significant abnormality noted. No significant abnormality noted. Small peripheral wedge-shaped focus in the right kidney is not as well seen on the prior study. This is indeterminant with the possibility of a small infarct not excluded. Enlarging porta hepatis lymph nodes, for reference a lymph node measures 1.8 cm x 1.4 cm. Additional mildly prominent retroperitoneal lymph nodes, noted, for reference a left periaortic lymph node measures 1.1 cm x 1.2 cm slightly increased in size from prior outside hospital CT study when it measured 1.0 cm x 0.8 cm. None. No significant abnormality noted. No significant abnormality noted. No significant abnormality noted. No significant abnormality noted. No significant abnormality noted. No significant abnormality noted. There is mild wall thickening of the sigmoid colon with associated diverticula likely reflecting chronic inflammatory change. Amorphous sclerosis of L5 is noted unchanged likely degenerative. No significant abnormality noted.
location descriptor_fin: ['bilateral']clinical findings_fin: {'scattered bilateral punctate micronodules': {'clinical finding': 'scattered bilateral punctate micronodules', 'existence': 'pos_dx', 'descriptive_term': 'scattered bilateral punctate', 'observation': 'micronodule'}}anatomical entity_fin: {'heart': {}}clinical findings_fin: {'pericardial effusion': {'clinical finding': 'pericardial effusion', 'cf_snomed': {'pericardial effusion': 373945007}, 'existence': 'neg_dx', 'descriptive_term': 'pericardial', 'observation': 'effusion'}}anatomical entity_fin: {'mediastinal lymph nodes': {}}clinical findings_fin: {'small mediastinal lymph nodes': {'clinical finding': 'small mediastinal lymph nodes', 'existence': 'pos_dx', 'descriptive_term': 'small mediastinal lymph', 'observation': 'node', 'strength_term': 'small'}}location descriptor_fin: ['right']clinical findings_fin: {'post partial right thyroidectomy': {'clinical finding': 'post partial right thyroidectomy', 'existence': 'pos_dx', 'descriptive_term': 'post partial right', 'observation': 'thyroidectomy', 'strength_term': 'partial'}}anatomical entity_fin: {'lobe': {}}location descriptor_fin: ['left']clinical findings_fin: {'enlarged': {'clinical finding': 'enlarged', 'existence': 'pos_dx', 'observation': 'enlarged'}, 'multiple thyroid nodules': {'clinical finding': 'multiple thyroid nodules', 'cf_snomed': {'thyroid nodule': 237495005}, 'existence': 'pos_dx', 'descriptive_term': 'multiple thyroid', 'observation': 'nodule', 'quantity_term': 'multiple'}, 'calcification': {'clinical finding': 'calcification', 'existence': 'pos_dx', 'observation': 'calcification'}}anatomical entity_fin: {'breast': {'location descriptor': 'bilateral'}}location descriptor_fin: ['bilateral']clinical findings_fin: {'bilateral breast calcifications': {'clinical finding': 'bilateral breast calcifications', 'existence': 'pos_dx', 'descriptive_term': 'bilateral breast', 'observation': 'calcification'}}anatomical entity_fin: {'skin': {}}imaging observation_fin: ['foci']location descriptor_fin: ['right']clinical findings_fin: {'right breast mass': {'clinical finding': 'right breast mass', 'existence': 'neg_dx', 'descriptive_term': 'right breast', 'observation': 'mass'}, 'punctate foci': {'clinical finding': 'punctate foci', 'existence': 'pos_dx', 'descriptive_term': 'punctate', 'observation': 'foci'}, 'gas': {'clinical finding': 'gas', 'existence': 'pos_dx', 'observation': 'gas'}}size_fin: [{'size': '16 mm'}]anatomical entity_fin: {'axillary lymph nodes': {'location descriptor': 'right'}, 'axillary lymph node': {}}location descriptor_fin: ['right']clinical findings_fin: {'multiple large right axillary lymph nodes': {'clinical finding': 'multiple large right axillary lymph nodes', 'existence': 'pos_dx', 'descriptive_term': 'multiple large right axillary lymph', 'observation': 'node', 'strength_term': 'large', 'quantity_term': 'multiple'}, 'largest axillary lymph node': {'clinical finding': 'largest axillary lymph node', 'existence': 'pos_dx', 'descriptive_term': 'largest