영문 CT scan의 "collapsed" 의미

[남군]

저희는 해외에 거주중이고요, 와이프가 원발불명의 전이암으로 3차까지 항암 (Cisplatin + Gemcitabine + Dubalumap)을 마치고 4차 항암을 기다리는 중 환자 상태가 좋지 않아 응급실을 거쳐 집중치료실(ICU)에 입원해 있는 상태입니다. 오늘 전이암 상태확인을 위해 CT 촬영을 했는데요, 영문결과지 내용 중 collapsed (붕괴되다)라고 표현하는 내용에 대해 혹시 아시는 분이 계실까 질문 올려봅니다. 방사선과에서 쓰는 collapsed라는 표현이 실제 해당 장기가 못 쓸정도로 망가졌다는 말인지 아니면 그냥 방사선 사진 이미지가 깨끗하지 않다는 말인지 모르겠어요.  아래 원문 중 밑줄친 내용을 "붕괴되다"로 해석하면 "당낭이 완전히 붕괴되었음", "대장이 완전히 붕괴되었음", "방광이 완전히 붕괴되었음", "붕괴된 골반" 이 되지만 대장이나 방광에는 암 전이가 없는것으로 알고 있어서요..

[CT ABDOMEN AND PELVIS]

Clinical history: VENT, CT CHEST ABDO PELVIS WITH CONTRAT FOR STAGING

Comparison exam:December 13, 2022

Axial volumetric CT images were obtained from above the level of the diaphragms to below the level of the ischial tuberosities following the use of intravenous contrast with 5 mm slice thickness.

FINDINGS:

HEPATOBILIARY: The liver is decreased in size compared to previous, now measuring 21.4 cm craniocaudally, previous 26 cm. Extensive metastatic infiltration of the liver with little visible normal parenchyma, not significantly changed. Markers:
-Segment 7 measures 3 cm on image 34, previous 2.7 cm.
-Segment 5 3.1 cm, image 78, previous 3 cm.
The central portal veins appear patent although attenuated and the left lobe. Left hepatic vein is not identifiable. The middle hepatic vein is only visible close to the IVC. Right hepatic vein appears patent.
Gallbladder is entirely collapsed.

SPLEEN: Borderline splenomegaly, similar to before. Heterogenous appearance of the spleen, particularly in the lower pole where there is subcapsular hypodensity, best seen on series 3 image 49-55, query infarct. Less well-defined hypodensities in
the upper pole, series 3 images 60, 61, and 59.

NODES: Adenopathy with markers as follows:
-Porta hepatis 1.6 cm on image 66, previous 2.5 cm.
-Aortocaval 0.8 cm on image 78, previous 1.2 cm.
No new adenopathy.

PERITONEUM/RETROPERITONEUM: Large volume ascites, increased. Right-sided tunneled peritoneal catheter is again noted with tip in the left iliac fossa. No measurable carcinomatosis.
Retroperitoneum is grossly stable.

BOWEL: The large bowel is entirely collapsed however appears thick-walled throughout. Small bowel loops are also mildly edematous diffusely. No bowel obstruction.

BONES AND BODY WALL:Extensive metastatic bone disease is again noted, overall not significantly changed. Dominant left sacral mass measures approximately 6 x 4.6 cm on image 150, previously 5.7 x 5.2 cm, relatively stable. Local extent is similar.
There is significant increased diffuse body wall edema, now severe.

GU TRACT: Kidneys demonstrate homogeneous symmetrical bilateral enhancement. No hydronephrosis.
Presumed uterine posterior fibroid appears mildly decreased in size measuring 5.3 cm on 2/57, previously 7 cm. Urinary bladder is entirely collapsed with Foley catheter in situ. Gas in the anterior aspect of the pelvis is likely within the collapsed
bladder, series 2 image 59. Adnexa are grossly unremarkable.

OTHER: Pancreas and adrenal glands are stable and grossly unremarkable.
Bilateral central femoral lines, arterial on the left and venous on the right.
Bilateral moderate to large pleural effusions.
Chest CT reported separately.

OPINION:
1.Previously noted moderate to severe hepatomegaly is improved. Metastatic infiltration of the liver is however grossly similar.
2.Adenopathy is mildly improved.
3.Large volume ascites, severe anasarca, and bilateral pleural effusions, all increased and likely in keeping with extensive third spacing. No definite carcinomatosis.
4.The large bowel is collapsed and diffusely thick-walled which could be due to overall third spacing as well, however colitis is in the differential.
5. Extensive bone metastases appear grossly similar.
6. Suspected splenic infarcts, predominantly in the lower pole.

