. Innumerable pulmonary nodules, enlarging and new. Reference lingular lung nodule larger, measuring 2.7 x 2.3 cm on image 47 series 5, previously measured 2.2 x 1.6 cm. New trace left pleural effusion. New and enlarging mediastinal and hilar adenopathy, associated left pulmonary vein narrowing, also visualized worsening cardiophrenic and pericardial adenopathy. Reference left paratracheal nodal lesion increased in size, measuring 5.5 x 4.5 cm on image 34 series 3, previously measured 4.2 x 3 cm, associated narrowing of left pulmonary artery visualized. Severe calcified coronary artery disease. Mild gynecomastia. Worsening hepatic metastatic disease, liver now measures 29 cm in craniocaudal dimension, previously measured 19 cm. Lesion measures 6.2 x 5.2 cm on image 92 series 3, previously measured 4.5 x 3.9 cm. Additional reference segment 7 lesion also difficult to see but measures approximately 4.2 x 2.8 cm on image 65 series 4, previously measured 3 x 2.8 cm. Hepatic veins and intrahepatic IVC not well assessed secondary to timing of IV contrast bolus but luminal narrowing visualized secondary to aforementioned masses. Visualized main left and right portal veins patent. Splenomegaly, measures 14.5 cm. Splenic vein near hilum not well visualized, likely reflecting partial thrombosis. Perigastric and perisplenic collateral vessels seen. Stable to mildly increased size of reference lesion adjacent to pancreatic tail but not as well seen, measures approximately 2.4 x 1.2 cm on image 94 series 3, previously measured 2.1 x 1.2 cm. Interval enlargement of right adrenal metastatic lesion, measuring at 5.2 x 3.5 cm on image 82 series 3, previously measured 3.7 x 2.7 cm. Mild left adrenal thickening. Unchanged exophytic left renal hypoattenuating focus, coronal image 33. Enlarging periportal and portacaval lymphadenopathy. Reference portacaval lymph node now measures 3.8 x 3.5 cm on image 112 series 3, previously measured 2.9 x 2.1 cm. Moderate to severe calcified aortobiiliac atherosclerotic disease. Enlarging peritoneal and mesenteric soft tissue nodularity, compatible with metastatic disease. Submitted for reference is upper mid abdominal soft tissue focus measuring 2 x 1.5 cm on image 120 series 3, previously measured up to 0.6 cm. New moderate ascites. No significant abnormality noted. No significant abnormality noted. Osseous metastatic disease with diffuse heterogeneity of bony structures seen. For example, moth-eaten appearance of right glenoid fossa of the scapula on image 10 series Please note that evaluation more sensitive with nuclear medicine bone scan or MRI, please refer to recent MRI spinal imaging for additional findings or better assessment of osseous metastatic disease. Similar to prior study is small subcentimeter subcutaneous soft tissue nodularity, for instance, in the left chest wall on image 43 and image 48, unchanged from prior exam.
clinical findings_fin: {'innumerable pulmonary nodules': {'clinical finding': 'innumerable pulmonary nodules', 'cf_snomed': {'nodule': 27925004}, 'existence': 'pos_dx', 'descriptive_term': 'innumerable pulmonary', 'observation': 'nodule'}}size_fin: [{'size': '2.7 x 2.3 cm'}, {'size': '2.2 x 1.6 cm'}]anatomical entity_fin: {'lung': {}}clinical findings_fin: {'reference lingular lung nodule': {'clinical finding': 'reference lingular lung nodule', 'cf_snomed': {'nodule': 27925004}, 'existence': 'pos_dx', 'descriptive_term': 'reference lingular lung', 'observation': 'nodule'}}location descriptor_fin: ['left']clinical findings_fin: {'pleural effusion': {'clinical finding': 'pleural effusion', 'cf_snomed': {'pleural effusion': 60046008}, 'existence': 'pos_dx', 'descriptive_term': 'pleural', 'observation': 'effusion'}}anatomical