Medullary thyroid carcinoma on clinical trial, history of pneumothorax, follow up examination for assessment of response CHEST:LUNGS AND PLEURA: There are persistent, widespread bilateral pulmonary micronodules, predominantly confluent. The reference conglomerate identified from the prior study has not significantly changed, measuring 35 x 25 mm on coronal image 28/57 ( 28 x 36 mm previous).The left pneumothorax has slightly increased, appearing to have further retracted from the chest wall.MEDIASTINUM AND HILA: The reference right paratracheal node currently measures 8 x 13 mm on image 34/153 (14 x 9 mm on previous). The right thyroid lesion (6/153) and right jugular lymphadenopathy (5/153) are unchanged.Stable calcified left hilar nodes. The heart size remains normal, without pericardial effusion.CHEST WALL: Multiple small sclerotic foci within the lumbar spine and mixed sclerotic and lytic lesion in the vertebral body of T1 are stable.Of particular note, there is a paucity of subcutaneous fat.ABDOMEN:LIVER, BILIARY TRACT: There is arterially enhancing lesion measuring 9 x 9 mm at the capsule of the posterior segment of the right hepatic lobe (84/153). This extends beyond the hepatic contour and is concerning for metastasis rather than hemangioma. The previous described low density, ill-defined lesion is again noted in the posterior hepatic lobe (81/153), also suspicious for metastasis.SPLEEN: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedPANCREAS: There is prominence of the pancreatic head which currently measures 34 mm in AP dimension on image 124/153. As compared to 26 mm on the prior study. Therefore, this raises question of enlarging conglomerate of peripancreatic lymph nodes or metastatic involvement with the pancreatic head. Further evaluation of this and of the hepatic lesions may be obtained with a dedicated MRI or triphasic CT abdomen.No intraperitoneal ascites appreciated.BOWEL, MESENTERY: No significant abnormality noted.
1. Metastatic thyroid carcinoma, predominantly stable.2. Arterially enhancing lesion in posterior hepatic lobe. Enlarging soft tissue density in the region of the pancreatic head. Both findings may be further characterized with dedicated abdominal MRI or triphasic CT.3. Slightly increased left pneumothorax.