History of invasive breast carcinoma progressed after aromatase inhibitor status post right radical mastectomy 12/14/2015 at outside hospital with bulky tumor left behind close margins positive nodes and direct skin extension. Evaluate for distant metastases. CHEST:LUNGS AND PLEURA: Numerous bilateral pulmonary nodules compatible with metastatic disease, see reference left apical nodule and right apical nodule measurements below. Left lung base paramedial mass, see measurements below.Right hilar mass/conglomerate lymphadenopathy and extensive soft tissue paramediastinal soft tissue thickening. The dominant right hilar/mediastinal mass measurement is provided below.There is nodular soft tissue pleural thickening and enhancement of the right hemi-thorax, suspicious for pleural metastatic disease.Small left pleural effusion.MEDIASTINUM AND HILA: Right hilar/mediastinal mass. Paratracheal lymphadenopathy measuring approximately. The right hilar/mediastinal lesion partially encases the SVC which is mildly narrowed. Small pericardial effusion.CHEST WALL: Postsurgical changes from right mastectomy. Abnormal restricted diffusion in the right axillary region may represent residual tumor. There is abnormal postcontrast enhancement which appears to involve several right lateral ribs such as on image 51 of series 100 which reflect metastatic osseous disease and less likely healing fractures.ABDOMEN:LIVER, BILIARY TRACT: Numerous liver metastases. Reference right hepatic dome segment 8 lesion measurement is provided below. No biliary ductal dilatation. The vessels are patent. Porta hepatis lymphadenopathy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple appearing and minimally complex cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 2/2/2016 13:00:00)LEFT APICAL NODULE: 1.5 x 1.1 cm (Image 15, Series 7).RIGHT APICAL NODULE: 1.4 x 1.3 cm (Image 14, Series 7).LEFT LUNG BASE PARAMEDIAL MASS: 5.2 x 3.9 cm (Image 38, Series 7).RIGHT HILAR MASS/CONGLOMERATE LYMPHADENOPATHY: 5.5 x 4.4 cm (Image 17, Series 10).PARATRACHEAL LYMPH NODE: 2.5 x 1.6 cm (Image 12, Series 10).RIGHT HEPATIC DOME SEGMENT 8 LESION: 1.6 x 1.3 cm (Image 8, Series 20).
Multiple bilateral pulmonary metastatic nodules/mass, right hilar mass/conglomerate lymphadenopathy and numerous liver metastases. Suspected metastatic right hemi-thorax pleural disease. Suspected right lateral rib metastases; consider bone scan for a more sensitive evaluation of bone metastases. Right axillary signal abnormality may be post-surgical or residual tumor. 