entity_fin: {'pulmonary vein': {'location descriptor': 'left'}}location descriptor_fin: ['left']clinical findings_fin: {'new and enlarging mediastinal and hilar adenopathy': {'clinical finding': 'new and enlarging mediastinal and hilar adenopathy', 'existence': 'pos_dx', 'descriptive_term': 'new and enlarging mediastinal and hilar', 'observation': 'adenopathy', 'temporal_term': 'new'}, 'associated left pulmonary vein narrowing': {'clinical finding': 'associated left pulmonary vein narrowing', 'cf_snomed': {'narrowing': 708528005}, 'existence': 'pos_dx', 'descriptive_term': 'associated left pulmonary vein', 'observation': 'narrowing'}, 'worsening cardiophrenic and pericardial adenopathy': {'clinical finding': 'worsening cardiophrenic and pericardial adenopathy', 'existence': 'pos_dx', 'descriptive_term': 'worsening cardiophrenic and pericardial', 'observation': 'adenopathy', 'strength_term': 'worsening', 'change_term': 'worsening'}}size_fin: [{'size': '5.5 x 4.5 cm'}, {'size': '4.2 x 3 cm'}]anatomical entity_fin: {'left pulmonary artery': {}}location descriptor_fin: ['left']clinical findings_fin: {'reference left paratracheal nodal lesion': {'clinical finding': 'reference left paratracheal nodal lesion', 'cf_snomed': {'lesion': 52988006}, 'existence': 'pos_dx', 'descriptive_term': 'reference left paratracheal nodal', 'observation': 'lesion'}, 'associated narrowing': {'clinical finding': 'associated narrowing', 'cf_snomed': {'narrowing': 708528005}, 'existence': 'pos_dx', 'descriptive_term': 'associated', 'observation': 'narrowing'}}anatomical entity_fin: {'coronary artery': {}}clinical findings_fin: {'severe calcified coronary artery disease': {'clinical finding': 'severe calcified coronary artery disease', 'cf_snomed': {'disease': 64572001}, 'existence': 'pos_dx', 'descriptive_term': 'severe calcified coronary artery', 'observation': 'disease', 'strength_term': 'severe', 'change_term': 'calcified'}}clinical findings_fin: {'mild gynecomastia': {'clinical finding': 'mild gynecomastia', 'cf_snomed': {'gynecomastia': 4754008}, 'existence': 'pos_dx', 'descriptive_term': 'mild', 'observation': 'gynecomastia', 'strength_term': 'mild'}}size_fin: [{'size': '29 cm', 'size_descriptor': 'disease'}, {'size': '19 cm', 'size_descriptor': 'liver'}]anatomical entity_fin: {'liver': {}}clinical findings_fin: {'hepatic metastatic disease': {'clinical finding': 'hepatic metastatic disease', 'cf_snomed': {'disease': 64572001}, 'existence': 'pos_dx', 'descriptive_term': 'hepatic metastatic', 'observation': 'disease'}}size_fin: [{'size': '6.2 x 5.2 cm'}, {'size': '4.5 x 3.9 cm'}]clinical findings_fin: {'lesion': {'clinical finding': 'lesion', 'cf_snomed': {'lesion': 52988006}, 'existence': 'pos_dx', 'observation': 'lesion'}}size_fin: [{'size': '4.2 x 2.8 cm', 'size_descriptor': 'segment'}, {'size': '3 x 2.8 cm', 'size_descriptor': 'lesion'}]clinical findings_fin: {'additional reference segment 7 lesion': {'clinical finding': 'additional reference segment 7 lesion', 'cf_snomed': {'lesion': 52988006}, 'existence': 'pos_dx', 'descriptive_term': 'additional reference segment 7', 'observation': 'lesion'}}anatomical entity_fin: {'hepatic veins': {}}clinical findings_fin: {'iv contrast': {'clinical finding': 'iv contrast', 'existence': 'unc_dx', 'descriptive_term': 'iv', 'observation': 'contrast'}, 'luminal narrowing': {'clinical finding': 'luminal narrowing', 'cf_snomed': {'narrowing': 708528005}, 'existence': 'pos_dx', 'descriptive_term': 'luminal', 'observation': 'narrowing'}, 'aforementioned masses': {'clinical finding': 'aforementioned masses', 'existence': 'pos_dx', 'descriptive_term': 'aforementioned', 'observation': 'mass'}}anatomical entity_fin: {'right portal veins': {}}location descriptor_fin: ['left']clinical findings_fin: {'visualized main left and right portal veins patent': {'clinical finding': 'visualized main left and right portal veins patent', 'existence': 'neg_dx', 'descriptive_term': 'visualized main left and right portal veins', 'observation': 'patent'}}size_fin: [{'size': '14.5 cm'}]clinical findings_fin: {'splenomegaly': {'clinical finding': 'splenomegaly', 'cf_snomed': {'splenomegaly': 16294009}, 'existence': 'pos_dx', 'observation': 'splenomegaly'}}anatomical entity_fin: {'splenic vein': {}, 'hilum': {}}clinical findings_fin: {'partial thrombosis': {'clinical finding': 'partial thrombosis', 'cf_snomed': {'thrombosis': 439127006}, 'existence': 'pos_dx', 'descriptive_term': 'partial', 'observation': 'thrombosis', 'strength_term': 'partial'}}clinical findings_fin: {'perigastric and perisplenic collateral vessels': {'clinical finding': 'perigastric and perisplenic collateral vessels', 'existence': 'pos_dx', 'descriptive_term': 'perigastric and perisplenic collateral', 'observation': 'vessel'}}size_fin: [{'size': '2.4 x 1.2 cm'}, {'size': '2.1 x 1.2 cm'}]location descriptor_fin: ['adjacent']clinical findings_fin: {'reference lesion': {'clinical finding': 'reference lesion', 'cf_snomed': {'lesion': 52988006}, 'existence': 'pos_dx', 'descriptive_term': 'reference', 'observation': 'lesion'}, 'pancreatic tail': {'clinical finding': 'pancreatic tail', 'existence': 'pos_dx', 'descriptive_term': 'pancreatic', 'observation': 'tail'}}size_fin: [{'size': '5.2 x 3.5 cm'}, {'size': '3.7 x 2.7 cm'}]location descriptor_fin: ['right']clinical findings_fin: {'right adrenal metastatic lesion': {'clinical finding': 'right adrenal metastatic lesion', 'cf_snomed': {'lesion': 52988006}, 'existence': 'pos_dx', 'descriptive_term': 'right adrenal metastatic', 'observation': 'lesion'}}location descriptor_fin: ['left']clinical findings_fin: {'mild left adrenal thickening': {'clinical finding': 'mild left adrenal thickening', 'existence': 'pos_dx', 'descriptive_term': 'mild left adrenal', 'observation': 'thickening', 'strength_term': 'mild'}}location descriptor_fin: ['left']clinical findings_fin: {'unchanged exophytic left renal hypoattenuating focus': {'clinical finding': 'unchanged exophytic left renal hypoattenuating focus', 'existence': 'pos_dx', 'descriptive_term': 'unchanged exophytic left renal hypoattenuating', 'observation': 'focus', 'strength_term': 'unchanged', 'change_term': 'unchanged'}}clinical findings_fin: {'enlarging periportal and portacaval lymphadenopathy': {'clinical finding': 'enlarging periportal and portacaval lymphadenopathy', 'cf_snomed': {'lymphadenopathy': 30746006}, 'existence': 'pos_dx', 'descriptive_term': 'enlarging periportal and portacaval', 'observation': 'lymphadenopathy'}}size_fin: [{'size': '3.8 x 3.5 cm'}, {'size': '2.9 x 2.1 cm'}]clinical findings_fin: {'reference portacaval lymph node': {'clinical finding': 'reference portacaval lymph node', 'existence': 'pos_dx', 'descriptive_term': 'reference portacaval lymph', 'observation': 'node'}}clinical findings_fin: {'moderate to severe calcified aortobiiliac atherosclerotic disease': {'clinical finding': 'moderate to severe calcified aortobiiliac atherosclerotic disease', 'cf_snomed': {'disease': 64572001}, 'existence': 'pos_dx', 'descriptive_term': 'moderate to severe calcified aortobiiliac atherosclerotic', 'observation': 'disease', 'strength_term': 'moderate - severe', 'change_term': 'calcified'}}clinical findings_fin: {'enlarging peritoneal and mesenteric soft tissue nodularity': {'clinical finding': 'enlarging peritoneal and mesenteric soft tissue nodularity', 'existence': 'pos_dx', 'descriptive_term': 'enlarging peritoneal and mesenteric soft tissue', 'observation': 'nodularity'}, 