66 year old female with history of metastatic renal cell cancer. Restaging scans status post 69 cycles of oral TKI . CHEST:LUNGS AND PLEURA: Multiple metastatic lung nodules and masses are reidentified:Reference right upper lobe nodule (series 4, image 15) measures 1.4 x 1.3 cm (stable).Reference right middle lobe mass (series 4, image 36) measures 4.3 x 3.8 cm (stable).MEDIASTINUM AND HILA: Extensive bilateral hilar adenopathy with reference left hilar mass (series 3, image 38) measuring 3.9 x 3.4 cm; previously measuring 4.3 x 3.6 cm. Heart size normal without pericardial effusion.Hiatal hernia.CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: Subcentimeter hypoattenuating focus in the right hepatic lobe (series 3, image 82) is too small to characterize but is unchanged from prior study from 7/30/2010.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy. Surgical clips are again seen in the nephrectomy bed without evidence of local recurrence.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Two ventral abdominal hernias are reidentified cone at the inferior one again seen containing only mesenteric fat (series 3, image 135). The more superior Richter hernia contains two separate wall segments of the transverse colon (series 3, image 114). No evidence of bowel obstruction or perforation.BONES, SOFT TISSUES: Sclerotic focus in the T8 vertebral body appears similar to prior study (series 3, image 52; series 8024, coronal image 30).PELVIS:UTERUS, ADNEXAE: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Left thigh intramuscular lipoma is partially seen.
Metastatic disease with reference measurements as above. No new sites of disease.