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CT-MRI_metrics_validation_dataset

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EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat. Patient weight: 150 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 78 sec Scan field of view: 384 mm. (accession CT220002391), Patient weight: 150 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 81 sec Scan field of view: 384 mm. DLP: 828.50 mGy cm. (accession CT220002392) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: No acute injury. No pneumothorax or pleural effusion. HEART / VESSELS: No significant abnormality. Coronary atherosclerotic calcifications. CABG with fracture of the inferior most sternal wire. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. ABDOMEN and PELVIS: LIVER: Steatotic. Otherwise normal without acute injury. BILIARY TRACT: Normal. GALLBLADDER: Uncomplicated cholelithiasis. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Punctate nonobstructing left renal stones. No acute injury. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. Moderate hiatal hernia. COLON / APPENDIX: No abnormality. Few noninflamed colonic diverticula. PERITONEUM / MESENTERY: No free fluid or free air. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Enlarged prostate gland. No acute abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Fractures of the right posterolateral fourth through 8th ribs. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. CONCLUSION: 1. Fractures of the right posterolateral 4th-8th ribs. 2. No additional acute traumatic injury within the chest, abdomen, or pelvis. 3. No acute osseous abnormality of the thoracolumbar spine. 4. Moderate hiatal hernia, punctate nonobstructing renal stones, and additional chronic/incidental findings as above.

FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: No acute injury. No pneumothorax or pleural effusion. HEART / VESSELS: No significant abnormality. Coronary atherosclerotic calcifications. CABG with fracture of the inferior most sternal wire. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. ABDOMEN and PELVIS: LIVER: Steatotic. Otherwise normal without acute injury. BILIARY TRACT: Normal. GALLBLADDER: Uncomplicated cholelithiasis. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Punctate nonobstructing left renal stones. No acute injury. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. Moderate hiatal hernia. COLON / APPENDIX: No abnormality. Few noninflamed colonic diverticula. PERITONEUM / MESENTERY: No free fluid or free air. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Enlarged prostate gland. No acute abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Fractures of the right posterolateral fourth through 8th ribs. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.

FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Left lower lobe solid spiculated pulmonary nodule measures 2.1 x 1.3 cm (series 2, image 40), previously 2.0 x 1.2 cm. Additional solid pulmonary nodule of the right lower lobe measures 0.5 x 0.3 cm (series 2, image 74), unchanged. No new pulmonary nodule. Patent central airways. No pneumothorax or pleural effusion. Mild right basilar atelectasis. HEART / VESSELS: Normal heart size. Normal caliber thoracic aorta and main pulmonary artery. Trace pericardial effusion. MEDIASTINUM / ESOPHAGUS: Circumferential thickening of distal esophagus, possibly reflux esophagitis. LYMPH NODES: Unchanged enlarged subcarinal node measuring 1.2 cm in short axis (series 2, image 52). CHEST WALL: Left chest wall AICD. UPPER ABDOMEN: Cholecystectomy changes. MUSCULOSKELETAL: No aggressive osseous lesion. Degenerative disc disease. Old lateral right 7th and 8th rib fractures.

RADIOLOGIC EXAM: CT Angio Neck, CT Cervical Spine From Reformat CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Angio Neck, CT Cervical Spine From Reformat Following CT of the neck, reformatted images were produced to optimize visualization of the osseous structures of the cervical spine. 3-D CT MIP and volume rendered angiographic images were generated in post processing. Patient weight: 150 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 268 mm. DLP: 909 mGy cm. FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (

FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (

Findings: Lines and Tubes: None. Body Wall and Abdomen: No destructive osseous lesions. Small hiatal hernia. Previous cholecystectomy. Lymph Nodes, Mediastinum and Neck: No axillary adenopathy. No mediastinal adenopathy. Postoperative changes in the anterior mediastinum. Lungs and Pleura: No pleural effusion. Linear opacities in both lung bases likely represent subsegmental atelectasis. Triangular opacity in the lingula likely represents a new region of subsegmental atelectasis. Cardiovascular: Heart size is at least at the upper limits of normal. Relatively low density blood pool. No pericardial effusion.

EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat. Patient weight: 150 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 78 sec Scan field of view: 384 mm. (accession CT220002391), Patient weight: 150 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 81 sec Scan field of view: 384 mm. DLP: 828.50 mGy cm. (accession CT220002392) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: No acute injury. No pneumothorax or pleural effusion. HEART / VESSELS: No significant abnormality. Coronary atherosclerotic calcifications. CABG with fracture of the inferior most sternal wire. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. ABDOMEN and PELVIS: LIVER: Steatotic. Otherwise normal without acute injury. BILIARY TRACT: Normal. GALLBLADDER: Uncomplicated cholelithiasis. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Punctate nonobstructing left renal stones. No acute injury. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. Moderate hiatal hernia. COLON / APPENDIX: No abnormality. Few noninflamed colonic diverticula. PERITONEUM / MESENTERY: No free fluid or free air. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Enlarged prostate gland. No acute abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Fractures of the right posterolateral fourth through 8th ribs. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. CONCLUSION: 1. Fractures of the right posterolateral 4th-8th ribs. 2. No additional acute traumatic injury within the chest, abdomen, or pelvis. 3. No acute osseous abnormality of the thoracolumbar spine. 4. Moderate hiatal hernia, punctate nonobstructing renal stones, and additional chronic/incidental findings as above.

FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: No acute injury. No pneumothorax or pleural effusion. HEART / VESSELS: No significant abnormality. Coronary atherosclerotic calcifications. CABG with fracture of the inferior most sternal wire. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. ABDOMEN and PELVIS: LIVER: Steatotic. Otherwise normal without acute injury. BILIARY TRACT: Normal. GALLBLADDER: Uncomplicated cholelithiasis. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Punctate nonobstructing left renal stones. No acute injury. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. Moderate hiatal hernia. COLON / APPENDIX: No abnormality. Few noninflamed colonic diverticula. PERITONEUM / MESENTERY: No free fluid or free air. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Enlarged prostate gland. No acute abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Fractures of the right posterolateral fourth through 8th ribs. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.

FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal within limits of technique. SPLEEN: Normal. Accessory spleen.. ADRENALS: Normal. KIDNEYS: Nonobstructing 4 mm renal calculus in the interpolar region of the left kidney. There is mild left hydronephrosis to the level of the UPJ without obstructing stone. The right kidney is normal abnormal. No perinephric stranding/fluid collection. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Unremarkable REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: No significant abnormality.

EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat. Patient weight: 150 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 78 sec Scan field of view: 384 mm. (accession CT220002391), Patient weight: 150 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 81 sec Scan field of view: 384 mm. DLP: 828.50 mGy cm. (accession CT220002392) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: No acute injury. No pneumothorax or pleural effusion. HEART / VESSELS: No significant abnormality. Coronary atherosclerotic calcifications. CABG with fracture of the inferior most sternal wire. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. ABDOMEN and PELVIS: LIVER: Steatotic. Otherwise normal without acute injury. BILIARY TRACT: Normal. GALLBLADDER: Uncomplicated cholelithiasis. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Punctate nonobstructing left renal stones. No acute injury. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. Moderate hiatal hernia. COLON / APPENDIX: No abnormality. Few noninflamed colonic diverticula. PERITONEUM / MESENTERY: No free fluid or free air. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Enlarged prostate gland. No acute abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Fractures of the right posterolateral fourth through 8th ribs. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. CONCLUSION: 1. Fractures of the right posterolateral 4th-8th ribs. 2. No additional acute traumatic injury within the chest, abdomen, or pelvis. 3. No acute osseous abnormality of the thoracolumbar spine. 4. Moderate hiatal hernia, punctate nonobstructing renal stones, and additional chronic/incidental findings as above.

FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: No acute injury. No pneumothorax or pleural effusion. HEART / VESSELS: No significant abnormality. Coronary atherosclerotic calcifications. CABG with fracture of the inferior most sternal wire. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. ABDOMEN and PELVIS: LIVER: Steatotic. Otherwise normal without acute injury. BILIARY TRACT: Normal. GALLBLADDER: Uncomplicated cholelithiasis. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Punctate nonobstructing left renal stones. No acute injury. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. Moderate hiatal hernia. COLON / APPENDIX: No abnormality. Few noninflamed colonic diverticula. PERITONEUM / MESENTERY: No free fluid or free air. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Enlarged prostate gland. No acute abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Fractures of the right posterolateral fourth through 8th ribs. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.

FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Pelvis Renal Transplant VASCULATURE: LOWER ABDOMINAL AORTA: Mild calcified atherosclerotic disease. RIGHT COMMON / INTERNAL ILIAC ARTERIES: Mild calcification of the right common iliac artery. No calcifications of the right RIGHT EXTERNAL ILIAC ARTERY: No calcified atherosclerotic disease. LEFT COMMON / INTERNAL ILIAC ARTERIES: Mild calcified atherosclerotic disease of the left internal iliac. LEFT EXTERNAL ILIAC ARTERY: Mild calcified atherosclerotic disease. LOWER ABDOMEN: BOWEL: There is a suture line at the rectoanal junction. There is moderate colonic diverticulosis. Normal appendix. PERITONEUM: Normal. OTHER: There is left hydroureter of the mid ureter. PELVIS: LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: There is a 6 mm calculus layering dependently in the posterior right urinary bladder. REPRODUCTIVE ORGANS: Prostate is markedly enlarged. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.

RADIOLOGIC EXAM: CT Angio Neck, CT Cervical Spine From Reformat CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Angio Neck, CT Cervical Spine From Reformat Following CT of the neck, reformatted images were produced to optimize visualization of the osseous structures of the cervical spine. 3-D CT MIP and volume rendered angiographic images were generated in post processing. Patient weight: 150 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 268 mm. DLP: 909 mGy cm. FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (

FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (

FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Transgastric stent is again observed in stable position with one end adjacent to the pancreatic body/tail and the other end within the stomach lumen. There has been interval decrease in peripancreatic inflammatory as well as many of the peripancreatic fluid collections. There is a well-circumscribed homogeneous fluid collection adjacent to the pancreatic body and stomach which measures increased in size compared to the prior exam measuring 4.4 x 3.7 cm (series 306 image 111), previously measuring 3.8 x 2.3 cm. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stent remains within the proximal stomach, unchanged. Small bowel loops are nondilated COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Interval resolution of previously observed presacral fluid. VESSELS: Moderate aortic atherosclerosis without aneurysm. Splenic vein and artery appear within normal limits. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Left-sided L5 pars defect without anterolisthesis.

