Question: A recent CT scan revealed "a right posterior lateral chest wall mass with lytic involvmentfo the right eighth rib" mass measures 4.8 x 5.5cm. Also, the "lungs demonstrate multiple bilateral pulmonary nodules , one measuring 1.4 x 1.8 cm on the right upper lobe and the other on right lower lobe at 1.7 x 1.9 cm."

I am having a biopsy for the nodules on Monday, XXXXXXX 27th (Sibley Hospital , Bethesda, MD) ...one of my major concerns is that the CT was predicated on my having very sharp pain in the lower right rib cage and yet no action taken on the ramifications of the lytic lesion. To date only the radiologist has evaluated the CT. Please advise on how best to proceed. Many thanks XXXX

Here is complete report followed by lab results

HISTORY: Chest and abdominal pain.

TECHNIQUE: Helical imaging of the chest, abdomen and pelvis following intravenous and oral contrast administration. 100 cc of Omnipaque 300 contrast was utilized.

FINDINGS:

CHEST: The lungs demonstrate multiple bilateral pulmonary nodules. Right lower lobe nodule measures 1.4 x 1.8 cm (image 37). Right upper lobe pulmonary nodule measures 1.7 x 1.9 cm (image 26). Small mediastinal lymph nodes are nonpathologic by size. The
heart is mildly enlarged. There is a right posterior lateral chest wall mass with lytic involvement of the right eighth rib. This mass measures 4.8 x 5.5 cm.

Abdomen pelvis: The liver demonstrates mild fatty infiltration. The gallbladder, spleen, pancreas, adrenal glands and kidneys are normal. The small bowel is normal. The colon is unremarkable. No abdominal or pelvic lymphadenopathy. The prostate gland is
surgically absent. The urinary bladder is underdistended. No ascites.
Impression
IMPRESSION:
1. Multiple pulmonary nodules consistent with metastatic disease.
2. Lytic right eighth rib lesion with expansile soft tissue mass consistent with metastatic disease.
3. No metastatic disease within the abdomen or pelvis.

This report has been electronically signed
Component Results
No Additional Information Available
General Information
Collected:
06/22/2016 11:56 AM
Resulted:
06/22/2016 3:19 PM
Ordered By: XXXXXXX Doria Hulse, DO
Result Status:
Edited Result - FINAL

une 23, 2016
XXXXXXX XXXXXXX XXXX


Dear Mr. XXXX,

Please find below the results from your recent visit:

Results for XXXX, XXXXXXX XXXXXXX (MRN S000005) as of 6/23/2016 08:56
     Ref. Range     6/22/2016 10:03
White Blood Cell Count     Latest Ref Range: 3.8-10.8 Thousand/uL     8.7
Red Blood Cell Count     Latest Ref Range: 4.20-5.80 Million/uL     5.61
Hemoglobin     Latest Ref Range: 13.2-17.1 g/dL     16.8
Hematocrit     Latest Ref Range: 38.5-50.0 %     52.6 (H)
Mean Corpuscular Volume     Latest Ref Range: 80-100 fL     94
Mean Corpus Hgb     Latest Ref Range: 27-33 pg     29.9
Mean Corpus Hgb Conc     Latest Ref Range: 32-36 g/dL     31.9 (L)
Mean Platelet Volume     Latest Ref Range: 7.5-11.5 fL     9.3
RBC Distribution Width     Latest Ref Range: 11.0-15.0 %     15.2 (H)
Platelet Count     Latest Ref Range: 140-400 Thousand/uL     186
Eosinophil %     Latest Units: %     3.1
Basophil %     Latest Units: %     0.4
ANC-Neutrophil Absolute     Latest Ref Range: 1500-7800 cells/uL     6099
Lymphcytes Absolute     Latest Ref Range: 850-3900 cells/uL     1627
Monocyte Absolute     Latest Ref Range: 200-950 cells/uL     670
Eosinophil Absolute     Latest Ref Range: 15-500 cells/uL     270
Basophil Absolute Count     Latest Ref Range: 0-200 cells/uL     35
Results for XXXX, XXXXXXX XXXXXXX (MRN SM405065) as of 6/23/2016 08:56
     Ref. Range     6/22/2016 10:03
Sodium     Latest Ref Range: 135-146 mmol/L     141
Potassium     Latest Ref Range: 3.5-5.3 mmol/L     4.9
Chloride     Latest Ref Range: 98-110 mmol/L     104
Carbon Dioxide     Latest Ref Range: 19-30 mmol/L     25
Glucose     Latest Ref Range: 65-99 MG/DL     102 (H)
Urea Nitrogen     Latest Ref Range: 7-25 MG/DL     17
Creatinine     Latest Ref Range: 0.70-1.18 mg/dL     0.96
BUN / Creatinine Ratio     Latest Ref Range: 6-22     N/A
Est GFR Afr-Am(MDRD Eqn)     Latest Ref Range: > OR = 60 mL/min/1.73m2     92
Est GFR NonAfrAm(MDRD Eqn)     Latest Ref Range: > OR = 60 mL/min/1.73m2     80
Calcium     Latest Ref Range: 8.6-10.3 MG/DL     10.0
Total Protein     Latest Ref Range: 6.1-8.1 G/DL     7.4
Total Protein     Latest Ref Range: 6.1-8.1 G/DL     7.4
Albumin     Latest Ref Range: 3.6-5.1 G/DL     4.4
Albumin/Globulin Ratio     Latest Ref Range: 1.0-2.5     1.5
Alkaline Phosphatase     Latest Ref Range: 40-115 U/L     60
Aspartate Amino Trans     Latest Ref Range: 10-35 U/L     23
Alanine Amino Trans     Latest Ref Range: 9-46 U/L     24
Bilirubin,Total     Latest Ref Range: 0.2-1.2 MG/DL     0.8
Glucose, Qual     Latest Ref Range: NEG.     NEG.
Lipase     Latest Ref Range: 7-60 U/L     65 (H)
Results for XXXX, XXXXXXX XXXXXXX (MRN SM405065) as of 6/23/2016 08:56
     Ref. Range     6/22/2016 10:03
Color, Urine     Latest Ref Range: YELLOW,STRAW OR XXXXXXX YELLOW
Specific Gravity, Urine     Latest Ref Range: 1.001-1.035     1.020
Protein Semiquant, UA     Latest Ref Range: NEG.     NEG.
Ketones, Urine, Qualitative     Latest Ref Range: NEG.     NEG.
Bilirubin, Urine, Qualitative     Latest Ref Range: NEG.     NEG.
Nitrite, Urine     Latest Ref Range: NEG.     NEG.
Leukocyte Esterase, Urine     Latest Ref Range: NEG.     NEG.
Red Blood Cells, Urine     Latest Ref Range: NEG.     NEG.

Thank you...I will let you know biopsy results