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



January 7, 2009

08 02 04 60 09010702




Millie

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Subject:   Report for CT Test December 30, 2008

Dear Millie,

[Attached are 2 reports for your CT test at Kaiser on December 30, 2008. The first report is on only the neck. The second report on the chest, abdomen, and pelvis.]


Sincerely,







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Patient
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Category Radiology

Page 1 Examination: 1 of 2
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72/F Radiology Report
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CT NECK (Digital)
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12/30/2008 10:45 at WCR Outpatient

Performed in: WCR -
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History

72 y/o female with metastatic breast cancer currently on Clinical Trial at UCSF.
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Technique:

Axial images were acquired at 5 mm slice collimation through the neck after the uncomplicated administration of intravenous contrast.
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Comparison: 11/07/2008
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Findings

The visualized intracranial structures show no evidence for abnormal enhancement.
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The visualized portions of the paranasal sinuses are clear.
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The left side supraclavicular nodes have significantly decreased when compared to the prior exam. The lymph node measured at image #33 on the prior study is no longer apparant.

The right sided supraclavicular lymph nodes have decreased in size but are still prominent. The one measured on the previous exam at 1 cm is now measuring 9 mm.
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The subpectoral soft tissue masses on the right are still present. There is also apparant lymphadenopathy in the right axilla that is incompletely imaged.

There is no nasopharyngeal or oropharygeal mass.
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The thyroid lobes enhance symetrically. No change in the right thyroid lob hypodensity.

Focal scarring is again seen in the left lung apex.
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Impression

Improvement in the lymphadenopathy on the left side with mild improvement on the right.




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Patient
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Category Radiology

Page 1 Examination: 2 of 2
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72/F Radiology Report
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CT CHEST, ABDOMEN, AND PELVIS
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HISTORY

72 y/o female with metastatic breast cancer currently on Clinical Trial at UCSF.
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Technique:

Standard CT chest, abdomen and pelvis protocol following intravenous and oral contrast.
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Comparison: 11/07/2008
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Findings

Right supraclavicular nodes are described on the accompanying CT of the neck.
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Better visualized on this study are the right prepectoral soft tissues and the right axillary lymph nodes. No significant change in size when compared to the prior study given slice selection bias of the more medial node mearsuing 1.6 x 1.5 cm. There is slight increase in size of the more lateral node measuring 1.5 x 1.6 cm on the current exam. These are measured on image #13. Additional axillary mixed hazy fat stranding and nodularity is seen. This is not significantly changed.
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No left axillary lymphadenopathy.
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Mediastinum, hilum: Normal
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Lungs: Ground glass and interstitial thickening in the left apex consistent with prior radiation unchanged. Additional scarring in the lingula.
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There appears to be a nodule in the right lower lobe just inferior to the inferior pulmonary vein. There is partial volume averaging with the vessel leading to difficulty accurately measuring the nodule. This does appear to be stable when compared to the prior studies.
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The ground glass in the right lung base is slightly more prominent. The tiny right sided nodules are unchanged.

Pleura: Normal
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Cardiovascular structures: Atherosclerotic disease.
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The power port appears to be functional on this exam as there was no right breast extravasation as on the prior exam.

The patient is status post a left mastectomy.
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Liver: Hepatic dome cyst.
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Gallbladder: Normal.
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Pancreas: Normal.
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Spleen: Calcifications consistent with prior granulomatous disease.
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Adrenal glands: Normal.
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Kidney: No change
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Bowel loops: Diverticulosis without evidence of diverticulitis.
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Lymphadenopathy: Not present.
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Free fluid: Not present.
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Pelvic structures: s/p hysterectomy.
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Urinary bladder: Normal.
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Significant splenic artery calcifications.
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Bony structures: Degenerative changes. Left sacral Tarlov cyst.
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Impression
  1. Minimal progression to no change in right axillary lymphadenopathy.
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  2. Progression of right base interstitial process; drug reaction seems likely etiology.

  3. The remaining pulmonary findings are not significantly changed.