还是第二原发癌？
这是最近一次CT检查引出的问题。
2023-8-18 做了CT，最终的报告五天后才出来。据医生说几乎所有会读片的都看了，反复几稿才定下来。初稿中说肝区多个微小新癌变灶，改成了末定。
Impression
1. No new lung nodules are seen. Interval slight increase in the right lower paratracheal lymph node, now measures 10 mm in comparison to the prior PET dated 06/06/2023.
2. Stable post radiation fibrosis bronchiectatic changes are seen in the left lung.
3. Unchanged right moderate and left loculated moderate pleural effusion with consolidation and or atelectasis of the lung bases. Continued follow-up is recommended.
4. Interval multiple new hypodensities along the right dome of the liver causing scalloping of the liver surface, concerning for peritoneal deposits.
5. 3 discrete stable hypodense lesions of the and hemangioma seen within the liver. Interval development of subcentimeter tiny hypodensities in the liver, too small to characterize.
6. Interval development of new ascites and omental stranding.
7. Uncomplicated right sided inguinal hernia containing fat, fluid, and vasculature. 8. Cholelithiasis without acute cholecystitis.
在分区细节中提到右肺的变化：
There is interval slight increase in the right lower paratracheal lymph node, now measures 10 mm in the maximum short axis dimension.
New pleural effusion seen on the right with blunting of the costophrenic angle.
Right lower lobe atelectasis is seen.
8-23日 看了医生。在仔细核实并对比以前的影像检查后，医生很踌躇，到底右肺和肝上发生了什么。我则直接点题：转移、还是第二原发？
讨论一番后，初步定下来：
1. 抽右侧胸水，做细胞学和生化检查。
2. 肝脏MRI扫描，以期确认那些新增病灶。
3. 腹水检测。
4. 结肠镜检。
5. 如果上述检查无果，做血液基因检测。
第二天，医生将我的病例在Tumor Board上做了会诊，晚上打电话告诉我将陆续安排上述检查。
后天将抽胸水。
待续……
