22-year-old female with a history of neuroblastoma. Baseline pre-stem cell transplant. CHEST:LUNGS AND PLEURA: The innumerable bilateral pulmonary nodules have increased in size and number. No significant pleural effusion is identified. Many of the metastatic nodules are pleural based.MEDIASTINUM AND HILA: The heart size is normal. The pre-vascular, subcarinal and right hilar lymphadenopathy has increased in size in the interval. The lymph nodes are in a conglomeration are not amenable to reproducible measurement.CHEST WALL: The previously described right axillary lymph node now measures 4.4 x 2 cm (image 13/2 a one). On the most recent exam this measured 3.6 x 2 centimeters.There is new sclerosis of the T5 and T6 vertebral bodies. The T6 vertebral body shows a loss of height of approximately 50%. While no involvement of the spinal canal is identified on this examination, if there is clinical concern for involvement, an MRI may be obtained. Multiple sclerotic metastatic lesions are seen in the ribs.ABDOMEN:LIVER, BILIARY TRACT: There are multiple hypodense lesions in both lobes of the liver. The phase of enhancement is different on today's examination and therefore reproducible measurement is not possible. However, it appears to these lesions have all increased in size. No biliary ductal dilatation is present.SPLEEN: No significant abnormality noted.PANCREAS: Multiple hypodense lesions are identified within the body and tail of the pancreas. Lesions in the tail of pancreas have increased slightly in size. Lesions in the body of the pancreas are not as clearly seen on this examination. This may be due to phase of contrast enhancement rather than actual decrease in size.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The right kidney is atrophic. No abnormalities are identified within the left kidney itself. However multiple nodules are identified surrounding the left kidney which likely represent metastatic nodules.RETROPERITONEUM, LYMPH NODES: Multiple retroperitoneal lymph nodes are increased in number but not enlarged by CT criteria.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Subtle sclerotic lesions are identified within the thoracic and lumbar spine. These correlate with the areas of increased uptake on recent bone scan likely represent metastatic disease.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: The uterus is small for age.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: See discussion of bones in the abdomen above.OTHER: No significant abnormality noted.
Interval worsening of metastatic disease in the chest, abdomen and pelvis as described above. Specifically new collapse of the T6 vertebral body is identified.