EXAM: CT Chest with contrast CLINICAL INFORMATION: History of hepatocellular carcinoma undergoing staging. COMPARISON: CT chest 6/29/2021, 3/23/2021 and 4/10/2019 TECHNIQUE: CT Chest with contrast. Patient weight: 205 lbs. IV contrast: Omnipaque 350, 180 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: 100 sec. Scan field of view: 410 mm. DLP: 1721 mGy cm. FINDINGS: LOWER NECK: Unchanged subcentimeter right thyroid lobe nodule. CHEST: LUNGS / AIRWAYS / PLEURA: Dependent secretions in the distal trachea. The central airways are otherwise patent. Noncalcified left upper lobe nodule measuring 5 mm (series 15, image 47), previously 4 mm. Left lower lobe peripheral groundglass nodule measuring 7 mm (series 15, image 91) remains unchanged. A tiny left lower lobe nodule on axial image 128; series 15, overall unchanged. Mild paraseptal emphysema in the bilateral lung apices. No focal airspace consolidation, mass, or pleural effusion. HEART / VESSELS: The heart is normal in size without pericardial effusion no large central pulmonary embolus. Mild atherosclerotic disease of the thoracic aorta. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous lesion. Partially imaged right humeral head bone anchor. Mild multilevel degenerative changes of the thoracic spine. CONCLUSION: 1. Slight interval increase in size of left upper lobe noncalcified nodule since 3/23/2021. Recommend attention on follow-up. 2. Left lower lobe groundglass nodule is unchanged since 4/10/2019 and almost certainly benign. 3. Respiratory secretions in the distal trachea. No other acute abnormality or evidence of metastatic disease in the chest. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.

FINDINGS: LOWER NECK: Unchanged subcentimeter right thyroid lobe nodule. CHEST: LUNGS / AIRWAYS / PLEURA: Dependent secretions in the distal trachea. The central airways are otherwise patent. Noncalcified left upper lobe nodule measuring 5 mm (series 15, image 47), previously 4 mm. Left lower lobe peripheral groundglass nodule measuring 7 mm (series 15, image 91) remains unchanged. A tiny left lower lobe nodule on axial image 128; series 15, overall unchanged. Mild paraseptal emphysema in the bilateral lung apices. No focal airspace consolidation, mass, or pleural effusion. HEART / VESSELS: The heart is normal in size without pericardial effusion no large central pulmonary embolus. Mild atherosclerotic disease of the thoracic aorta. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous lesion. Partially imaged right humeral head bone anchor. Mild multilevel degenerative changes of the thoracic spine.

FINDINGS: Intracranially there is no evidence of acute vascular territory ischemia, hemorrhage, mass or mass effect. The ventricles are normal in size and configuration. The cortical sulci and subarachnoid cisterns are symmetric and age-appropriate. There is no extra-axial pathology. The calvarium and skull base show no focal bony abnormality. Visualized paranasal sinus and mastoid aerations are clear.

EXAM: CT Abdomen wo+w contrast CLINICAL INFORMATION: Status post liver transplant, history of HCC COMPARISON: 9/28/2021 TECHNIQUE: CT Abdomen wo+w contrast. Patient weight: 205 lbs. IV contrast: Omnipaque 350, 180 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: Bolus Tracked. Scan field of view: 410 mm. DLP: 1721 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen LOWER CHEST: Please see separately reported chest CT. ABDOMEN: LIVER: Postsurgical changes related to orthotopic liver transplant. No suspicious mass or lesion identified. Noncirrhotic morphology. No steatotic. Hepatic artery anastomosis is difficult to visualize given surrounding streak artifact. BILIARY TRACT: No abnormality. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Small hypodense lesion within the right upper pole, too small to accurately characterize but likely simple renal cyst. Small bilateral nonobstructing renal calculi in the bilateral renal pelvises, unchanged. No obstructing mass or lesion visualized. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: Scattered colonic diverticula without surrounding inflammation. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Mild nonspecific stranding around the kidneys bilaterally. VESSELS: Mild atherosclerosis involving the descending aorta and branching vessels. BODY WALL: Mild diastasis recti with small protrusion of transverse colon through this defect. No ischemia or obstruction. MUSCULOSKELETAL: No acute or aggressive osseous abnormality. Small sclerotic focus at the T12 costovertebral junction is unchanged. L5-S1 laminectomy changes. Mild degenerative changes involving the visualized thoracolumbar spine. CONCLUSION: 1. Stable postoperative appearance of orthotopic liver transplant. No findings of hepatocellular carcinoma. 2. Other stable abdominal findings as outlined above. Please see separately reported chest CT. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.

