Kaiser Permanente
Permanente Medical Group, Inc.
1425 South Main Street
Walnut Creek, CA 94596
925 295 4000 fax or 800...



November 13, 2008 0852

08 02 04 60 08111301




Millie

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Subject:   CT Test 081107 Neck Only

Dear Millie,

[Here is a second report for the CT test performed on November 7, 2008 at Kaiser in Walnut Creek, and for the neck only. This supplements the report for the same the CT test on November 7th, 2008, with results below the neck].

Sincerely,




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Procedure Note 0357370411/07/200813:01:44WCRX0101 11/12/2008 SPADIA, JILL ELIZABETH (M.D.)

Document Text
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CT NECK
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** HISTORY **:

72-year old female with history of invasive breast ca of the left breast who was initially diagnosed 3/4/02. She had recurrent disease noted initially in the cervical lymph nodes 3/3/04. On E2100 study with Avastin she had a PE noted on CT 11/3/04. Then, because of progression of disease, the patient was started on Taxotere and Xeloda 4/15/05. She had a total of 8 cycles ending 9/16/05. She had a palliative left mastectomy performed 10/21/05. Then her left chest lesions began expanding again. The patient started Taxotere and Xeloda again 7/21/06 for 7 cycles. She was started on a clinical trial 2/1/07 at UCSF and was randomized to the Erbitux only (no carbo) arm. She had weekly carboplatin added 3/13/08 because of progression of disease. Her disease has progressed again and she is seen considered for Phase I/II study of Sunitinib (SU11248) at UCSF.
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TECHNIQUE: Routine CT of the neck protocol utilized with IV contrast. The study was performed in conjunction with the study of the CT of the chest, abdomen and pelvis. 150 ml IV Omnipaque 300 were administered in total for both exams.
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COMPARISON: No prior neck CT is available for direct comparison. Comparison is made with images of chest CT 7/18/08.
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FINDINGS:

Tubing from right sided central venous line is noted.
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Numerous enlarged supraclavicular lymph nodes are seen bilaterally. These are much more prominent on the right than the left. Size of the supraclavicular nodes have increased from the prior exam. The largest node on the right now measures 1 cm in diameter (image 36). This previously measured 9 mm on the exam 7/18/08.
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A 5 mm supraclavicular node is seen on the left as well. In addition, there is enhancing irregularly shaped mass seen in the left supraclavicular region near the tail of the sternocleidomastoid muscle. This is seen best on image 33. It measures 1.2 x 1.3 cm in transverse diameter. I do not appreciate this on the prior exam but it may have been excluded. This may represent a direct tumor implant or an enlarged irregularly shaped node.
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Note is also made of multiple enlarged irregularly shaped right axillary lymph nodes. These are better evaluated on the chest CT.
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Within the neck itself, few shotty, nonenlarged lymph nodes are seen in the right jugulodigastric region and right posterior triangle. The largest of these nodes measures 7 mm.
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The nasopharynx and oropharynx appear unremarkable. The parotid glands and submandibular glands appear symmetric and normal.
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Visualized portions of the brain appear unremarkable.
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5 mm hypodensity is seen in the right lobe of the thyroid (image 33). This is unchanged from previous studies. Focal scarring is again seen in the left lung apex.
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** IMPRESSION **:

Worsening supraclavicular adenopathy bilaterally. The adenopathy is greater on the right than the left. However, there is a prominent irregular shaped enhancing mass seen in the superior left neck/supraclavicular region near the tail of the left sternocleidomastoid muscle. This measures 1.2 x 1.3 cm and may represent an enlarged node or focal metastatic implant. Adenopathy in the right axillae appreciated. This is better evaluated on chest CT however. No significant adenopathy within the neck itself.