axillary lymph', 'observation': 'node'}}anatomical entity_fin: {'axillary lymph nodes': {'location descriptor': 'left'}}location descriptor_fin: ['left']clinical findings_fin: {'additional smaller left axillary lymph nodes': {'clinical finding': 'additional smaller left axillary lymph nodes', 'existence': 'pos_dx', 'descriptive_term': 'additional smaller left axillary lymph', 'observation': 'node'}}anatomical entity_fin: {'right scapula': {}}clinical findings_fin: {'sclerotic lesion': {'clinical finding': 'sclerotic lesion', 'cf_snomed': {'lesion': 52988006}, 'existence': 'pos_dx', 'descriptive_term': 'sclerotic', 'observation': 'lesion'}}imaging observation_fin: ['borders']clinical findings_fin: {'new and enlarging bilobar hypodense lesions': {'clinical finding': 'new and enlarging bilobar hypodense lesions', 'cf_snomed': {'lesion': 52988006}, 'existence': 'pos_dx', 'descriptive_term': 'new and enlarging bilobar hypodense', 'observation': 'lesion', 'temporal_term': 'new'}, 'metastatic disease': {'clinical finding': 'metastatic disease', 'cf_snomed': {'disease': 64572001}, 'existence': 'pos_dx', 'descriptive_term': 'metastatic', 'observation': 'disease'}}size_fin: [{'size': '3.4 cm x 2.2 cm'}, {'size': '3.0 cm x 2.1 cm'}]anatomical entity_fin: {'lobe': {}}location descriptor_fin: ['right']clinical findings_fin: {'previously referenced mass': {'clinical finding': 'previously referenced mass', 'existence': 'pos_dx', 'descriptive_term': 'previously referenced', 'observation': 'mass'}}imaging observation_fin: ['borders']clinical findings_fin: {'these lesions': {'clinical finding': 'these lesions', 'cf_snomed': {'lesion': 52988006}, 'existence': 'pos_dx', 'descriptive_term': 'these', 'observation': 'lesion'}, 'ill-defined infiltrated': {'clinical finding': 'ill-defined infiltrated', 'existence': 'unc_dx', 'descriptive_term': 'ill-defined', 'observation': 'infiltrated', 'strength_term': 'ill-defined'}, 'mild perihepatic stranding': {'clinical finding': 'mild perihepatic stranding', 'existence': 'pos_dx', 'descriptive_term': 'mild perihepatic', 'observation': 'strand', 'strength_term': 'mild'}}anatomical entity_fin: {'cell': {}}imaging observation_fin: ['blood']clinical findings_fin: {'metastatic disease': {'clinical finding': 'metastatic disease', 'cf_snomed': {'disease': 64572001}, 'existence': 'pos_dx', 'descriptive_term': 'metastatic', 'observation': 'disease'}, 'superimposed infection': {'clinical finding': 'superimposed infection', 'cf_snomed': {'superimposed infection': 193198003}, 'existence': 'unc_dx', 'descriptive_term': 'superimposed', 'observation': 'infection'}}clinical findings_fin: {'intra or extrahepatic biliary ductal dilatation': {'clinical finding': 'intra or extrahepatic biliary ductal dilatation', 'cf_snomed': {'dilatation': 25322007}, 'existence': 'neg_dx', 'descriptive_term': 'intra or extrahepatic biliary ductal', 'observation': 'dilatation'}}clinical findings_fin: {'cholelithiasis': {'clinical finding': 'cholelithiasis', 'existence': 'pos_dx', 'observation': 'cholelithiasis'}, 'cholecystitis': {'clinical finding': 'cholecystitis', 'cf_snomed': {'cholecystitis': 76581006}, 'existence': 'neg_dx', 'observation': 'cholecystitis'}}clinical findings_fin: {'significant abnormality': {'clinical finding': 'significant abnormality', 'existence': 'neg_dx', 'descriptive_term': 'significant', 'observation': 'abnormality'}}clinical findings_fin: {'significant abnormality': {'clinical finding': 'significant abnormality', 'existence': 'neg_dx', 'descriptive_term': 'significant', 'observation': 'abnormality'}}clinical findings_fin: {'significant abnormality': {'clinical finding': 'significant abnormality', 'existence': 'neg_dx', 'descriptive_term': 'significant', 'observation': 'abnormality'}}anatomical entity_fin: {'right kidney': {}}imaging observation_fin: ['wedge']location descriptor_fin: ['peripheral']clinical findings_fin: {'small peripheral wedge-shaped focus': {'clinical finding': 'small peripheral wedge-shaped focus', 'existence': 'neg_dx', 'descriptive_term': 