FINDINGS: STRUCTURED REPORT: CT Abdomen LOWER CHEST: Please see separately reported chest CT. ABDOMEN: LIVER: Postsurgical changes related to orthotopic liver transplant. No suspicious mass or lesion identified. Noncirrhotic morphology. No steatotic. Hepatic artery anastomosis is difficult to visualize given surrounding streak artifact. BILIARY TRACT: No abnormality. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Small hypodense lesion within the right upper pole, too small to accurately characterize but likely simple renal cyst. Small bilateral nonobstructing renal calculi in the bilateral renal pelvises, unchanged. No obstructing mass or lesion visualized. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: Scattered colonic diverticula without surrounding inflammation. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Mild nonspecific stranding around the kidneys bilaterally. VESSELS: Mild atherosclerosis involving the descending aorta and branching vessels. BODY WALL: Mild diastasis recti with small protrusion of transverse colon through this defect. No ischemia or obstruction. MUSCULOSKELETAL: No acute or aggressive osseous abnormality. Small sclerotic focus at the T12 costovertebral junction is unchanged. L5-S1 laminectomy changes. Mild degenerative changes involving the visualized thoracolumbar spine.

FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus. Pulmonary artery caliber is normal. LUNGS / AIRWAYS / PLEURA: Moderate left-sided pleural effusion has mildly increased in size with persistent atelectasis in the left lung. Small right pleural effusion is similar to prior. There are no patchy and nodular opacities scattered throughout the right lung. Mild increased dependent consolidation within the right lower lobe. No pneumothorax. ET tube tip terminates approximately 3 cm to the carina. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Esophagogastric tube terminates in the gastric fundus. LYMPH NODES: Few enlarged mediastinal nodes such as right upper paratracheal node measuring 1.2 cm in short axis on image 25, series 401 CHEST WALL: No significant abnormality. MUSCULOSKELETAL: No acute fracture or destructive osseous lesion.

EXAM: CT Chest wo contrast CLINICAL INFORMATION: Lung nodule follow-up. Status post biopsy of right lower lobe subpleural nodule with pathology consistent with necrotizing granulomatous inflammation and cryptococcal fungal organisms. COMPARISON: CT chest 9/30/2021 and PET/CT 12/6/2020 TECHNIQUE: CT Chest wo contrast. Scan field of view: 350 mm. DLP: 145.91 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent with unchanged mild bilateral lower lobe bronchiectasis. Redemonstration of right lower lobe paramediastinal subpleural nodule measuring 1.9 x 0.9 cm (series 2, image 137), unchanged. Nodularity along the biopsy tract is seen posterolateral to the nodule. The previously characterized subpleural nodularity in the superior segment of the right lower lobe is decreased in size. Several additional areas of subpleural nodularity in the left lung also appear decreased in size. Subsegmental linear atelectasis or scarring in the right lower lobe. HEART / VESSELS: Postsurgical changes from heart transplant. Moderate calcified atherosclerotic disease of the thoracic aorta and proximal arch vessels. MEDIASTINUM / ESOPHAGUS: Hyperdense ingested material is seen in the distal esophagus, which can be seen with gastroesophageal reflux. LYMPH NODES: None enlarged. CHEST WALL: Dependent lead is again seen in the left anterior chest subcutaneous tissues. Postsurgical changes from median sternotomy with intact sternotomy wires and plates. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No aggressive osseous lesion. Mild multilevel degenerative changes of the thoracic spine. CONCLUSION: 1. Post biopsy changes of the right lower lobe paramediastinal nodule with nodularity, likely seeding of infection along the biopsy tract. Additional areas of subpleural nodularity in the bilateral lungs overall appear decreased in size compared to prior, possibly postinfectious or inflammatory, with similar etiology as biopsied nodule. Recommend attention on follow-up, for change. 2. Stable postsurgical changes from prior heart transplant. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.

FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent with unchanged mild bilateral lower lobe bronchiectasis. Redemonstration of right lower lobe paramediastinal subpleural nodule measuring 1.9 x 0.9 cm (series 2, image 137), unchanged. Nodularity along the biopsy tract is seen posterolateral to the nodule. The previously characterized subpleural nodularity in the superior segment of the right lower lobe is decreased in size. Several additional areas of subpleural nodularity in the left lung also appear decreased in size. Subsegmental linear atelectasis or scarring in the right lower lobe. HEART / VESSELS: Postsurgical changes from heart transplant. Moderate calcified atherosclerotic disease of the thoracic aorta and proximal arch vessels. MEDIASTINUM / ESOPHAGUS: Hyperdense ingested material is seen in the distal esophagus, which can be seen with gastroesophageal reflux. LYMPH NODES: None enlarged. CHEST WALL: Dependent lead is again seen in the left anterior chest subcutaneous tissues. Postsurgical changes from median sternotomy with intact sternotomy wires and plates. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No aggressive osseous lesion. Mild multilevel degenerative changes of the thoracic spine.

FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Cirrhotic liver. Otherwise normal without focal lesion BILIARY TRACT: Normal. GALLBLADDER: Prior cholecystectomy. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: New noninflamed colonic diverticula. PERITONEUM / MESENTERY: No free fluid or free air. RETROPERITONEUM: Normal. VESSELS: Moderate aortoiliac atherosclerotic disease without aneurysm or flow-limiting stenosis. Foci of gas within the left femoral and external iliac vein are presumably iatrogenic. URINARY BLADDER: Foley catheter with partially decompressed bladder. The bladder appears thick-walled mucosal hyperenhancement. REPRODUCTIVE ORGANS: No acute abnormality. Prior hysterectomy. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute fracture or new osseous abnormality. Bilateral femoral head osteonecrosis without collapse.

