 BRAIN: The most superior aspect of the brain is not included on this exam. This exam is also degraded by motion artifact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered patchy foci of T2 hyperintensity throughout the supratentorial white matter most compatible with chronic small vessel ischemic disease. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is minimal paranasal sinus mucosal thickening and a small right sphenoid sinus retention cyst.SPINE: There is a large heterogeneously enhancing partially imaged retroperitoneal mass that may rise from the left kidney. There is a partially imaged pleural or rib based mass involving the right sixth rib that measures at least 28 x 38 mm. There is also a pleural-based mass within the left posterior chest wall invading into the left sixth rib that measures 18 x 15 mm.There is a large heterogeneously enhancing mass involving the posterior elements of L3 and L4 that measures 98 x 62 mm. It involves the spinous processes as well as the left lateral masses and pushes the dura anteriorly resulting in severe cauda equina stenosis at the L3 and L4 levels. The mass also results in severe left neural foramen stenosis at L3-L4 and L4-L5. There is an additional heterogeneously enhancing mass involving the L1 posterior elements that measures approximately 27 x 29 mm. It abuts the dura without spinal canal or neural foramen stenosis.There are moderate degenerative changes within the cervical spine as evidenced by multilevel disc desiccation, mild loss of disc height, facet and uncovertebral joint arthropathy and a grade 1 retrolisthesis of C4 on C5. These findings result in mild spinal canal stenosis at C4-C5, and multilevel neural foramen stenosis that is moderate on the left at C3-C4, and severe bilaterally at C4-C5. There are also moderate degenerative changes within the thoracic spine as evidenced by multilevel disc desiccation, loss of disc height, end plate degenerative changes, and mild anterior wedging of T7 with an exaggerated kyphosis. There are small central disc protrusions at T6-T7 and T7-T8 without significant spinal canal stenosis. The left thyroid lobe is enlarged and heterogeneous. There is no evidence of spinal cord or conus compression. The spinal cord displays normal signal and morphology.
Large partially imaged retroperitoneal mass that may arise from the left kidney. There are presumed metastases invading the posterior chest wall and sixth ribs bilaterally. There are also presumed metastases involving the posterior elements of L1 as well as at L3-L4 where there is severe spinal canal stenosis and severe left neural foramen stenosis at L3-L4 and L4-L5. There is no evidence of spinal cord or conus compression. A CT chest / abdomen / pelvis is recommended for further characterization and staging purposes. 