Lung cancer with known metastatic disease, please evaluate known sacral lesion. PELVIS: Internal pelvic contents are unchanged and remain grossly unremarkable in this limited evaluation. Specifically only minimal effacement of the presacral fat is observed. No evidence of additional pelvic floor abnormalities, specifically vascular structures appear intact and unremarkable.BONES, SOFT TISSUES: A large and markedly enlarged since October centrally necrotic enhancing sacral mass is again observed extending from the superior margin inferiorly with mild extension into the right sacral notch. The mass measures 7.8 x 5.1 cm axially (image 22 series 1/1/2001) and abuts the right SI joint along the posterior margin and extends to within 2 cm of the left SI articulation.Of particular note is neural foraminal narrowing with essentially complete occlusion with nerve encasement of the right S2 foramina and marked narrowing of the right S1 and left S2 foramina. More minimal involvement of the S3 foramina bilaterally.Additional focal lesion measuring 2.1 cm in the right iliac wing (image 22 series 501) with cortical destruction, homogeneous enhancement and extension with minimal fat effacement under the overlying gluteus minimus.OTHER: The surrounding and overlying soft tissues and external muscular compartments are otherwise unremarkable.
1.Large necrotic sacral mass, more pronounced and extensive when compared to prior exam from October. Measurements and extent including sacral nerve encasement described.2.Additional enhancing metastatic focus observed in right iliac wing