CLINICAL HISTORY: nph, G91.2 (Idiopathic) normal pressure hydrocephalus EXAM: CT Head wo contrast TECHNIQUE: 5 mm thick serial axial images were obtained throughout the head without intravenous contrast. Scan field of view: 230 mm. DLP: 889 mGy cm. FINDINGS: There is a right frontal approach ventricular catheter with tip abutting the septum pellucidum. Visualized catheter tubing within the right scalp and neck soft tissues appears intact. The ventricles are stable in size with mild ventriculomegaly. There is no extra-axial collection. There is no acute intracranial hemorrhage. There are no abnormal areas of hypoattenuation to suggest acute infarction. There are stable mild to moderate periventricular hypodensities reflecting microangiopathic changes. There is mild generalized atrophy. There are advanced atherosclerotic calcifications of the distal left vertebral artery and also moderate atherosclerotic calcifications of both distal ICAs. The calvarium is intact other than right frontal burr hole. The visualized paranasal sinuses and mastoid air cells are clear. There is no acute abnormality of the orbits. CONCLUSION: 01. Stable shunted ventricles stable ventriculomegaly. 02. Stable age related changes.

FINDINGS: There is a right frontal approach ventricular catheter with tip abutting the septum pellucidum. Visualized catheter tubing within the right scalp and neck soft tissues appears intact. The ventricles are stable in size with mild ventriculomegaly. There is no extra-axial collection. There is no acute intracranial hemorrhage. There are no abnormal areas of hypoattenuation to suggest acute infarction. There are stable mild to moderate periventricular hypodensities reflecting microangiopathic changes. There is mild generalized atrophy. There are advanced atherosclerotic calcifications of the distal left vertebral artery and also moderate atherosclerotic calcifications of both distal ICAs. The calvarium is intact other than right frontal burr hole. The visualized paranasal sinuses and mastoid air cells are clear. There is no acute abnormality of the orbits.

FINDINGS: Head CT: The calvarium and skull base are intact. Intracranially there is no evidence of cerebral contusion, hemorrhage, edema or mass effect. No evidence of acute cerebral ischemic pathology is noted. The ventricles are proportionate to parenchymal volume loss. There is no extra-axial pathology. Visualized paranasal sinus, orbits and maxillofacial bones are unremarkable. C-spine CT: There is degenerative grade 2 anterolisthesis of T1 on T2 measuring 4.6 mm of anterior slippage. Mild anterolisthesis of C7 on T1 is also present. Anterior cervical fusion hardware and intervertebral cage at C4-C5 are intact. There is no evidence of acute fracture in the cervical spine. Bilateral C2-C3 facet joints show degenerative fusion. The posterior column integrity is preserved. The cervicovertebral junction and atlantoaxial joint relationships are normal. The spinal canal is capacious.

EXAM: CT Angio Chest wo+w contrast CLINICAL INFORMATION: Covid COMPARISON: None. TECHNIQUE: CT Angio Chest wo+w contrast. Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 226 lbs. IV contrast: Omnipaque 350, 61 ml, per protocol. IV contrast injection rate: 4 ml per sec. Scan delay: Bolus Track Scan field of view: 350 mm. KVP: 100 DLP: 508 mGy cm. FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Patchy and confluent peripheral predominant groundglass opacities throughout both lungs. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Mildly enlarged right hilar node measuring 13 mm in short axis on image 187, series 301. Additional subcentimeter mediastinal nodes. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. No pulmonary embolism 2. COVID pneumonia

FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Patchy and confluent peripheral predominant groundglass opacities throughout both lungs. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Mildly enlarged right hilar node measuring 13 mm in short axis on image 187, series 301. Additional subcentimeter mediastinal nodes. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No significant abnormality.

FINDINGS: Head CT: The calvarium and skull base are intact. Intracranially there is no evidence of cerebral contusion, hemorrhage, edema or mass effect. No evidence of acute cerebral ischemic pathology is noted. The ventricles are proportionate to parenchymal volume loss. There is no extra-axial pathology. Visualized paranasal sinus, orbits and maxillofacial bones are unremarkable. C-spine CT: There is degenerative grade 2 anterolisthesis of T1 on T2 measuring 4.6 mm of anterior slippage. Mild anterolisthesis of C7 on T1 is also present. Anterior cervical fusion hardware and intervertebral cage at C4-C5 are intact. There is no evidence of acute fracture in the cervical spine. Bilateral C2-C3 facet joints show degenerative fusion. The posterior column integrity is preserved. The cervicovertebral junction and atlantoaxial joint relationships are normal. The spinal canal is capacious.

