CT CHEST/ABD/PELVIS W/CONTRAST performed on 7/13/2009 8:14 AM ACCESSION #: 4660946 - CT CHEST, ABDOMEN AND PELVIS WITH CONTRAST

FINDINGS: Left thoracic cardiac rhythm management device is noted with leads entering the right atrium and right ventricle. Enlarged heterogeneous appearing thyroid gland is noted probably consistent with goiter. Atherosclerotic disease noted within the thoracic aorta without dissection or aneurysm. A few lymph nodes are noted within the mediastinum, which are not enlarged by CT criteria. Coronary calcifications are noted. The heart is not enlarged. No lesions are seen. Axillary regions are grossly negative. Innumerable pulmonary nodules are noted throughout the right and left lungs. The more prominent ones are noted and when compared appear relatively stable, except for the largest lesion present within the right upper lung posterior segment. It measures approximately 9.8 mm. There is a central cavitation, which was not present on the prior scan. Also, the lesion appears slightly enlarged. Findings are concerning for possible cavitary metastatic lesion given the history of melanoma. There is a slight asymmetry to the appearance of the proximal clavicles with the right side slightly more anterior compared to the left and there is some degenerative changes around the right clavicular sternal junction. Spondylosis to the spine is seen. Surgical resection of the liver is identified. Low-density lesion along the anterior surgical margin is present, which appears unchanged compared to the prior scan. This area is multilobulated low-density lesion. There is a low-density structure present within the right liver on image #63, which is stable compared to prior scan. This measures approximately 3 mm in size. Another 1 to 2 mm low-density lesion in the right liver is not identified on image #65, which is a new finding compared with prior scan may be in a different phase of enhancement. Spleen, pancreas and adrenals are grossly negative. There are multiple low-density lesions present within the cortex of the left kidney probably consistent with renal cyst. The largest present within the lower pole measuring approximately 1.5 cm. Patient is status post right nephrectomy. There is compensatory enlargement of the right kidney. There is extrarenal pelvis. Stool is present throughout the colon. Bowel loops are grossly negative. There is no periportal or periaortic adenopathy. The retroperitoneal regions are grossly negative. Pelvis structures are intact, except the prostate bed shows multiple surgical clips. There is some tiny inguinal lymph nodes. Open reduction and internal fixation of the right femur is identified. No destructive osseous lesions are identified. There is multilevel facet arthropathy and some right sacroiliitis. IMPRESSION: 1. Innumerable pulmonary nodules, which are stable except for a single large pulmonary nodule in the right upper lung posterior segment, which shows a small cavitation. It also appears slightly larger. 2. Low-density lesions in the liver appear stable with a multilobulated lesion along the surgical margin, which is unchanged. 3. Stable left renal cyst. COMMENTS: 07/13/2009 8:14 AM, assess progression of disease for tx/NKDM/ LABS TO BE DONE NOTE: PROVIDER NOTIFICATION SYSTEM IMPLEMENTED. Transcribed: 07/13/2009 by rer CONPROVADD Interface,Powerscribe 7/13/2009 8:02:00 PM RESPROVADD Interface,Powerscribe 7/13/2009 8:02:00 PM TRANSCRIBE Interface,Powerscribe 7/13/2009 8:02:01 PM Interpreted By MAUNG,TONY 7/14/2009 4:18:57 PM FINALIZED MAUNG,TONY 7/14/2009 4:18:57 PM ***The reference ranges displayed above are based on national averages. Individual results may vary. Your provider’s office will contact you if any follow-up is needed.