'metastatic disease': {'clinical finding': 'metastatic disease', 'cf_snomed': {'disease': 64572001}, 'existence': 'pos_dx', 'descriptive_term': 'metastatic', 'observation': 'disease'}}size_fin: [{'size': '2 x 1.5 cm'}, {'size': '0.6 cm'}]anatomical entity_fin: {'abdominal': {}}location descriptor_fin: ['upper']clinical findings_fin: {'upper mid abdominal soft tissue focus': {'clinical finding': 'upper mid abdominal soft tissue focus', 'existence': 'pos_dx', 'descriptive_term': 'upper mid abdominal soft tissue', 'observation': 'focus'}}clinical findings_fin: {'new moderate ascites': {'clinical finding': 'new moderate ascites', 'cf_snomed': {'ascites': 389026000}, 'existence': 'pos_dx', 'descriptive_term': 'new moderate', 'observation': 'ascite', 'strength_term': 'moderate', 'temporal_term': 'new'}}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: {'osseous metastatic disease': {'clinical finding': 'osseous metastatic disease', 'cf_snomed': {'disease': 64572001}, 'existence': 'pos_dx', 'descriptive_term': 'osseous metastatic', 'observation': 'disease'}}anatomical entity_fin: {'right glenoid fossa': {}, 'scapula': {}}imaging observation_fin: ['assessment']clinical findings_fin: {'osseous metastatic disease': {'clinical finding': 'osseous metastatic disease', 'cf_snomed': {'disease': 64572001}, 'existence': 'unc_dx', 'descriptive_term': 'osseous metastatic', 'observation': 'disease'}}anatomical entity_fin: {'chest wall': {'location descriptor': 'left'}}location descriptor_fin: ['left']clinical findings_fin: {'small subcentimeter subcutaneous soft tissue nodularity': {'clinical finding': 'small subcentimeter subcutaneous soft tissue nodularity', 'existence': 'pos_dx', 'descriptive_term': 'small subcentimeter subcutaneous soft tissue', 'observation': 'nodularity', 'strength_term': 'small'}}
<s>[INST] Write the finding section for a radiology report based on the following information: clinical findings_fin: {'innumerable pulmonary nodules': {'clinical finding': 'innumerable pulmonary nodules', 'cf_snomed': {'nodule': 27925004}, 'existence': 'pos_dx', 'descriptive_term': 'innumerable pulmonary', 'observation': 'nodule'}}size_fin: [{'size': '2.7 x 2.3 cm'}, {'size': '2.2 x 1.6 cm'}]anatomical entity_fin: {'lung': {}}clinical findings_fin: {'reference lingular lung nodule': {'clinical finding': 'reference lingular lung nodule', 'cf_snomed': {'nodule': 27925004}, 'existence': 'pos_dx', 'descriptive_term': 'reference lingular lung', 'observation': 'nodule'}}location descriptor_fin: ['left']clinical findings_fin: {'pleural effusion': {'clinical finding': 'pleural effusion', 'cf_snomed': {'pleural effusion': 60046008}, 'existence': 'pos_dx', 'descriptive_term': 'pleural', 'observation': 'effusion'}}anatomical entity_fin: {'pulmonary vein': {'location descriptor': 'left'}}location descriptor_fin: ['left']clinical findings_fin: {'new and enlarging mediastinal and hilar adenopathy': {'clinical finding': 'new and enlarging mediastinal and hilar adenopathy', 'existence': 'pos_dx', 'descriptive_term': 'new and enlarging mediastinal and hilar', 'observation': 'adenopathy', 'temporal_term': 'new'}, 'associated left pulmonary vein narrowing': {'clinical finding': 'associated left pulmonary vein narrowing', 'cf_snomed': {'narrowing': 708528005}, 'existence': 'pos_dx', 'descriptive_term': 'associated left pulmonary vein', 'observation': 'narrowing'}, 'worsening cardiophrenic and pericardial adenopathy': {'clinical finding': 'worsening cardiophrenic and pericardial adenopathy', 'existence': 'pos_dx', 'descriptive_term': 'worsening cardiophrenic and pericardial', 'observation': 'adenopathy', 'strength_term': 'worsening', 'change_term': 'worsening'}}size_fin: [{'size': '5.5 x 4.5 cm'}, {'size': '4.2 