EXAM: CT Chest High Resolution wo contrast CLINICAL INFORMATION: 63-year-old female with chronic cough. COMPARISON: CT chest dated 3/29/2005 TECHNIQUE: CT Chest High Resolution wo contrast. Scan field of view: 250 mm. DLP: 1748 mGy cm. High-resolution CT imaging of the chest was performed per protocol with inspiratory and expiratory technique in supine position. FINDINGS: LOWER NECK: Subcentimeter lymph nodes. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent with areas of traction bronchiectasis, peripheral reticulations and scattered groundglass opacities. No definite honeycombing is identified. No suspicious nodule. No true expiratory mages are available. HEART / VESSELS: Mildly dilated pulmonary artery. MEDIASTINUM / ESOPHAGUS: Trace hiatal hernia. LYMPH NODES: Enlarged mediastinal and partially calcified hilar lymph nodes mildly prominent axillary lymph nodes.. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: Multilevel degenerative changes in the thoracic spine. No destructive osseous lesion. CONCLUSION: 1. Mixed cellular and fibrotic NSIP pattern of interstitial lung disease, which can be seen with connective tissue disease. Post infectious interstitial lung disease can also have similar appearance. 2. Mildly enlarged mediastinal, hilar and axillary lymph nodes, that could be reactive. Attention at follow-up studies is recommended.

FINDINGS: LOWER NECK: Subcentimeter lymph nodes. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent with areas of traction bronchiectasis, peripheral reticulations and scattered groundglass opacities. No definite honeycombing is identified. No suspicious nodule. No true expiratory mages are available. HEART / VESSELS: Mildly dilated pulmonary artery. MEDIASTINUM / ESOPHAGUS: Trace hiatal hernia. LYMPH NODES: Enlarged mediastinal and partially calcified hilar lymph nodes mildly prominent axillary lymph nodes.. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: Multilevel degenerative changes in the thoracic spine. No destructive osseous lesion.

FINDINGS: The contrast bolus is excellent and no pulmonary thromboembolus is identified. The pulmonary arteries are not dilated and there are no findings of right heart strain. The supraclavicular region is unremarkable. Central airways are patent. The thoracic aorta is nonaneurysmal. There is concentric apical predominant hypertrophy of the left ventricle. No pericardial effusion. Prominent right hilar lymph nodes are seen measuring up to 12 mm in short axis. A 14 mm short axis AP window lymph node seen on image 36 of series 906. No enlarged supraclavicular or axillary lymph nodes. The esophagus is not dilated. There is a small hiatal hernia. There is mild upper lobe predominant emphysema. There is also some subpleural reticulation and groundglass opacities most significant within the upper and midlungs. Additional patchy areas of groundglass opacity are indeterminate. There is a 9 x 7 mm subpleural nodule within the lateral segment of the middle lobe on image 63. There is a fissural nodules along the left major fissure on image 54 measuring up to 7 mm have the appearance of intrapulmonary lymph nodes. 2 mm left upper lobe nodule on image 74. No pleural effusion or pleural thickening. No acute or aggressive osseous abnormality.

EXAM: CT Angio Chest wo+w contrast CLINICAL INFORMATION: Shortness of breath, tachycardia. COMPARISON: US lower extremity 1/2/2022. CT abdomen and pelvis 12/27/2021. TECHNIQUE: CT Angio Chest wo+w contrast. Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 227 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 397 mm. KVP: 120 DLP: 386 mGy cm. FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Mildly suboptimal quality with incomplete evaluation of subsegmental pulmonary arteries. LOWER NECK: No significant abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus within the limitations of exam. LUNGS / AIRWAYS / PLEURA: No focal consolidation, pleural effusion, or pneumothorax. Central airways are patent. HEART / OTHER VESSELS: Left ventricular hypertrophy. No pericardial effusion. Markedly dilated main pulmonary artery measuring 4.0 cm. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: No significant abnormality. MUSCULOSKELETAL: Mild chronic anterior vertebral body height loss of T9-T11. CONCLUSION: 1. No evidence of pulmonary embolus. 2. Left ventricular hypertrophy and markedly dilated main pulmonary artery, suggestive of underlying pulmonary artery hypertension. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.

FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Mildly suboptimal quality with incomplete evaluation of subsegmental pulmonary arteries. LOWER NECK: No significant abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus within the limitations of exam. LUNGS / AIRWAYS / PLEURA: No focal consolidation, pleural effusion, or pneumothorax. Central airways are patent. HEART / OTHER VESSELS: Left ventricular hypertrophy. No pericardial effusion. Markedly dilated main pulmonary artery measuring 4.0 cm. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: No significant abnormality. MUSCULOSKELETAL: Mild chronic anterior vertebral body height loss of T9-T11.

FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Pelvis Renal Transplant VASCULATURE: LOWER ABDOMINAL AORTA: Mild calcified atherosclerotic disease. RIGHT COMMON / INTERNAL ILIAC ARTERIES: Mild calcified atherosclerotic disease. RIGHT EXTERNAL ILIAC ARTERY: Moderate calcified atherosclerotic disease, particularly in the mid and distal external iliac artery. Multiple surgical clips noted adjacent to the distal right external iliac artery. The proximal right external iliac artery is free of significant atherosclerotic disease. Right common femoral artery appears aneurysmal, measuring up to 2.2 cm on axial series 2, image 161 and with multiple adjacent surgical clips in the right inguinal region/upper thigh. LEFT COMMON / INTERNAL ILIAC ARTERIES: Mild calcified atherosclerotic disease. LEFT EXTERNAL ILIAC ARTERY: No calcified atherosclerotic disease. LOWER ABDOMEN: BOWEL: Bowel anastomotic suture line noted in the anterior midabdomen. PERITONEUM: Normal. OTHER: No other abnormality. PELVIS: LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostate is enlarged, measuring 5.2 cm in transverse dimension. BODY WALL: Tiny radiodensities seen within the right lateral upper thigh, perhaps sequelae of prior penetrating ballistic injury. MUSCULOSKELETAL: No significant abnormality.

EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Prostate cancer COMPARISON: CT 07/15/2021. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 130 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 2.60 ml per sec. Scan delay: 70 sec. Scan field of view: 360 mm. DLP: 555.22 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Chest CT is reported separately. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Interval simple right upper pole renal cyst. No definite calculus, hydronephrosis or hydroureter. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Small hiatal hernia. No abnormal dilatation small bowel loops. COLON / APPENDIX: Uncomplicated colonic diverticulosis. PERITONEUM / MESENTERY: No ascites or pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: Aorta is nonaneurysmal. Aorta, IVC, portal, splenic and superior mesenteric veins and hepatic veins are patent. Circumaortic left renal vein-normal variation. URINARY BLADDER: Partially distended. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Lytic sclerotic lesions in the and L2 vertebral bodies are unchanged. Sclerotic lesion in the lateral right iliac blade. No new suspicious destructive osseous lesions. CONCLUSION: 1. Stable osseous metastasis. 2. No soft tissue metastasis in the abdomen and pelvis. 2. Other stable findings as above. Chest CT reported separately.

FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Chest CT is reported separately. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Interval simple right upper pole renal cyst. No definite calculus, hydronephrosis or hydroureter. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Small hiatal hernia. No abnormal dilatation small bowel loops. COLON / APPENDIX: Uncomplicated colonic diverticulosis. PERITONEUM / MESENTERY: No ascites or pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: Aorta is nonaneurysmal. Aorta, IVC, portal, splenic and superior mesenteric veins and hepatic veins are patent. Circumaortic left renal vein-normal variation. URINARY BLADDER: Partially distended. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Lytic sclerotic lesions in the and L2 vertebral bodies are unchanged. Sclerotic lesion in the lateral right iliac blade. No new suspicious destructive osseous lesions.

FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately dictated CT chest. ABDOMEN and PELVIS: LIVER: Unchanged indeterminate hypoattenuating lesion in the lateral segment left hepatic lobe, which measures 1.0 x 0.7 cm (image 63 series 5), unchanged from prior image 37 series 601. No new liver lesions. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Left adrenal nodule measures 2.6 cm (image 145 series 307), previously 2.6 cm on image 66 series 601) and previously characterized as adenoma. Unchanged bilateral adrenal thickening, left greater than right. KIDNEYS: Right lower pole renal cyst. LYMPH NODES: Unchanged prominent lower paraesophageal lymph node measuring 1.5 x 1.2 cm on image 46 series 5. STOMACH / SMALL BOWEL: Persistent but improved thickening along the lesser curvature of the stomach compared to the prior exam. Small bowel is normal in caliber. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerotic calcifications of the abdominal aorta and branch vessels. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostatomegaly, unchanged. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.

CT Chest with contrast CLINICAL INFORMATION: 72-year-old male with prostate cancer, C61 Malignant neoplasm of prostate TECHNIQUE: Scout images were obtained for localization. Helical CT examination of the chest was then performed after IV injection of nonionic contrast. Axial, sagittal and Coronal reformatted images were reconstructed at 2.5 mm and reviewed. Patient weight: 130 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 2.60 ml per sec. Scan delay: 70 sec. Scan field of view: 360 mm. DLP: 555.22 mGy cm. COMPARISON: Prior chest CT dated 7/15/2021. FINDINGS: Scouts: No additional findings. Lower neck and Mediastinum: Partially visualized stenosis of the right common carotid artery is again noted. Tiny right thyroid lobe nodule measuring up to 6 mm similar to prior (series 2, image 19). No evidence of focal esophageal wall abnormalities. A small sliding hiatal hernia appears similar to prior. Lymph nodes: Multiple small mediastinal and hilar lymph nodes are unchanged. No new pathologically enlarged intrathoracic lymph nodes. Heart and great arteries: Cardiac chambers are normal in size. No pericardial effusion. Mediastinal great arteries are normal in caliber. No evidence of large central pulmonary thromboembolic disease. Moderate calcification of the aortic valve leaflets and mild atherosclerotic calcification of the coronary arteries is again noted. Airways: The trachea and central bronchi are patent and clear. Lungs : Interval new multiple patchy groundglass opacities within the right lung. Subpleural pulmonary reticulations and septal thickening is again noted. No definitive new suspicious pulmonary nodules or masses. Pleura: No pleural effusion or pneumothorax. Upper abdomen: The CT of the abdomen and pelvis will be reported separately. Bones and soft tissues: Chest wall soft tissues are unremarkable. Degenerative bony changes are noted, without evidence of new aggressive or destructive intrathoracic osseous lesions. CONCLUSION: 1. Interval new patchy groundglass opacities diffusely within the right lung, nonspecific to etiology, but are more likely to be infectious/inflammatory rather than metastatic. 2. No otherwise convincing CT evidence of intrathoracic metastatic disease. 3. Stable other incidental findings as described.

