85 year-old male with metastatic lung cancer status post fall Brain: Previously seen hemorrhagic metastatic lesions in the posterior left parietal lobe and high left frontal lobe slightly smaller than the prior study. Low attenuation lesion in the right parasagittal region superior to the right lateral ventricle most likely representing metastatic disease is also decreased in size. Cerebellar metastatic lesion is not easily appreciated on this noncontrast examination. No new lesions or areas of hemorrhage are identified. The ventricles and basal cisterns are unchanged in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.Cervical spine: The cervical spine demonstrates normal alignment. Well-defined lucent areas are seen within the dens and lamina of C2. Additionally, a lucent area is seen in the spinous process of C3 that is less well defined posteriorly and is worrisome for metastatic lesions given the patient's history. An MRI would provide further characterization. Degenerative changes are seen throughout the cervical spine. No evidence for fracture.Thoracic spine: Thoracic spine demonstrates normal alignment. Large left apical mass representing patient's known malignancy is seen. The mass abuts the neural foramen of T2/T3. No definite extension into the canal is seen nor is there any is displacement of the thecal sac. No lesions are seen in the vertebral bodies. No evidence of fracture. Degenerative changes are seen throughout the thoracic spine. Right posterior old rib fractures are identified.Paraseptal emphysema identified in the lungs.Lumbar spine: Lumbar spine demonstrates normal alignment. No vertebral body lesions are seen. No evidence for fracture. Degenerative changes of the lumbar spine. Thickening of the lateral limb of the left adrenal gland again seen.
1. Reidentification of multiple cerebral metastatic lesions, some of which are smaller on this exam. No new intracranial process is seen.2. Lucent lesions identified in C1- C3, with the C3 spinous process lesion being more ill-defined possibly representing metastatic disease. MRI recommended for further evaluation.3. Degenerative changes seen throughout the spine with no evidence for fracture.4. Large left apical mass abutting the neural foramina of T2/T3 with no definite extension into the spinal canal.