x 3 cm'}]anatomical entity_fin: {'left pulmonary artery': {}}location descriptor_fin: ['left']clinical findings_fin: {'reference left paratracheal nodal lesion': {'clinical finding': 'reference left paratracheal nodal lesion', 'cf_snomed': {'lesion': 52988006}, 'existence': 'pos_dx', 'descriptive_term': 'reference left paratracheal nodal', 'observation': 'lesion'}, 'associated narrowing': {'clinical finding': 'associated narrowing', 'cf_snomed': {'narrowing': 708528005}, 'existence': 'pos_dx', 'descriptive_term': 'associated', 'observation': 'narrowing'}}anatomical entity_fin: {'coronary artery': {}}clinical findings_fin: {'severe calcified coronary artery disease': {'clinical finding': 'severe calcified coronary artery disease', 'cf_snomed': {'disease': 64572001}, 'existence': 'pos_dx', 'descriptive_term': 'severe calcified coronary artery', 'observation': 'disease', 'strength_term': 'severe', 'change_term': 'calcified'}}clinical findings_fin: {'mild gynecomastia': {'clinical finding': 'mild gynecomastia', 'cf_snomed': {'gynecomastia': 4754008}, 'existence': 'pos_dx', 'descriptive_term': 'mild', 'observation': 'gynecomastia', 'strength_term': 'mild'}}size_fin: [{'size': '29 cm', 'size_descriptor': 'disease'}, {'size': '19 cm', 'size_descriptor': 'liver'}]anatomical entity_fin: {'liver': {}}clinical findings_fin: {'hepatic metastatic disease': {'clinical finding': 'hepatic metastatic disease', 'cf_snomed': {'disease': 64572001}, 'existence': 'pos_dx', 'descriptive_term': 'hepatic metastatic', 'observation': 'disease'}}size_fin: [{'size': '6.2 x 5.2 cm'}, {'size': '4.5 x 3.9 cm'}]clinical findings_fin: {'lesion': {'clinical finding': 'lesion', 'cf_snomed': {'lesion': 52988006}, 'existence': 'pos_dx', 'observation': 'lesion'}}size_fin: [{'size': '4.2 x 2.8 cm', 'size_descriptor': 'segment'}, {'size': '3 x 2.8 cm', 'size_descriptor': 'lesion'}]clinical findings_fin: {'additional reference segment 7 lesion': {'clinical finding': 'additional reference segment 7 lesion', 'cf_snomed': {'lesion': 52988006}, 'existence': 'pos_dx', 'descriptive_term': 'additional reference segment 7', 'observation': 'lesion'}}anatomical entity_fin: {'hepatic veins': {}}clinical findings_fin: {'iv contrast': {'clinical finding': 'iv contrast', 'existence': 'unc_dx', 'descriptive_term': 'iv', 'observation': 'contrast'}, 'luminal narrowing': {'clinical finding': 'luminal narrowing', 'cf_snomed': {'narrowing': 708528005}, 'existence': 'pos_dx', 'descriptive_term': 'luminal', 'observation': 'narrowing'}, 'aforementioned masses': {'clinical finding': 'aforementioned masses', 'existence': 'pos_dx', 'descriptive_term': 'aforementioned', 'observation': 'mass'}}anatomical entity_fin: {'right portal veins': {}}location descriptor_fin: ['left']clinical findings_fin: {'visualized main left and right portal veins patent': {'clinical finding': 'visualized main left and right portal veins patent', 'existence': 'neg_dx', 'descriptive_term': 'visualized main left and right portal veins', 'observation': 'patent'}}size_fin: [{'size': '14.5 cm'}]clinical findings_fin: {'splenomegaly': {'clinical finding': 'splenomegaly', 'cf_snomed': {'splenomegaly': 16294009}, 'existence': 'pos_dx', 'observation': 'splenomegaly'}}anatomical entity_fin: {'splenic vein': {}, 'hilum': {}}clinical findings_fin: {'partial thrombosis': {'clinical finding': 'partial thrombosis', 'cf_snomed': {'thrombosis': 439127006}, 'existence': 'pos_dx', 'descriptive_term': 'partial', 'observation': 'thrombosis', 'strength_term': 'partial'}}clinical findings_fin: {'perigastric and perisplenic collateral vessels': {'clinical finding': 'perigastric and perisplenic collateral vessels', 'existence': 'pos_dx', 'descriptive_term': 'perigastric and perisplenic