'small peripheral wedge-shaped', 'observation': 'focus', 'strength_term': 'small'}}clinical findings_fin: {'small infarct': {'clinical finding': 'small infarct', 'cf_snomed': {'infarct': 55641003}, 'existence': 'unc_dx', 'descriptive_term': 'small', 'observation': 'infarct', 'strength_term': 'small'}}size_fin: [{'size': '1.8 cm x 1.4 cm'}]anatomical entity_fin: {'porta hepatis': {}}clinical findings_fin: {'hepatis lymph nodes': {'clinical finding': 'hepatis lymph nodes', 'existence': 'pos_dx', 'descriptive_term': 'hepatis lymph', 'observation': 'node'}, 'lymph node': {'clinical finding': 'lymph node', 'existence': 'pos_dx', 'descriptive_term': 'lymph', 'observation': 'node'}}size_fin: [{'size': '1.1 cm x 1.2 cm', 'size_descriptor': 'nodes'}, {'size': '1.0 cm x 0.8 cm', 'size_descriptor': 'node'}]location descriptor_fin: ['left']clinical findings_fin: {'prominent retroperitoneal lymph nodes': {'clinical finding': 'prominent retroperitoneal lymph nodes', 'existence': 'pos_dx', 'descriptive_term': 'prominent retroperitoneal lymph', 'observation': 'node', 'strength_term': 'prominent'}, 'left periaortic lymph node': {'clinical finding': 'left periaortic lymph node', 'existence': 'pos_dx', 'descriptive_term': 'left periaortic lymph', 'observation': 'node'}}clinical findings_fin: {'significant abnormality': {'clinical finding': 'significant abnormality', 'existence': 'neg_dx', 'descriptive_term': 'significant', 'observation': 'abnormality'}}clinical findings_fin: {'significant abnormality': {'clinical finding': 'significant abnormality', 'existence': 'neg_dx', 'descriptive_term': 'significant', 'observation': 'abnormality'}}clinical findings_fin: {'significant abnormality': {'clinical finding': 'significant abnormality', 'existence': 'neg_dx', 'descriptive_term': 'significant', 'observation': 'abnormality'}}clinical findings_fin: {'significant abnormality': {'clinical finding': 'significant abnormality', 'existence': 'neg_dx', 'descriptive_term': 'significant', 'observation': 'abnormality'}}clinical findings_fin: {'significant abnormality': {'clinical finding': 'significant abnormality', 'existence': 'neg_dx', 'descriptive_term': 'significant', 'observation': 'abnormality'}}clinical findings_fin: {'significant abnormality': {'clinical finding': 'significant abnormality', 'existence': 'neg_dx', 'descriptive_term': 'significant', 'observation': 'abnormality'}}anatomical entity_fin: {'sigmoid colon': {}}clinical findings_fin: {'mild wall thickening': {'clinical finding': 'mild wall thickening', 'existence': 'pos_dx', 'descriptive_term': 'mild wall', 'observation': 'thickening', 'strength_term': 'mild'}, 'chronic inflammatory change': {'clinical finding': 'chronic inflammatory change', 'existence': 'pos_dx', 'descriptive_term': 'chronic inflammatory', 'observation': 'change', 'temporal_term': 'chronic'}}clinical findings_fin: {'sclerosis of l5': {'clinical finding': 'sclerosis of l5', 'cf_snomed': {'sclerosis': 43846000}, 'existence': 'pos_dx', 'descriptive_term': 'sclerosis of', 'observation': 'l5'}}clinical findings_fin: {'significant abnormality': {'clinical finding': 'significant abnormality', 'existence': 'neg_dx', 'descriptive_term': 'significant', 'observation': 'abnormality'}}
<s>[INST] Write the finding section for a radiology report based on the following information: location descriptor_fin: ['bilateral']clinical findings_fin: {'scattered bilateral punctate micronodules': {'clinical finding': 'scattered bilateral punctate micronodules', 'existence': 'pos_dx', 'descriptive_term': 'scattered bilateral punctate', 'observation': 'micronodule'}}anatomical entity_fin: {'heart': {}}clinical findings_fin: {'pericardial effusion': {'clinical finding': 'pericardial effusion', 'cf_snomed': {'pericardial effusion': 373945007}, 'existence': 'neg_dx', 'descriptive_term': 'pericardial', 'observation': 'effusion'}}anatomical entity_fin: {'mediastinal lymph nodes': {}}clinical findings_fin: {'small mediastinal lymph nodes': {'clinical finding': 'small mediastinal lymph nodes', 