Kaiser Permanente
Permanente Medical Group, Inc.
1425 South Main Street
Walnut Creek, CA 94596
925 295 4000 fax or 800...
November 12, 2008 1410
|
08 02 04 60 08111201
|
Millie
..
Dear Millie,
[Here is the report for the CT test
performed on November 7, 2008
at Kaiser in Walnut Creek.]
..
Sincerely,
..
Procedure Note 0357370411/07/200813:22:19WCRX0101 11/12/2008 SPADIA, JILL
ELIZABETH (M.D.)
Document Text
..
CT OF CHEST, ABDOMEN AND PELVIS
..
** HISTORY **:
72-year-old female with history of IVC of left breast who was
initially diagnosed 03/04/02. She had recurrent disease noted
initially in the cervical lymph nodes 03/03/04. On E2100 study
with avastin but she had a PE noted on CT 11/03/04. Then because
of progression of disease, the patient was started on taxotere and
Xeloda 04/15/05. She had a total of 8 cycles ending 09/16/05.
She had a palliative left mastectomy performed 10/21/05. Then her
left chest lesions began expanding again. The patient started on
taxotere and Xeloda again 07/21/06 for 7 cycles. She was started
on a clinical trial of 02/01/07 at UCSF and was randomized to the
Erbitux only (no carboplatin) arm. She had weekly carboplatin
added 03/13/08 because of progression of disease. Her disease has
progressed again and she is being considered for phase 1/2 study
of Sunitinib (SU112408) at UCSF).
..
** FINDINGS **:
..
TECHNIQUE: Routine CT of chest, abdomen and pelvis performed
with IV and oral contrast. 150 ml IV Omnipaque 300 were
administered.
..
FINDINGS: This study is compared with prior exacerbate dated
07/18/08.
..
Port-a-Cath is again seen in the right chest wall. The patient
appears unchanged from prior exam.
..
As seen on prior study, a 5-mm hypodensity as seen on the right
lobe of the thyroid. This is stable.
..
Several enlarged right supraclavicular lymph nodes are seen.
These measure 1 to 1.1 cm in longest axis. They do appear
slightly larger than on the prior study when they measured 9 mm.
The 4-mm node is seen lateral to the left lobe of the thyroid
(image #4). This appears larger than on the prior exam.
..
Numerous enlarged lymph nodes are seen in the right axilla. These
appear to have enlarged and progressed since the prior study. The
two largest nodes now measure 1.6 x 1.4 cm and 1.6 x 1.6 cm
respectively. These measured 1.6 x 1.3 cm and 1.3 x 1.3 cm
respectively on the prior exam. Other enlarging nodes are seen.
These nodes all measure less than 1 cm in size but have progressed
from the prior exam. The most prominent node which has enlarged
is seen on image #16 deep towards the chest wall. This node now
measures 1.0 x 0.7 cm. Diffuse ill-defined hazy opacity is seen
throughout the right axilla.
..
No significant left axillary adenopathy is noted.
The patient is status post left mastectomy. Diffuse dense tissue
is seen throughout the right breast. A coarse calcification is
seen medially in the right breast, unchanged from prior exam.
..
Few, shotty, nonenlarged pretracheal and prevascular lymph nodes
are seen. On image #20, there is suggestion of a 1.2 cm AP window
node which appears enlarged compared with the prior examination.
Some of this appearance, however, may be volume averaging with the
overlying pulmonary artery. A 1-cm pretracheal lymph node is also
identified.
..
Stable 5-mm left hilar lymph node is noted. No significant right hilar
adenopathy is identified.
..
Lung windows show stable scarring in the left lung apex. Small 2-mm
nodule is again seen in the right upper lobe and in the region of the
minor fissure. Stable 4 mm nodular density is seen along the pleura
anteriorly in the right middle lobe (image #37). Stable nodular
density is seen laterally along the pleura of the right lower lobe
(image #45). Stable scarring is seen anteriorly in the lingula,
likely related to prior radiation.
..
What appears to be
interstitial disease is seen in the right lower lobe. This does
appear to have progressed from the prior exam in July of 2008 and
it appears more similar to those studies of February of 2008. No
new parenchymal nodules are seen. No pleural effusions are noted.
..
As noted on prior studies, a well-circumscribed hypodense
cystic-appearing lesion is seen in the liver at the hepatic dome.
This measures 1.9 x 1.5 cm on the current exam. When comparing in
similar plane, I do not believe this has changed from the prior
studies. No new hepatic masses are seen. No biliary ductal
dilatation is noted.
..
Numerous coarse calcifications are again see in the spleen consistent with
prior granulomatous infection. Calcifications are in the splenic artery are
again identified and appear unchanged.
..
The gallbladder, pancreas and adrenals appear
unchanged. On the left 1 cm hypodensities are seen in the kidneys
as before. This is most prominent in the lower pole of the left
kidney. These are stable and likely represent small cysts. No
hydronephrosis or renal masses are noted.
..
The small bowel and colon appear unchanged and normal.
..
No significant adenopathy as seen within the abdomen or pelvis. No free fluid
or focal fluid collections are identified.
..
The bone windows show degenerative changes in the lumbar spine.
No lytic or blastic lesions are seen.
..
IMPRESSION
Interval progression of metastatic adenopathy particularly within
the right axilla and right supraclavicular region. There is
possible progression of adenopathy within the mediastinum with an
apparent enlarged node within the AP window. This, however, may
merely be volume averaging with the overlying vessel. Some
interval worsening of the interstitial lung disease seen at the
right lower lobe. This, however, does appear to somewhat wax and
wane as it was improved on the prior exam and appears now more
similar to the study of February of 2008. No other significant
interval changes.