collateral', 'observation': 'vessel'}}size_fin: [{'size': '2.4 x 1.2 cm'}, {'size': '2.1 x 1.2 cm'}]location descriptor_fin: ['adjacent']clinical findings_fin: {'reference lesion': {'clinical finding': 'reference lesion', 'cf_snomed': {'lesion': 52988006}, 'existence': 'pos_dx', 'descriptive_term': 'reference', 'observation': 'lesion'}, 'pancreatic tail': {'clinical finding': 'pancreatic tail', 'existence': 'pos_dx', 'descriptive_term': 'pancreatic', 'observation': 'tail'}}size_fin: [{'size': '5.2 x 3.5 cm'}, {'size': '3.7 x 2.7 cm'}]location descriptor_fin: ['right']clinical findings_fin: {'right adrenal metastatic lesion': {'clinical finding': 'right adrenal metastatic lesion', 'cf_snomed': {'lesion': 52988006}, 'existence': 'pos_dx', 'descriptive_term': 'right adrenal metastatic', 'observation': 'lesion'}}location descriptor_fin: ['left']clinical findings_fin: {'mild left adrenal thickening': {'clinical finding': 'mild left adrenal thickening', 'existence': 'pos_dx', 'descriptive_term': 'mild left adrenal', 'observation': 'thickening', 'strength_term': 'mild'}}location descriptor_fin: ['left']clinical findings_fin: {'unchanged exophytic left renal hypoattenuating focus': {'clinical finding': 'unchanged exophytic left renal hypoattenuating focus', 'existence': 'pos_dx', 'descriptive_term': 'unchanged exophytic left renal hypoattenuating', 'observation': 'focus', 'strength_term': 'unchanged', 'change_term': 'unchanged'}}clinical findings_fin: {'enlarging periportal and portacaval lymphadenopathy': {'clinical finding': 'enlarging periportal and portacaval lymphadenopathy', 'cf_snomed': {'lymphadenopathy': 30746006}, 'existence': 'pos_dx', 'descriptive_term': 'enlarging periportal and portacaval', 'observation': 'lymphadenopathy'}}size_fin: [{'size': '3.8 x 3.5 cm'}, {'size': '2.9 x 2.1 cm'}]clinical findings_fin: {'reference portacaval lymph node': {'clinical finding': 'reference portacaval lymph node', 'existence': 'pos_dx', 'descriptive_term': 'reference portacaval lymph', 'observation': 'node'}}clinical findings_fin: {'moderate to severe calcified aortobiiliac atherosclerotic disease': {'clinical finding': 'moderate to severe calcified aortobiiliac atherosclerotic disease', 'cf_snomed': {'disease': 64572001}, 'existence': 'pos_dx', 'descriptive_term': 'moderate to severe calcified aortobiiliac atherosclerotic', 'observation': 'disease', 'strength_term': 'moderate - severe', 'change_term': 'calcified'}}clinical findings_fin: {'enlarging peritoneal and mesenteric soft tissue nodularity': {'clinical finding': 'enlarging peritoneal and mesenteric soft tissue nodularity', 'existence': 'pos_dx', 'descriptive_term': 'enlarging peritoneal and mesenteric soft tissue', 'observation': 'nodularity'}, 'metastatic disease': {'clinical finding': 'metastatic disease', 'cf_snomed': {'disease': 64572001}, 'existence': 'pos_dx', 'descriptive_term': 'metastatic', 'observation': 'disease'}}size_fin: [{'size': '2 x 1.5 cm'}, {'size': '0.6 cm'}]anatomical entity_fin: {'abdominal': {}}location descriptor_fin: ['upper']clinical findings_fin: {'upper mid abdominal soft tissue focus': {'clinical finding': 'upper mid abdominal soft tissue focus', 'existence': 'pos_dx', 'descriptive_term': 'upper mid abdominal soft tissue', 'observation': 'focus'}}clinical findings_fin: {'new moderate ascites': {'clinical finding': 'new moderate ascites', 'cf_snomed': {'ascites': 389026000}, 'existence': 'pos_dx', 'descriptive_term': 'new moderate', 'observation': 'ascite', 'strength_term': 'moderate', 'temporal_term': 'new'}}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: {'osseous metastatic disease': {'clinical finding': 'osseous metastatic disease', 'cf_snomed': {'disease': 64572001}, 'existence': 