'existence': 'pos_dx', 'descriptive_term': 'small mediastinal lymph', 'observation': 'node', 'strength_term': 'small'}}location descriptor_fin: ['right']clinical findings_fin: {'post partial right thyroidectomy': {'clinical finding': 'post partial right thyroidectomy', 'existence': 'pos_dx', 'descriptive_term': 'post partial right', 'observation': 'thyroidectomy', 'strength_term': 'partial'}}anatomical entity_fin: {'lobe': {}}location descriptor_fin: ['left']clinical findings_fin: {'enlarged': {'clinical finding': 'enlarged', 'existence': 'pos_dx', 'observation': 'enlarged'}, 'multiple thyroid nodules': {'clinical finding': 'multiple thyroid nodules', 'cf_snomed': {'thyroid nodule': 237495005}, 'existence': 'pos_dx', 'descriptive_term': 'multiple thyroid', 'observation': 'nodule', 'quantity_term': 'multiple'}, 'calcification': {'clinical finding': 'calcification', 'existence': 'pos_dx', 'observation': 'calcification'}}anatomical entity_fin: {'breast': {'location descriptor': 'bilateral'}}location descriptor_fin: ['bilateral']clinical findings_fin: {'bilateral breast calcifications': {'clinical finding': 'bilateral breast calcifications', 'existence': 'pos_dx', 'descriptive_term': 'bilateral breast', 'observation': 'calcification'}}anatomical entity_fin: {'skin': {}}imaging observation_fin: ['foci']location descriptor_fin: ['right']clinical findings_fin: {'right breast mass': {'clinical finding': 'right breast mass', 'existence': 'neg_dx', 'descriptive_term': 'right breast', 'observation': 'mass'}, 'punctate foci': {'clinical finding': 'punctate foci', 'existence': 'pos_dx', 'descriptive_term': 'punctate', 'observation': 'foci'}, 'gas': {'clinical finding': 'gas', 'existence': 'pos_dx', 'observation': 'gas'}}size_fin: [{'size': '16 mm'}]anatomical entity_fin: {'axillary lymph nodes': {'location descriptor': 'right'}, 'axillary lymph node': {}}location descriptor_fin: ['right']clinical findings_fin: {'multiple large right axillary lymph nodes': {'clinical finding': 'multiple large right axillary lymph nodes', 'existence': 'pos_dx', 'descriptive_term': 'multiple large right axillary lymph', 'observation': 'node', 'strength_term': 'large', 'quantity_term': 'multiple'}, 'largest axillary lymph node': {'clinical finding': 'largest axillary lymph node', 'existence': 'pos_dx', 'descriptive_term': 'largest axillary lymph', 'observation': 'node'}}anatomical entity_fin: {'axillary lymph nodes': {'location descriptor': 'left'}}location descriptor_fin: ['left']clinical findings_fin: {'additional smaller left axillary lymph nodes': {'clinical finding': 'additional smaller left axillary lymph nodes', 'existence': 'pos_dx', 'descriptive_term': 'additional smaller left axillary lymph', 'observation': 'node'}}anatomical entity_fin: {'right scapula': {}}clinical findings_fin: {'sclerotic lesion': {'clinical finding': 'sclerotic lesion', 'cf_snomed': {'lesion': 52988006}, 'existence': 'pos_dx', 'descriptive_term': 'sclerotic', 'observation': 'lesion'}}imaging observation_fin: ['borders']clinical findings_fin: {'new and enlarging bilobar hypodense lesions': {'clinical finding': 'new and enlarging bilobar hypodense lesions', 'cf_snomed': {'lesion': 52988006}, 'existence': 'pos_dx', 'descriptive_term': 'new and enlarging bilobar hypodense', 'observation': 'lesion', 'temporal_term': 'new'}, 'metastatic disease': {'clinical finding': 'metastatic disease', 'cf_snomed': {'disease': 64572001}, 'existence': 'pos_dx', 'descriptive_term': 'metastatic', 'observation': 'disease'}}size_fin: [{'size': '3.4 cm x 2.2 cm'}, {'size': '3.0 cm x 2.1 cm'}]anatomical entity_fin: {'lobe': {}}location descriptor_fin: ['right']clinical findings_fin: {'previously referenced mass': {'clinical finding': 'previously referenced mass', 'existence': 'pos_dx', 'descriptive_term': 'previously referenced', 'observation': 'mass'}}imaging observation_fin: ['borders']clinical findings_fin: {'these lesions': {'clinical finding': 'these lesions', 'cf_snomed': {'lesion': 52988006}, 'existence': 'pos_dx', 'descriptive_term': 