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

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Subject:   CT Report

Dear Millie,

[Here is the report for the CT test performed on November 7, 2008 at Kaiser in Walnut Creek.]
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Sincerely,





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Procedure Note 0357370411/07/200813:22:19WCRX0101 11/12/2008 SPADIA, JILL ELIZABETH (M.D.)

Document Text
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CT OF CHEST, ABDOMEN AND PELVIS
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** 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).
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** FINDINGS **:
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TECHNIQUE: Routine CT of chest, abdomen and pelvis performed with IV and oral contrast. 150 ml IV Omnipaque 300 were administered.
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FINDINGS: This study is compared with prior exacerbate dated 07/18/08.
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Port-a-Cath is again seen in the right chest wall. The patient appears unchanged from prior exam.
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As seen on prior study, a 5-mm hypodensity as seen on the right lobe of the thyroid. This is stable.
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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.
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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.
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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.
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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.
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Stable 5-mm left hilar lymph node is noted. No significant right hilar adenopathy is identified.
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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.
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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.
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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.
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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.
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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.
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The small bowel and colon appear unchanged and normal.
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No significant adenopathy as seen within the abdomen or pelvis. No free fluid or focal fluid collections are identified.
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The bone windows show degenerative changes in the lumbar spine. No lytic or blastic lesions are seen.
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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.