70 old male with NSCLC status post RT to the right lung, assess for response, has history of rheumatoid pulmonary nodules CHEST:LUNGS AND PLEURA: Previously noted spiculated mass in the posterior segment of the right upper lobe is less well delineated on the current exam due increased atelectasis involving its segment as well as an increasing right loculated pleural effusion.Noted are multiple pulmonary nodules, some demonstrating cavitation that are stable and may be related to rheumatoid nodules or secondary to chronic infection.Marked changes of centrilobular emphysema with scarring and areas of bronchiectasis noted particularly at the lung basesMEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Stable small hypodense lesions, most likely representing hepatic cystsSPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Extrarenal pelvis bilaterally and/or peripelvic cysts, with punctate, nonobstructing calculus in the right kidneyPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Compression fractures of T7, T8, 6 vertebrae are stable. However new fracturesare noted at T4 and T5. At T4 there is extension posteriorly into the spinal canal. MRI of the thoracic spine is recommended to evaluate for stenosis/cord compressionOTHER: Atherosclerotic changes of the aorta
1. Increased atelectasis in associated pleural reaction is identified in the posterior segment right upper lobe.2. Multiple pulmonary nodules, some cavitating are stable and again consistent with rheumatoid nodules and/or chronic infection.3. Extensive centrilobular emphysema, as well as scarring and bronchiectatic changes, more pronounced in the lower lobes unchanged4. New compression fractures at T4 and T5 with extension of the T4 fracture into the spinal canal. Correlation with previous MRI (12/10/09) to evaluate for stenosis/cord compression