'these', 'observation': 'lesion'}, 'ill-defined infiltrated': {'clinical finding': 'ill-defined infiltrated', 'existence': 'unc_dx', 'descriptive_term': 'ill-defined', 'observation': 'infiltrated', 'strength_term': 'ill-defined'}, 'mild perihepatic stranding': {'clinical finding': 'mild perihepatic stranding', 'existence': 'pos_dx', 'descriptive_term': 'mild perihepatic', 'observation': 'strand', 'strength_term': 'mild'}}anatomical entity_fin: {'cell': {}}imaging observation_fin: ['blood']clinical findings_fin: {'metastatic disease': {'clinical finding': 'metastatic disease', 'cf_snomed': {'disease': 64572001}, 'existence': 'pos_dx', 'descriptive_term': 'metastatic', 'observation': 'disease'}, 'superimposed infection': {'clinical finding': 'superimposed infection', 'cf_snomed': {'superimposed infection': 193198003}, 'existence': 'unc_dx', 'descriptive_term': 'superimposed', 'observation': 'infection'}}clinical findings_fin: {'intra or extrahepatic biliary ductal dilatation': {'clinical finding': 'intra or extrahepatic biliary ductal dilatation', 'cf_snomed': {'dilatation': 25322007}, 'existence': 'neg_dx', 'descriptive_term': 'intra or extrahepatic biliary ductal', 'observation': 'dilatation'}}clinical findings_fin: {'cholelithiasis': {'clinical finding': 'cholelithiasis', 'existence': 'pos_dx', 'observation': 'cholelithiasis'}, 'cholecystitis': {'clinical finding': 'cholecystitis', 'cf_snomed': {'cholecystitis': 76581006}, 'existence': 'neg_dx', 'observation': 'cholecystitis'}}clinical findings_fin: {'significant abnormality': {'clinical finding': 'significant abnormality', 'existence': 'neg_dx', 'descriptive_term': 'significant', 'observation': 'abnormality'}}clinical findings_fin: {'significant abnormality': {'clinical finding': 'significant abnormality', 'existence': 'neg_dx', 'descriptive_term': 'significant', 'observation': 'abnormality'}}clinical findings_fin: {'significant abnormality': {'clinical finding': 'significant abnormality', 'existence': 'neg_dx', 'descriptive_term': 'significant', 'observation': 'abnormality'}}anatomical entity_fin: {'right kidney': {}}imaging observation_fin: ['wedge']location descriptor_fin: ['peripheral']clinical findings_fin: {'small peripheral wedge-shaped focus': {'clinical finding': 'small peripheral wedge-shaped focus', 'existence': 'neg_dx', 'descriptive_term': 'small peripheral wedge-shaped', 'observation': 'focus', 'strength_term': 'small'}}clinical findings_fin: {'small infarct': {'clinical finding': 'small infarct', 'cf_snomed': {'infarct': 55641003}, 'existence': 'unc_dx', 'descriptive_term': 'small', 'observation': 'infarct', 'strength_term': 'small'}}size_fin: [{'size': '1.8 cm x 1.4 cm'}]anatomical entity_fin: {'porta hepatis': {}}clinical findings_fin: {'hepatis lymph nodes': {'clinical finding': 'hepatis lymph nodes', 'existence': 'pos_dx', 'descriptive_term': 'hepatis lymph', 'observation': 'node'}, 'lymph node': {'clinical finding': 'lymph node', 'existence': 'pos_dx', 'descriptive_term': 'lymph', 'observation': 'node'}}size_fin: [{'size': '1.1 cm x 1.2 cm', 'size_descriptor': 'nodes'}, {'size': '1.0 cm x 0.8 cm', 'size_descriptor': 'node'}]location descriptor_fin: ['left']clinical findings_fin: {'prominent retroperitoneal lymph nodes': {'clinical finding': 'prominent retroperitoneal lymph nodes', 'existence': 'pos_dx', 'descriptive_term': 'prominent retroperitoneal lymph', 'observation': 'node', 'strength_term': 'prominent'}, 'left periaortic lymph node': {'clinical finding': 'left periaortic lymph node', 'existence': 'pos_dx', 'descriptive_term': 'left periaortic lymph', 'observation': 'node'}}clinical findings_fin: {'significant abnormality': {'clinical finding': 'significant abnormality', 'existence': 'neg_dx', 'descriptive_term': 'significant', 'observation': 'abnormality'}}clinical findings_fin: {'significant abnormality': {'clinical finding': 'significant abnormality', 'existence': 'neg_dx', 'descriptive_term': 'significant', 'observation': 'abnormality'}}clinical findings_fin: {'significant abnormality': {'clinical