70-year-old female with advanced stage small cell lung cancer presenting with diffuse pain. Assess for progressive neoplastic disease. CHEST:LUNGS: There is moderate centrilobular emphysema with a predominantly upper lobe distribution. Abnormal soft tissue surrounds the structures of the right hilum, representing lymphadenopathy and/or the primary tumor. This appears similar to the prior CT dated 6/4/2010.Several new nodular lesions suspicious for metastases are present in the right lung. A reference lesion in the right middle lobe (series 5, image 65) measures 0.9 x 0.8 cm.MEDIASTINUM: Enhancing mediastinal lymph nodes and right hilar lymphadenopathy remains. A reference pre-carinal lymph node (series 3, image 37) now measures 1.7 x 1.7 cm compared to 0.8 x 0.8 cm on the scan dated 6/4/2010.Coronary artery calcifications.CHEST WALL: Scattered sclerotic lesions are present in the ribs and thoracic vertebral bodies. These are not appreciably changed in comparison to the prior CT and likely reflect the patient's known diffuse osseous metastases.ABDOMEN: LIVER, BILIARY TRACT: The liver metastases appear increased in size and number in comparison to the prior CT but are not as extensive as on the scan dated 5/3/2010. The reference lesion in segment 7 (series 3 image 82) now measures 1.7 x 1.6 cm. This lesion was not clearly visible on the scan dated 6/4/2010 and measured 1.8 x 1.7 cm on the scan dated 5/3/2010.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple-appearing left renal cysts remain.RETROPERITONEUM, LYMPH NODES: Extensive aortic atherosclerosis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is heterogeneous sclerosis throughout the vertebral bodies of the cervical, thoracic, and lumbar spine as well as the bones of the pelvis -- reflecting the diffuse osseous metastases seen on the recent MRI.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: As above.OTHER: No significant abnormality noted.
1. Interval progression of pulmonary metastases and mediastinal lymphadenopathy.2. Interval progression of hepatic metastases.3. Diffuse osseous metastases.