The test results
1. Subtle findings but consistent with progression. Most notably in the abdomen
with there is a 3 cm low-density lesion now present in the caudate is slightly
progressive biliary dilation in the right posterior biliary tree. Left biliary
stent remains in good position but the left ducts appear slightly more dilated
as well. In addition there may be one additional tiny 3 mm pulmonary nodule seen
best on image 161 this is a very subtle finding and as to significance is
uncertain.
2. Changes of advanced emphysema and atherosclerosis noted.
Electronically signed by: MICHAEL SARSON, Radiology Associates of Keene, at 11/19/2018 3:05 PM
Narrative
EXAMINATION: CT CHEST ABDOMEN PELVIS W CONTRAST (GENERIC)
CLINICAL HISTORY: History of metastatic cholangiocarcinoma evaluate for interval
change
TECHNIQUE: Helical CT of the chest, abdomen, and pelvis was performed following
intravenous administration of 103 ml of Omnipaque 350 Oral contrast was
administered.
COMPARISON: 8/18/2018 7/5/2018
FINDINGS:
Chest:
Lungs and large airways: Changes of advanced emphysema are again noted. Chronic
consolidation in the right middle lobe is unchanged.
3 mm nodule seen on image # 161 left lower lobe noted. There is also a
pleural-based 3 mm nodule adjacent to the major fissure seen best on
high-resolution image #187 there is a 3 mm subpleural nodule seen best on image
#257 and a 5 mm subpleural nodule seen best on image #263 both of these are in
the lower lobe basal segments compared to our prior examinations the nodule in
the left lower lobe seen best on image #161 appears new although it is very
small the other nodules are more likely stable.
Pleura: No pleural or pericardial effusion
Heart/vasculature: Coronary artery disease
Lymph nodes: I do not see any mediastinal or hilar masses or adenopathy. No
axillary or supraclavicular nodes
Mediastinum and hila: Normal.
Abdomen/pelvis:
Liver: There is a low-attenuation lesion now visible in the caudate lobe of the
liver this measures 3 cm maximally and does appear to be new when compared to
our prior study. I do not see any other definitive masses in the liver.
Bile ducts: Left biliary stent is in place remains in good position however the
left biliary tree is slightly more distended there is now also distention slight
of the right posterior biliary radicals.
Gallbladder: Contracted
Pancreas: Normal attenuation without ductal dilatation.
Spleen: Normal.
Adrenals: Normal.
Kidneys: Normal.
Urinary Bladder: Normal.
Vasculature: No aneurysm.
Lymph Nodes: No enlarged lymph nodes.
Bowel: Nondilated, no wall thickening.
Peritoneum and mesentery: No ascites, free air, or loculated fluid collection.
No mesenteric inflammation.
Abdominal wall: Normal.
Reproductive organs: Normal.
Osseous structures: No suspicious lesions.