finding': 'significant abnormality', 'existence': 'neg_dx', 'descriptive_term': 'significant', 'observation': 'abnormality'}}clinical findings_fin: {'significant abnormality': {'clinical finding': 'significant abnormality', 'existence': 'neg_dx', 'descriptive_term': 'significant', 'observation': 'abnormality'}}clinical findings_fin: {'significant abnormality': {'clinical finding': 'significant abnormality', 'existence': 'neg_dx', 'descriptive_term': 'significant', 'observation': 'abnormality'}}clinical findings_fin: {'significant abnormality': {'clinical finding': 'significant abnormality', 'existence': 'neg_dx', 'descriptive_term': 'significant', 'observation': 'abnormality'}}anatomical entity_fin: {'sigmoid colon': {}}clinical findings_fin: {'mild wall thickening': {'clinical finding': 'mild wall thickening', 'existence': 'pos_dx', 'descriptive_term': 'mild wall', 'observation': 'thickening', 'strength_term': 'mild'}, 'chronic inflammatory change': {'clinical finding': 'chronic inflammatory change', 'existence': 'pos_dx', 'descriptive_term': 'chronic inflammatory', 'observation': 'change', 'temporal_term': 'chronic'}}clinical findings_fin: {'sclerosis of l5': {'clinical finding': 'sclerosis of l5', 'cf_snomed': {'sclerosis': 43846000}, 'existence': 'pos_dx', 'descriptive_term': 'sclerosis of', 'observation': 'l5'}}clinical findings_fin: {'significant abnormality': {'clinical finding': 'significant abnormality', 'existence': 'neg_dx', 'descriptive_term': 'significant', 'observation': 'abnormality'}} [/INST] . Scattered bilateral punctate micronodules. Normal size heart with no pericardial effusion. Small mediastinal lymph nodes which are not pathologic by CT size criteria. Status post partial right thyroidectomy. Enlarged left thyroid lobe containing multiple thyroid nodules with calcification. None. Bilateral breast calcifications. The right breast mass is not as pronounced in comparison to the prior outside hospital study with punctate foci of gas underlying the skin, correlate with procedural history. Multiple large right axillary lymph nodes are stable to slightly increased from prior study reference largest axillary lymph node measures 16 mm is unchanged. Additional smaller left axillary lymph nodes noted. Sclerotic lesion in the right scapula is unchanged. New and enlarging bilobar hypodense lesions compatible with metastatic disease with ill-defined borders making direct comparison difficult. However previously referenced mass in the right hepatic lobe measures 3.4 cm x 2.2 cm previously 3.0 cm x 2.1 cm. The majority appear of these lesions demonstrate ill-defined infiltrated borders and are clustered in appearance additionally there is mild perihepatic stranding. Although metastatic disease is favored, clinical correlation as well as correlation with the patients white blood cell count is recommended to exclude superimposed infection. No intra or extrahepatic biliary ductal dilatation. Cholelithiasis without evidence of cholecystitis. No significant abnormality noted. No significant abnormality noted. No significant abnormality noted. Small peripheral wedge-shaped focus in the right kidney is not as well seen on the prior study. This is indeterminant with the possibility of a small infarct not excluded. Enlarging porta hepatis lymph nodes, for reference a lymph node measures 1.8 cm x 1.4 cm. Additional mildly prominent retroperitoneal lymph nodes, noted, for reference a left periaortic lymph node measures 1.1 cm x 1.2 cm slightly increased in size from prior outside hospital CT study when it measured 1.0 cm x 0.8 cm. None. No significant abnormality noted. No significant abnormality noted. No significant abnormality noted. No significant abnormality noted. No significant abnormality noted. No significant abnormality noted. There is mild wall thickening of the sigmoid colon with associated diverticula likely reflecting chronic inflammatory change. Amorphous sclerosis of L5 is noted unchanged likely degenerative. No significant abnormality noted. </s>