The pigtail catheter remains in the right pleural space. A small residual thickwalled right pleural fluid collection remains which is marginally smaller compared to the previous study. The associated air bubbles seen on the previous study are no longer identified.
There is a spiculated soft tissue mass again seen in the right perihilar region which has increased in size now measuring 3.7 x 2.8 cm, previous 3.0 cm. A smaller nodule seen more inferiorly now measures 3.1 cm, previous 2.2 cm. Increased soft tissue density surrounds the right hilum causing narrowing of the right mainstem bronchus, this soft tissue density abuts the heart. Innumerable small pulmonary nodules are again seen especially in the right upper lobe. These tiny nodules are all essentially unchanged. The marker nodule at the left apex measures 0.5 cm which is unchanged as seen on image 20, series 3. Increasing soft tissue density is also seen in the subcarinal region, mild lymph node enlargement is seen in the right peritracheal space.
The liver is normal in size. A poorly defined hypodense liver lesion is again seen in the medial aspect of the left lobe abutting the falciform ligament. This has decreased in size but due to its rather ill-defined nature, accurate measurements is not possible. The spleen is enlarged. A small benign cyst is again seen at the splenic tip. A stable benign cortical cyst is again seen in the lower pole of the right kidney. The solid organs of the upper abdomen otherwise appear unremarkable. No evidence of retroperitoneal or mesenteric lymphadenopathy is seen in the upper abdomen.
A sclerotic / lytic metastatic lesion is again seen involving the T11 vertebral body which is unchanged. Metastatic bony involvement is again seen involving the left side of the T6 vertebral. Bony metastatic disease is seen involving the left femoral head, the intertrochanteric region of both proximal femurs are not included on the images provided. No new areas of involvement