Reason: hx of bladder cancer, evaluate for metastatic disease.Additional history per electronic medical record:Ronnie Thomas is a 68Yrs old male with a history of bladder cancer status post cystectomy, orthotopic neobladder in 7/2006. Final pathology revealed high grade noninvasive papillary urothelial carcinoma and Gleason 3+3=6 adenocarcinoma of the prostate (pT2cN0Mx). He was most recently seen by Dr. Steinberg, who performed his cystectomy, and was found to be NED. He has also been admitted in the interim for SBO, managed conservatively.  He presented to clinic to discuss new gross hematuria, for which he was recently seen in the ED. His most recent CT scan was 9/20/2015 which revealed no evidence of recurrent or metastatic disease. ABDOMEN:LUNG BASES: Partially visualized thoracic aortic dissection. Sternotomy changes.LIVER, BILIARY TRACT: The liver demonstrates normal signal intensity and enhancement. There is a 2 mm nonenhancing focus within hepatic segment 6 which is too small to characterize. No additional focal hepatic lesions are identified.Cholelithiasis without pericholecystic inflammatory changes. No biliary ductal dilatation.SPLEEN: Normal variant splenule.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a 2 mm nonenhancing focus within the midpole of the right kidney which is too small to characterize but may reflect a cyst. No suspicious enhancing renal lesions are identified. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Partially visualized aortic dissection extending to near the level of the right renal artery origin appearing grossly similar to prior CTA.BOWEL, MESENTERY: Interval resolution of previously seen dilated small bowel.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Postsurgical changes related to cystoprostatectomy and neobladder formation.2.No specific evidence of residual or metastatic neoplastic disease. 2 mm nonenhancing hepatic segment 6 lesion too small to characterize but may reflect a cyst and can be followed on subsequent examinations.3.Partially imaged aortic dissection appearing grossly similar to prior.4.Interval resolution of previously seen small bowel obstruction. Persistent small bowel containing left inguinal hernia.5.Cholelithiasis.