65-year-old female with metastatic sarcoma CHEST:LUNGS AND PLEURA: Stable pulmonary nodules. The reference 15 x 13 mm left lower lobe nodule (series 5; image 39) and 14 x 9 mm right lower lobe nodule (series 5; image 32), unchanged when remeasured. Small left pleural effusion has increased.MEDIASTINUM AND HILA: Punctate nonobstructive thrombus in the right brachiocephalic vein (series 4; image 19), unchangedCHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Tumor thrombus is seen in the IVC. Extension to the base of the right atrium as well as the left hepatic vein (series 4; image 56) has developed. Extension into the right hepatic vein and both renal veins is again identified. Tumor thrombus extends inferiorly to the bifurcation of the IVC. At this level, the common iliac veins are not well seen. The diameter of the IVC has increased, suggestive of worsening, measuring 4.2 x 4.2 cm just superior to the right renal vein (series 4; image 81), previously 4.0 x 3.8 cm.Heterogeneous enhancement of the liver is likely secondary to altered hemodynamics.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Tumor involves the psoas muscles, left greater than right, with mild overall increase on the left. A reference measurement of the left psoas muscle is 5.5 x 5.0 cm (series 4; image 107), previously 5.5 x 4.8 cm. The second previously measured low-density lesion in the left psoas muscle measures 2.6 x 2.3 cm (series 4; image 121), previously 2.5 x 2.2 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes involving the lumbar vertebral bodies and sacrum. Soft tissue density is seen in the posterior paravertebral region with extension to the spinal canal, not significantly changed.OTHER: Mild ascites.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Varicosities are identified, likely due to extensive thrombosis.OTHER: No significant abnormality noted.
Mild increase of tumor thrombus, now with extension into the base of the heart. Mild increase of tumor infiltration affecting the psoas muscle (though the specific reference lesions are stable).Small right pleural effusion come increased.