CT Results (August 31, 2018)

I decided to make the CT results a separate entry, since there is a lot of detail in the report this time (not as thorough as others we’ve had, but certainly better than some recent ones).

I know CT reports generally contain more medical detail than many of you can follow. Ask questions, in comments, or privately, if you don’t understand something! I am providing as much “plain, very basic, English” clarification as I can, and will include some links (bold and underlined) to helpful pages.

There will be a third post as soon as possible after this one regarding our going to Duke Cancer Center (Durham, NC).



Chest: Small right-sided pulmonary nodules are new from previous exams. Largest nodule involving right lower lobe near the fissure measures 13mm in long axis. Additional new nodules are present on images 24 and 38 series 3 within the right lung. A new less than 6mm nodule present in the left lower lobe (image 36 series 3). Moderate to large right pleural effusion is redemonstrated (NOTE: This was drained as much as possible on 9/6). Small to moderate volume left pleural effusion redemonstrated. Overall pleural fluid volume on the right appears slightly diminished from July 3, 2018. No pneumothorax or pericardial effusion. MediPort catheter appears adequately positioned. The heart is not enlarged. No thoracic aortic aneurysm. Osseous structures demonstrate no new aggressive focal or lytic blastic change.

Chest in plain terms: In earlier scans, they found a 4mm, non-spiculated (no spikes) nodule in her lower right lobe. The lungs is a common first place for LMS to metastasize to. But malignant nodules are spiculated, and this one wasn’t. There was a good chance it was scar tissue from her first, painful, thoracentesis. The CTs that followed we were told it was “still tiny” but no actual size. I requested they specify this time. The report doesn’t mention anything about the appearance, just the size. It is possible for benign nodules to grow, but the bigger they get, the more likely they’re malignant. A small one could be malignant, but it is more likely once they get larger than 30mm.

However, it is discouraging that there are more showing up. And it’s less likely now that these are spots of scar tissue from the thoracentesis procedures.

The pleural effusion is the liquid that is drained off the lung during the thoracentesis procedure. Her most recent one was on 9/6, so the fluid the CT is referring to on her right side is the fluid that was drained out (nearly 3 liters) this past Thursday.

No pneumothorax: No collapsed lung.
No pericardial effusion: No fluid around her heart.
MediPort: This is the port she receives her chemo and other fluids through. They check it on each CT to make sure it hasn’t moved out of place – which can happen.
Osseous structures: No bone changes.

Abdomen: Extensive intraperitoneal disease is redemonstrated. The underlying peritoneal disease is difficult to discern between ascites and necrotic mass. The overall transverse dimension of the peritoneal abnormality equals 30.3cm. This previously measured up to 26.4cm. No free intraperitoneal air. Peritoneal disease again results in lobulated abnormality along the anterior capsular margin of the left hepatic lone and inferior right hepatic lobe. There appears to be a new moderate size gastric hernia.  Spleen, pancreas, adrenal glands, and kidneys appear stable. The gallbladder is present. The abdominal aorta demonstrates no indication of aneurysm. Bowel gas pattern is predominantly located cephalad within the peritoneal space.

Abdomen in plain terms: There’s a lot of disease in the peritoneum. This is a thin, transparent membrane which lines the walls of abdominal (i.e. peritoneal) cavity and encloses the abdominal organs such as the stomach and the intestines. There is difficulty telling the difference between ascites (fluid in the abdomen) vs necrotic (dead) tumor.  It’s possible the chemo did kill some of the tumor, and then the tumor became resistant. But it is also possible that parts of the tumor died because it ran out of food. That’s not really a good thing, despite how it sounds, because the food for the tumor is the blood supply. 

The primary tumor has now regrown to 30.3cm on the largest side.  The tumor Dr. Greene removed last August was 30.5cm. 
Hepatic lobes: The liver. This second tumor is now on both sides of the liver, not just one. There’s been risk mentioned in extensive bleeding from the liver when resecting this tumor, despite that from everything we’ve been told, the liver is not invaded (and I like to think they would have said so on this last CT if it had, since that would be a pretty major change). I’ve asked if the liver can be partially resected, since it can regenerate, and Dr. Musgrave said they should be able to. I’m also going to ask at Teresa’s surgical consult if they can do any pre-op radiation on that tumor and the other smaller ones, and the nodules, to give the surgeons a better chance at clean margins.

Gastric hernia: There may actually be 2 now. I see two spots (along the original incision near her belly button and on the top of her abdomen). We know the first is a hernia per Dr. Musgrave. The second, I think, is also likely, but we won’t know for sure until Friday. Muscle weakness along an incision can cause these, but in Teresa’s case, I suspect it is more likely that it is just the size of the tumor and the pressure it is causing. The second is nowhere near the incision.

Spleen, pancreas, adrenal glands, and kidneys appear stable. The gallbladder is present. The abdominal aorta demonstrates no indication of aneurysm. Bowel gas pattern is predominantly located cephalad within the peritoneal space.  These organs are unchanged from previous CTs, and there’s never been a problem with any of them (aside from that she seems to have extra spleens). 

Pelvis: Contiguous axial imaging through the pelvis demonstrates continuation of the marked abnormal peritoneal disease. The mixed right attenuation right paramidline component/mass measured 15cm in long axis, enlarged from July 3, 2018. The bowel is without evidence of obstruction. The urinary bladder is obscured or nearly entirely decompressed.

The osseous structures of the abdomen and pelvis demonstrate no aggressive new focal lytic or blastic changes.

Pelvis in plain terms: Contiguous means sharing a common border, or touching; next to each other in sequence. No gaps in between. Axial is the plane of acquisition. An explanation with visuals can be found here.

Attenuation is a general term which refers to any reduction in the strength of a signal. In radiology, this is the reduction in power and intensity of sound waves as they travel through the tissue. Paramidline – next to/adjacent to the midline of the plane, which for this section would be the pelvis. 

It is not clear if this measurement is referring to another side of the 30.3cm tumor or not. Until we’re told otherwise, I’m assuming it is, as the original tumor was debulked down to the cervix, which is in the pelvis. 

Her bowel is not obstructed by the tumor (but she could still require bowel – and/or bladder ostomies in surgery all the same), and her bladder was not visible.  T believes she did not have a full bladder prior to the CT, which could explain this.

She is not currently having bowel or bladder problems, but if having ostomies will give her a better chance of survival, she’s accepted having to have them.

Benign Tarlov Cysts: These nonaggressive cystic changes at the sacrum appear stable to left of midline. Tarlov cysts appear unaltered dating back to at least August 23, 2017.

Follow this link for an explanation of Tarlov cysts.

IMPRESSION: Interval disease progression above and below the diaphragm including new pulmonary nodules and enlargement of extensive peritoneal disease. (i.e. There’s more disease and more nodules in the lungs; whether the nodules are benign or not we do not know at this time.)

New moderate size gastric hernia.

Moderate/large right pleural effusion (again, she had this drained on 9/6), less conspicuous in size from July 3, 2018. No apparent change involving small to moderate volume left pleural effusion.

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