06.23.2004 CT scan results CT thorax, abdomen, & pelvis. FINDINGS: Within the chest, the heart & great vessels remain normal in appearance. There has been interval development of a new soft tissue mass at the base of the left neck at the level of the thyroid gland that measures 2.8 x 2.0 x 2.0 cm in size. There is a necrotic portion of this mass. There is associated mass effect & compression of the left internal jugular vein with the left internal jugular vein shifted forward anteriorly. The left internal jugular is patent. This mass extends inferior to the level of the great vessels. No mediastinal, hilar, or axillary lymphadenopathy is identified. No pleural or per pericardial effusions are seen. On lung window settings, there has been increase in size, as well as internal development of new multiple periperal lung opacities. The largest is at the left lung base & measures approximately 1.5 cm. These findings would be worrisome for progression of disease. Within the abdomen & pelvis the liver, spleen, gallbladder, pancreas, bilateral adrenal glands, & right kidney all remain unremarkable in appearance. Again, the left kidney is noted to be smaller than the right & appears unchanged. The bladder appears unremarkable. There has been internal development of borderline-sized to mildly enlarged lymph nodes within the left illiac chain & left inguinal region. The largest lymph node within the left inguinal region measures approximately 1 cm in size. There has been internal development of a new soft tissue mass within the left illiac chain region that measures 3.0 x 1.8 x 2.3 cm. There has also been internal development of of a new 1.0 x 2.2 cm necrotic node within the left inguinal region. On bone window settings, no suspicious lytic or scleoric legions are identified. IMPRESSION: 1. Findings consistent with progression of disease. There has been interval development of new mass at the base of the left neck that extends at the level of the thyroid gland; that extends inferior to the level of the great vessels & demonstrates mass effect in the left internal jugular vein. The left internal jugular vein is patent. There is also interval development of soft tissue masses within the left illiac chain of the left inguinal region. There has also been interval development of new borderline to mildly enlarged lymph nodes in the left illiac chain & left inguinal regions. 2. Increasing as well as interval development of new periperal lung opacities throughout both lungs which is also worrisome for progression of disease. 3. Stable appearance to the small left kidney.
06.23.2004 bone scan (whole body) results. FINDINGS: There has been further increase in the size of the area of increased activity involving proximal portion of the left tibia which now involves about the proximal one-third of the shaft. However, the distribution of activity throughout the skeletal system otherwise remains essentially within normal limits with the normal physiological areas of increased activity noted. IMPRESSION: Progressive involvement of proximal portion of the left tibia representing metastatic neuroblastoma. No additional sites of involvement noted at this time.