76-year-old male with prostate cancer CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Atherosclerotic changes of the thoracic aorta.Calcified subcarinal and right hilar lymph nodes, all unchanged.Coronary artery calcifications.Moderate hiatal hernia, unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: There is a 2.5 x 2.8 cm left adrenal mass (series 3 3, image 104), new since the prior examination.KIDNEYS, URETERS: Bilateral renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: Index left para-aortic lymph node (series 3, image 121) measures 3.4 x 3.0 cm (previously 4.6 x 4.2 cm). Previously noted periaortic node, just above the iliac bifurcation (series 3, image 139) measures 19 x 15 mm (previously 20 x 12 mm).Although these reference nodes are stable or smaller, the para-aortic lymph nodes have become confluent, encasing the infrarenal aorta. Additionally, there is new retroperitoneal lymphadenopathy more superiorly. An enlarged periaortic lymph node adjacent to the SMA (series 3, image 106) is new since the prior examination.These nodes cause new mass-effect on the IVC and on the renal vasculature.BOWEL, MESENTERY: Colonic diverticulosis without evidence of acute inflammationBONES, SOFT TISSUES: Presumed T9 hemangioma, unchanged. However, ill defined sclerotic lesions have developed in the vertebral bodies T4, T8, and L1, not seen on the prior study and concerning for metastatic lesions.PELVIS:PROSTATE, SEMINAL VESICLES: Not visualizedBLADDER: No significant abnormality noted.LYMPH NODES: Right common iliac node (series 3, image 147) measures 9 x 8 mm (previously 10 x 9 mm).Conglomerate left external iliac node (series 3, image 186) measures 5.4 x 2.1 cm. When measured using the same technique, this measured 4.1 x 2.0 cm on the prior examination (prior study series 3, image 184).Other external iliac nodes have also increased in the interval. BOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: Sclerotic osseous lesions, as described above.Worsening anasarca is seen in the lower abdomen and lower extremities.
Interval worsening of retroperitoneal and pelvic lymphadenopathy, new adrenal mass, and new osseous lesions, compatible with progression of disease.