Thyroid carcinoma, known metastatic disease. Shortness of breath with hemoptysis, query pulmonary embolism. PULMONARY ARTERY: This is a technically adequate examination for the evaluation of pulmonary embolism. No pulmonary embolism is noted to the subsegmental level.LUNGS AND PLEURA: Despite the short term interval, there is evidence of interval progression of metastatic disease. Some of the innumerable pulmonary nodules throughout both lungs have slightly enlarged. For example, on image 47/156, a pulmonary nodule measures 11 mm as compared to 10 mm one month ago. A second nodule in the right upper lobe (image 36/156) currently measures 8 mm as opposed to 6 mm.Progressive thickening of the major fissure with irregular nodularity is noted. There is progressive increased reticulonodular thickening of the interlobular septae raising a question of lymphangitic involvement. Persistent atelectasis at the superior segment of the left lower lobe.MEDIASTINUM AND HILA: The mediastinal and hilar lymphadenopathy has increased in size. The right low pretracheal lymph node now measures 22 x 26 mm, compared to 26 x 19 mm one month ago. The subcarinal lymph node is also enlarged, measuring 26 x 22 mm as compared to 22 x 22 mm.The left paraesophageal lymph node is stable, measuring 20 x 20 millimeters.CHEST WALL: A right breast nodule inferior at the nipple line on image 168/313 has slightly enlarged, measuring 10 x 10 mm, as opposed to 9 x 6 mm. A second nodule in the inferomedial left breast currently measures 8 mm AP dimension as opposed to 6 mm.UPPER ABDOMEN: The enhancing left adrenal nodule has increased in size, measuring 27 x 20 mm on image 290/313 as opposed to 18 x 24 mm. The right adrenal mass with central low density is not significantly changed in size. However, there is a new enhancing nodule anterior to the right adrenal gland measuring approximately 9 mm in its transverse dimension.Although this is not optimized for evaluation of the hepatic parenchyma, there are new foci of hyperdensity throughout the right hepatic lobe suspicious for hypervascular metastases. Further evaluation may be performed with either triphasic CT or dedicated hepatic MRI. Incidentally, there is a replaced right hepatic artery.A hiatal hernia is present. BONES: There are multiple osseous lesions in the mid and lower thoracic and upper lumbar vertebral bodies compatible with metastases.
1. No evidence of pulmonary embolism to the subsegmental level2. Progression of pulmonary metastases with enlarging pulmonary nodules and mediastinal lymphadenopathy.3. Interval appearance of hypervascular lesions throughout the right hepatic lobe suspicious for metastatic disease. Further investigation with a triphasic CT or dedicated hepatic MRI recommended.,