Radiologist’s report: May 8, 2008

After some difficulty and persistence I managed to get hold the radiologist’s report for the CT scan that was performed last week. It is not happy reading, although of course we already know the main conclusions from the consultation with the oncologist that I have already reported.

Axial MD CT acquisitions have been acquired through the chest, abdomen and pelvis after administration of intravenous oral and oral contrast. Comparison is made with the previous examination performed 31/10/07.

CT CHEST: The lobulated mass within the right upper lobe medially has increased in size. On today’s examination, it has dimensions of approxiamately 53 x 56 x 54mm. It contains central areas of both increaased and decreased attenuation. Medially, the lesion extents to abut the trachea and mediastinum, as well as the upper thoracic vertebrae. Inferiorly, it now extends to abut the right upper lobe bronchus. No definite desctruction of the adjacent vertebral bodies is, however seen. Since the previous examination, multiple mass lesions have developed within those lungs, throughout the lobes. The largest, in the right middle lobe measures approximately 1cm in transverse diameter. The largest in the left upper lobe measure approxiamtely 5mm in transverse diameter. No pleural effusion. Bi-apical fibrosis and centrilobular emphysema are again noted. Enlared mediastinal nodes are now present. One, lying anterior to the trachea measures approxiamately 13mm in transverse diameter, one anterior to the carina messures approximately 15 mm in transverse diameter. There is an enlarged right hilar node measuring approximately 15mm in transverse diameter.

CT ABDOMEN AND PELVIS: The low attenuation lesion within the junctional region of segments 7 and 8 is relatively unchanged in size and appearance since the previous examination. No other definate focal liver lesions are present. Post contrast, it is soft in attenuation. The hepatic and portal veins are patent. There is an exophytic low attenuation lesion arising from the midpole of the right kidney, measuring approximately 48 x 45 x 50 mm in dimension. It has a central low attenuation and some peripheral high attenuation. There is an exophytic low attentuation lesion arising from the midpole of the right kidney, measuring approximately 48 c 45 x 50mm in dimension. Although it was not completley imaged on the previous examination, it has increased in size on today’s examination. Multiple other smaller hypodense lesions are also present within the kidneys. They are unfortunatley too small to further characterise on this post contrast examination.

The spleen, pancreas, and adrenal glands are normal. Enlarged para-aoritc lymph nodes are present at the level of the kidneys, measuring approximately 11 to 12mm in transverse diamter. The main right renal vein is patent. No significantly enlarged inguinal or pelvic side wall lymph noes. The scierotic lesion is again identified medially in the right 12th rib.

CONCLUSION:

1. Since the previous examination, there has been a marked increase in size of the right upper lobe mass. There is now multiple bilateral lung mass lesions, consistent with widespread metastases. The differential diagnosis would include widespread atypical infection including lung infection. 2. There is an exophytic lesion arising from the midpole of the right kidney which is suspicious for either a metastases or a primary renal cell carcinoma. There is localised para-aortic lymphadenopathy. 3. The liver lesion is unchanged.