 There is a new pathologic compression fracture of the T11 vertebral body with mild retropulsion. However, there is no significant spinal canal stenosis at this level. Again noted are post-operative changes related to posterior laminectomies as well removal of the spinous processes for tumor resection at the T8 and T9 levels with posterior spinal fusion and placement of bipedicular screws at the T7 and T10 levels. Susceptibility artifact limits evaluation of these levels; however, there is suspected narrowing of the spinal canal with mass effect of the cord at the T8/T9 levels related to epidural tumor spread. There are metastatic lesions in the T10 spinous process, T8, T9, T11, T12, L3, L5 vertebral bodies and S1, S2 segments. There may be narrowing of the bilateral S1 foramen. There are additional metastases to the pelvic bones. The visualized spinal cord otherwise displays normal signal characteristics. There is no detectable enhancement of the cord or the meninges.Incidentally noted are enlarged subcarinal, pretracheal, aortopulmonary window and left hilar lymph nodes, which are increased in size compared to prior study. A left adrenal mass measuring up to 3.4 cm is also increased in size. A partially imaged T2 hyperintense lesion at the right lung base is incompletely evaluated. There is a trace left pleural effusion.
1. New pathologic compression fracture of the T11 vertebra with mild retropulsion, but no significant spinal canal stenosis.2. Post-operative changes related to T8/9 posterior laminectomies with posterior spinal fusion at the T7 and T10 levels. Evaluation of the spinal canal is limited by susceptibility artifact from spinal hardware at these levels; however, there is suspected narrowing of the spinal canal and mass effect on the cord at the T8/T9 levels related to epidural tumor spread. 3. Metastatic lesions of the T10 spinous process, T8, T9, T11, T12, L3, L5 vertebral bodies and S1, S2 segments, at least one of which is new at T12. Pelvic osseous metastases with suspected S1 foraminal narrowing.4. Interval increase in size of mediastinal and left hilar lymphadenopathy. 5. Interval increase in size of a left adrenal mass measuring up to 3.4 cm, which likely represents metastasis.6. A partially imaged T2 hyperintense lesion at the right lung base, may represent a new loculated effusion. However, this is incompletely evaluated and CT may be considered for further evaluation. Findings conveyed to Dr. Melotek by EPIC email on 3/7/2015 at the time of dictation.  