[CT CHEST]

PROVIDED HISTORY: O2, VENT, re restaging of CA...please do asap

COMPARISON STUDY: Previous chest CT from December 13, 2022

TECHNIQUE: Volumetric scanning with intravenous contrast medium administration through the chest was performed (lung windows: 1 mm slice thickness, mediastinal windows: 2 mm slice thickness) with axial, sagittal and coronal reconstructions. Axial
MIP reconstructions were also created.

FINDINGS:

SUPPORT DEVICES:
The endotracheal tube tip terminates 38 mm above the carina.
Right portacatheter tip terminates at the atriocaval junction.

LUNG PARENCHYMA:
There are new extensive peribronchial vascular consolidative and groundglass opacities in lungs bilaterally. New right middle lobe consolidation and partial collapse. New moderate passive atelectasis in the right lower lobe.

Some of the previous pulmonary nodules are obscured by the new airspace opacities bilaterally as are unchanged. For example:
-Right apical 3 mm (image 63), unchanged
-Right lower lobe 5 mm (image 109), unchanged
-Left apical 6 mm (image 53)

PLEURA:
There is a large right pleural effusion and moderate size left pleural effusion. No pleural thickening or nodularity detected.

AIRWAYS:
The central tracheobronchial tree is patent.

LYMPH NODES:
There is suboptimal assessment of the nodes due to mediastinal and chest wall edema. Previously noted nodes as follow:
-Right paratracheal 8 mm node (image 32), unchanged
-Right pericardial 5 mm node (image 105), previously 7 mm
-Inferior pericaval 7 mm node (image 180), unchanged
No definite new thoracic adenopathy.

HEART - MAJOR VESSELS - PERICARDIUM:
The heart is normal in size. The caliber of the thoracic aorta and main pulmonary artery is within normal limits. There is no pericardial effusion.

OTHER MEDIASTINAL STRUCTURES:
The thyroid gland and esophagus are unremarkable.

BONES-SOFT TISSUES:
No significant change in the mixed lytic and sclerotic osseous metastasis.

New diffuse anasarca.

UPPER ABDOMEN:
The abdomen is reported separately. Please refer to that report.

CONCLUSION:

1. New bilateral extensive consolidative and groundglass opacities are likely infectious/inflammatory in etiology. Drug reaction is a consideration. Pulmonary edema is considered unlikely but cannot be entirely excluded.
2. No significant change in the visualized pulmonary nodules.
3. Large right pleural effusion and moderate size left pleural effusion. No pleural thickening or nodularity detected.
4. Decrease in a right pericardial node. Remaining thoracic nodes are unchanged.
5. Mediastinal edema and diffuse anasarca noted.
6. No significant change in the osseous metastasis.

[승리의 힘]

승리의 힘입니다.
질문에대한 조언만 드려봅니다

- 저는 해석시 '쪼그라들었다' '쭈그러듬' 정도로 합니다. (반대라면 확장, 팽만이라 distention으로 표현하구요)
- 장이 쪼그라들면... 간혹 판독에 제한이 좀 있다고 합니다.

*** 꼭 ICU에서 순조로운 경과를보여 일반병실로 잘 전원하시길 기원해봅니다

[남군]

네, 조금 전에 의사선생님들한테 다시 설명을 들었고요, 말씀해 주신것처럼 쪼그라든 (shrink) 거라고 말해주셨습니다.

[승리의 힘]

네... Shrink 맞습니다.
힘내십시요~

[천수답]

조속히 치료되고, 잘되시기를 바랍니다. 무엇보다 주님의 도우심이 강하게 의료진의 손길에 지혜에, 약효에 나타나시기를 바랍니다ㅣ.

[남군]

네 정말 감사드려요. 오늘 상담후 항암을 중단하기로 했습니다. 지금까지 쓴 항암약이 듣지 않았다고 하고요, 몸이 더 나아질 확률이 희박하고 혹여 나아지더라도 다른 쓸만한 약이 없다고 합니다. 집에 돌아갈 수 있을때까지만 잡아둔 후 집에서 연명치료에만 집중하라고 합니다.