56-year-old female history of recurrent cervical cancer. Patient received chemo 4/08 -- 5/08 with ICRT 6/09. Evaluate for disease. Patient will be starting chemotherapy protocol. Patient is status post librt biopsy. Also complaining of low back pain and buttock pain and swelling left leg. Rule out metastases. CHEST:LUNGS AND PLEURA: Several lung lesions have increased in size. Index lesion in the right middle lobe series 5 image 50, 1.3 x 1.3 cm. In particular some of the lesions at the left lung base have increased significantly in size (see series 5 images 77 -- 81). Other micronodules stable.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Scattered hypoattenuating lesions consistent with metastases seen in the liver several of which have increased in size. Lesion in segment 7 measured on series 2 image 99, 2.6 x 2.3 cm. Several of the lesions have also increased in size. No evidence of biliary obstruction. No evidence of hepatic or portal venous thrombosis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small left kidney with thinning consistent with vascular compromise. Several nonspecific lesions that are bright in the cortical nephrogram phase. These could be evaluated better with delayed images.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Peritoneal implants redemonstrated some of which have increased in size. Implant on the ventral surface of the left lobe of the liver seen on series 3 image 105 measures 1.3 x 0.8 cm. (On the June 10 study series 2 image 106 it measured .4 x .3 cm.)Lesion in the mesentery in the left abdomen series image 125 measures 2.5 x 1.6 cm. there are several other scattered lesions. A small amount of free fluid. The bowel is distorted but not obstructed.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: The soft tissue masses in the pelvis likely peritoneal in nature rather than lymphatic. No discrete measurable nodes. See description of bowel below. Small nodes right inguinal area and a hypodense center suspicious for metastatic noted.BOWEL, MESENTERY: Ostomy seen right lower quadrant. Second ostomy left lower quadrant. Evaluation limited by streak artifact from a right hip prosthesis but there are multifocal implants scattered throughout the pelvis which is increased in size particularly in the cul-de-sac and along the left pelvic wall. These distort but do not obstruct the adjacent bowel. There is loss of fat plane to the presacral space and left pelvic sidewall invasion of adjacent muscle and vessels is likely.The soft tissue masses with rim enhancement extends caudally along the left paracervical and pararectal fat. See series 3 image 188-192.BONES, SOFT TISSUES: Right hip prosthesis.OTHER: There is no evidence of edema in the perineum or thigh. However the clinically described swelling of the left leg is likely related to compression of the left external iliac vasculature and possibly left internal iliac vasculature and there is may be nerve involvement in the sacrosciatic notch which may cause buttock pain. The gluteus muscles per se and subcutaneous lack of fat and peritoneal fat are normal.
Progression of disease in the lungs, liver and peritoneum. Involvement of left pelvic sidewall and sacrosciatic notch likely explain patient's symptoms of buttock pain and left leg swelling. Other findings as above.