'pos_dx', 'descriptive_term': 'osseous metastatic', 'observation': 'disease'}}anatomical entity_fin: {'right glenoid fossa': {}, 'scapula': {}}imaging observation_fin: ['assessment']clinical findings_fin: {'osseous metastatic disease': {'clinical finding': 'osseous metastatic disease', 'cf_snomed': {'disease': 64572001}, 'existence': 'unc_dx', 'descriptive_term': 'osseous metastatic', 'observation': 'disease'}}anatomical entity_fin: {'chest wall': {'location descriptor': 'left'}}location descriptor_fin: ['left']clinical findings_fin: {'small subcentimeter subcutaneous soft tissue nodularity': {'clinical finding': 'small subcentimeter subcutaneous soft tissue nodularity', 'existence': 'pos_dx', 'descriptive_term': 'small subcentimeter subcutaneous soft tissue', 'observation': 'nodularity', 'strength_term': 'small'}} [/INST] . Innumerable pulmonary nodules, enlarging and new. Reference lingular lung nodule larger, measuring 2.7 x 2.3 cm on image 47 series 5, previously measured 2.2 x 1.6 cm. New trace left pleural effusion. New and enlarging mediastinal and hilar adenopathy, associated left pulmonary vein narrowing, also visualized worsening cardiophrenic and pericardial adenopathy. Reference left paratracheal nodal lesion increased in size, measuring 5.5 x 4.5 cm on image 34 series 3, previously measured 4.2 x 3 cm, associated narrowing of left pulmonary artery visualized. Severe calcified coronary artery disease. Mild gynecomastia. Worsening hepatic metastatic disease, liver now measures 29 cm in craniocaudal dimension, previously measured 19 cm. Lesion measures 6.2 x 5.2 cm on image 92 series 3, previously measured 4.5 x 3.9 cm. Additional reference segment 7 lesion also difficult to see but measures approximately 4.2 x 2.8 cm on image 65 series 4, previously measured 3 x 2.8 cm. Hepatic veins and intrahepatic IVC not well assessed secondary to timing of IV contrast bolus but luminal narrowing visualized secondary to aforementioned masses. Visualized main left and right portal veins patent. Splenomegaly, measures 14.5 cm. Splenic vein near hilum not well visualized, likely reflecting partial thrombosis. Perigastric and perisplenic collateral vessels seen. Stable to mildly increased size of reference lesion adjacent to pancreatic tail but not as well seen, measures approximately 2.4 x 1.2 cm on image 94 series 3, previously measured 2.1 x 1.2 cm. Interval enlargement of right adrenal metastatic lesion, measuring at 5.2 x 3.5 cm on image 82 series 3, previously measured 3.7 x 2.7 cm. Mild left adrenal thickening. Unchanged exophytic left renal hypoattenuating focus, coronal image 33. Enlarging periportal and portacaval lymphadenopathy. Reference portacaval lymph node now measures 3.8 x 3.5 cm on image 112 series 3, previously measured 2.9 x 2.1 cm. Moderate to severe calcified aortobiiliac atherosclerotic disease. Enlarging peritoneal and mesenteric soft tissue nodularity, compatible with metastatic disease. Submitted for reference is upper mid abdominal soft tissue focus measuring 2 x 1.5 cm on image 120 series 3, previously measured up to 0.6 cm. New moderate ascites. No significant abnormality noted. No significant abnormality noted. Osseous metastatic disease with diffuse heterogeneity of bony structures seen. For example, moth-eaten appearance of right glenoid fossa of the scapula on image 10 series Please note that evaluation more sensitive with nuclear medicine bone scan or MRI, please refer to recent MRI spinal imaging for additional findings or better assessment of osseous metastatic disease. Similar to prior study is small subcentimeter subcutaneous soft tissue nodularity, for instance, in the left chest wall on image 43 and image 48, unchanged from prior exam. </s>