February 11th 2019 - CT Report From February 6th - Mixed Review - Mostly Good with ?????

I have been waiting 6 days for this report. What I can determine is that we have great news on the battle with Cancer. However the liver and bones has gotten worse. Not by much. slightly, so they can say , "Primary Diagnostic Code: NO ALERT REQUIRED"
We have to find out the reason for the Liver and bones. I don’t know if it is from the chemo treatments, cancer or another problem. I will ask the question with the oncologist tomorrow.

I had to stop because the social worker from Hospice stopped by to see if I needed anything and explained what she does assist with. They have all kinds of items that they provide. I can tell you for sure that a boat is not one of them. There useless. LOL. They provide alll the medical assistances that one would require for primary essentials self care.

I have provided the whole report for your review. If you have any questions that you think needs to be addressed or answered let me know. I have a lot of question depending on answers. Some answer will cause more question

I go to oncology tomorrow at 10 am for blood test then at 11am is the appointment with the oncologist.
I did have a good meal prepared by my wife. She does take good care of me. This is a hard period to go through. I will put out more information as I get it

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Report:
CT chest with contrast

Indication: Small cell lung cancer status post chemotherapy
presenting for restaging and subsequent treatment strategy
planning.

Technique: Post IV contrast axial images were obtained to the
chest, abdomen, and pelvis with coronal and sagittal reformats.
100 mL of Optiray 320 was administered IV.

Comparison: 12/7/2018

Findings:
Thorax:
Index lesions are as follows:

The index area of
pleural/proximal scarring versus nodularity in the right lower
lobe medial basilar segment has improved and now measures 1.9 x
0.8 cm (series 3, image 52), previously remeasured to be 2.8 x
1.7 cm on 12/7/2018 (series 4, image 57).

The index precarinal lymph node currently measures 1.7 x 0.6
cm (series 3, image 27), previously remeasured to be 1.8 x 1.1 cm
on 12/7/2018 (series 3, image 31).

The index subcarinal lymph node currently measures 2.5 x 1.5
cm (series 3, image 32), previously remeasured to be 3.6 x 1.4 cm
on 12/7/2018 (series 3, image 37).

The previously seen paraesophageal lymph node is no longer
identified.

The heart size is normal. There is no pericardial effusion. The
caliber of the thoracic aorta is normal. The aerodigestive tract
is unremarkable. No new thoracic lymphadenopathy is seen.
No new pulmonary nodule or mass is identified. There is no
consolidation or pleural effusion.

On review of bone windows, there are multiple sclerotic lesions
throughout the visualized axial and appendicular skeleton
consistent with osseous metastasis. These findings have slightly
progressed since the prior exam. For reference, there is a new
sclerotic lesion in the right T1 vertebral body measuring 2.9 x
1.6 cm (series 3, image 10). No pathologic fracture is
identified.

Abdomen and pelvis:
The liver is mildly enlarged. There has been
interval development of new low-attenuation lesions in the liver.
For reference, a peripherally enhancing lesion in segment
VII/VIII measures 1.7 x 1.4 cm (series 5, image 14), previously
remeasured to be 1.3 x 1.1 cm on 12/7/2018 (series 2, image 15).
The portal vein is patent. The spleen is not enlarged. The
adrenal glands and pancreas have a normal appearance. The
gallbladder appears within normal limits. There is no biliary
dilatation.
There is a nonobstructing calculus in the right lower pole kidney
measuring 3 mm (series 2, image 47). There are benign Bosniak
category I cysts in the right and left kidneys. Other
subcentimeter right and left renal low-attenuation lesions are
too small to characterize but likely represent additional benign
renal cysts.
There are atherosclerotic calcifications in the aortoiliac
arteries. No aneurysmal dilatation is seen. No pathologically
enlarged lymph nodes are seen in the abdomen or pelvis.
The bladder and prostate are unremarkable. There is a small
fat-containing left renal hernia. There is no pelvic ascites or
pelvic lymphadenopathy.
On review of bone windows, there are innumerable sclerotic
lesions throughout the visualized axial and appendicular
skeleton. No pathologic fracture is seen.
Impression:

Mixed treatment response with interval improvement in the
index paratracheal and mediastinal lymph nodes and right lower
lobe medial basilar segment lesion since 12/7/2018 and interval
development of worsening osseous metastasis in the skeleton and
worsening liver metastasis.
Nonobstructing right lower pole calculus measuring 4 mm. Other
incidental findings are detailed above.
Primary Diagnostic Code: NO ALERT REQUIRED

wolfhart