 There is diffuse osseous metastatic involvement that has significantly progressed compared to the prior exam. There are unchanged mild compression deformities of T4, T6, and T12. While on the prior exam there was minimal ventral epidural tumor at T6 and T8 without cord compression, there is now new epidural extension of varying degress throughout the thoracic spine at the T3 - T12 levels. The tumor is mainly ventral and lateral, circumferentially encasing the spinal cord from the T3 through T7 levels and mainly on the right and dorsal to the spinal cord at the T8 and T9 levels. There is also new mild T11-T12 right foraminal epidural extension. The spinal cord compression is most severe at the T4, T6, and T8 levels with T2 hyperintense cord signal at the T8-T9 level and questionably at the T5-T6 level. In addition, there multilevel degenerative changes with disc osteophyte complexes at C3 through C7 resulting in mild spinal canal stenosis and mild degenerative changes at the remaining spinal levels. There is reidentified partially imaged mediastinal lymphadenopathy. There are redemonstrated subcentimeter lesions within both kidneys which likely represent cysts. In addition there is an unchanged subcentimeter T2 hypointense lesion within the right kidney that likely represents a complex cyst. There is a small left pleural effusion and a nonspecific partially imaged lesion within the left upper lobe of the lung.
1.Marked progression of diffuse osseous metastatic disease with significant worsening of the epidural extension that is now throughout the thoracic spine resulting in cord compression that is most severe at the T4, T6, and T8 levels. There is resultant new cord signal abnormality at the T8-T9 level and questionably at the T5-T6 level.2.Partially imaged mediastinal lymphadenopathy, small left pleural effusion, and a left pulmonary mass that are better assessed on CT.