Metastatic prostate cancer, neuropathy in right arm, history of disease in shoulder, evaluate for progression. Compared to spine CT, there has been enlargement of soft tissue masses involving the lower neck soft tissues including the bilateral supraclavicular fossa and upper paratracheal regions. For example round left upper paratracheal nodule previously measuring 13 x 13 now measures 15 x 16 mm in the coronal plane. Previously seen two nodules just more inferior to this one on the left have a more conglomerate appearance now and measure approximately 3.2 x 2.0 cm total in the transverse and craniocaudal dimensions in the coronal plane. On the right, upper paratracheal mass measures 2.9 x 5.9 x 3.3 cm, previously 2.9 x 5.1 x 3.2 cm. Again noted is diffuse tumor tumor involvement of the T1 vertebral body with extension into the posterior elements. There is epidural tumor involving mostly the right lateral aspect of the spinal canal extending from the right C6-C7 level to the T2-T3 level. There is flattening of the cord related to tumor in the epidural space bilaterally at the C7-T1 level, with suggestion of T2 hyperintensity (axial T2 image 29 of series 9). Tumor extends through the right-sided neural foramen from C6-C7 to T2-3 paravertebral soft tissues. Tumor also seen abutting the superior and medial pleural surface at the right lung apex. There is likely impingement of the right C7, C8, and T1 nerve roots of the brachial plexus at the level of the neural foramen and extraforaminal levels. Degenerative changes including disc osteophyte complexes C4-C5, C5-C6, and C6-C7 with associated mild spinal canal stenosis. There is also mild to moderate bilateral C4-C5 and right C5-C6 neural foraminal stenosis on a degenerative basis.
1. Bulky metastatic tumor involving the bilateral lower neck, supraclavicular fossa, paratracheal, and paravertebral soft tissues, which appears progressed compared to noncontrast CT dated 8/28/2015.2. There is epidural tumor extending from the C6-C7 level to the T2-T3 level with maximal mass effect and deformity of the cord at the C7-T1 level. There is probable T2 cord signal abnormality at the C7-T1 level (axial T2 image 29 of series 9). 3. Tumor involves the right neural foramen and extraforaminal soft tissues involving the right C7, C8, T1, and T2 nerve roots.4. Diffuse marrow infiltration involving the T1 vertebral body extending to the posterior elements. May consider total spine MRI with gadolinium to better assess the full extent of known tumor, as prior spine imaging was limited to CT.Dr. Ali discussed findings with Dr. Nabhan at 1027 hrs on 10/13/2015. Patient will be transported to the ED.