67-year-old woman with known breast cancer metastatic on chemo. Reevaluate. CHEST:LUNGS AND PLEURA: Stable appearance of left apical traction bronchiectasis with fibrosis likely due to radiation change. New moderate to large left pleural effusion. Stable subcentimeter micronodule in the right upper lobe (image 27/95). There is a new air space opacity involving the left lingular segment anteriorly (image 45/95) that demonstrated increased activity on recent PET scan.MEDIASTINUM AND HILA: The left vocal cord is midline, compatible with known vocal cord paralysis. Thyroid hypodense lesions. Paratracheal enhancing soft tissue has decreased. Normal cardiac size. Mild pericardial wall thickening. Subcentimeter mediastinal nodes are unchanged. Slightly increased right hilar nodes.CHEST WALL: No significant axillary lymphadenopathy. Surgical clips are noted left axilla. Status post left mastectomy. A right-sided chest port is seen with its tip in the SVC/RA junction. Interval development of multiple sclerotic foci in the mid and lower thoracic spine suspicious for metastatic disease.ABDOMEN:LIVER, BILIARY TRACT: Stable hypodense lesion in the lateral segment of the left lobe (image 95/144).SPLEEN: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Scattered borderline mesenteric nodes. The largest measures approximately 11 mm (image 140/144) adjacent to the cecum.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Interval development of multiple sclerotic foci with inferior endplate depression involving the lumbar spine suspicious for metastatic disease better demonstrated on recent MRI from 7/2/08.
1. Interval development of new moderate left pleural effusion with new airspace opacity in the left lingular segment that was shown to have increased activity on PET/CT from 6/24/08.2. Interval development of multiple thoracic and lumbar osseous metastatic disease better seen on MRI from 7/2/08.