FINDINGS: Scouts: No additional findings. Lower neck and Mediastinum: Partially visualized stenosis of the right common carotid artery is again noted. Tiny right thyroid lobe nodule measuring up to 6 mm similar to prior (series 2, image 19). No evidence of focal esophageal wall abnormalities. A small sliding hiatal hernia appears similar to prior. Lymph nodes: Multiple small mediastinal and hilar lymph nodes are unchanged. No new pathologically enlarged intrathoracic lymph nodes. Heart and great arteries: Cardiac chambers are normal in size. No pericardial effusion. Mediastinal great arteries are normal in caliber. No evidence of large central pulmonary thromboembolic disease. Moderate calcification of the aortic valve leaflets and mild atherosclerotic calcification of the coronary arteries is again noted. Airways: The trachea and central bronchi are patent and clear. Lungs : Interval new multiple patchy groundglass opacities within the right lung. Subpleural pulmonary reticulations and septal thickening is again noted. No definitive new suspicious pulmonary nodules or masses. Pleura: No pleural effusion or pneumothorax. Upper abdomen: The CT of the abdomen and pelvis will be reported separately. Bones and soft tissues: Chest wall soft tissues are unremarkable. Degenerative bony changes are noted, without evidence of new aggressive or destructive intrathoracic osseous lesions.

FINDINGS: Limitations: None. Chest: Lines, tubes, and devices: Right IJ port catheter with tip at the mid SVC. Lung parenchyma and pleura: No consolidation. No suspicious pulmonary nodule. Mild centrilobular emphysema. No pleural effusion. Central airways are patent. Thoracic inlet, heart, and mediastinum: Stable appearance of enlarged left thyroid lobe with low-attenuation nodule. No new or enlarging thoracic lymphadenopathy. Suspected small hiatal hernia. Stable mild ectasia of the midascending aorta, measures 4.0 cm. Main pulmonary artery is normal in caliber. There is left atrial enlargement. Moderate coronary calcification. No pericardial effusion. Blood appears hypodense relative to the interventricular septum, a finding which could be seen with anemia. Bones and soft tissues: No destructive bone lesion. Chest wall is unremarkable. Upper abdomen: Reported separately.

CT Head wo contrast CLINICAL INFORMATION: pseudotumor, G93.2 Benign intracranial hypertension COMPARISON: CT head 10/18/2016, MRI brain 2/28/2017 TECHNIQUE: CT Head wo contrastScan field of view: 229 mm. DLP: 1122 mGy cm. STRUCTURED REPORT: CT Head FINDINGS: BRAIN PARENCHYMA: Right frontal approach ventriculostomy catheter is unchanged in position with tip again terminating near the left caudate head. Brain parenchyma is normal in appearance. No intracranial hemorrhage, evidence of acute territorial infarct, mass effect, or midline shift. Small linear region of hypoattenuation in the medial right cerebellar hemisphere, slightly more prominent compared to prior, likely representing remote lacunar infarct. Gray-white matter differentiation maintained. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. No aggressive osseous lesion. VENTRICULAR SYSTEM: No hydrocephalus. Ventricles remain largely decompressed. ORBITS: Normal. SINUSES: Normal. CONCLUSION: Stable shunted ventricles. No hydrocephalus or acute intracranial abnormality.

FINDINGS: BRAIN PARENCHYMA: Right frontal approach ventriculostomy catheter is unchanged in position with tip again terminating near the left caudate head. Brain parenchyma is normal in appearance. No intracranial hemorrhage, evidence of acute territorial infarct, mass effect, or midline shift. Small linear region of hypoattenuation in the medial right cerebellar hemisphere, slightly more prominent compared to prior, likely representing remote lacunar infarct. Gray-white matter differentiation maintained. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. No aggressive osseous lesion. VENTRICULAR SYSTEM: No hydrocephalus. Ventricles remain largely decompressed. ORBITS: Normal. SINUSES: Normal.

Findings: Lines and Tubes: None. Body Wall and Abdomen: Mild focal expansion of the right lateral seventh rib around image 134 series 9 is similar. No destructive osseous lesions. CT of abdomen and pelvis will be reported separately. Lymph Nodes, Mediastinum and Neck: No axillary adenopathy. Previous right mastectomy. No mediastinal adenopathy. Lungs and Pleura: No pleural effusion. Consolidation or scarring in the right lung apex has a similar appearance. This is associated with right upper lobe volume loss and mild bronchiectasis. Probable radiation changes in the middle lobe are similar. No suspicious appearing pulmonary nodules. Cardiovascular: Heart size is normal. No central PTE or pericardial effusion.

RADIOLOGIC EXAM: CT Head wo contrast, CT Maxillofacial wo contrast CLINICAL INFORMATION: fall, agonal breathing COMPARISON: None. TECHNIQUE: CT of the head without intravenous contrast. Scan field of view: 230 mm. DLP: 1434.30 mGy cm. (accession CT220002411), Scan field of view: 234 mm. DLP: 1071.30 mGy cm. (accession CT220002415) FINDINGS: BRAIN PARENCHYMA: No hemorrhage, acute infarct, or cerebral edema. No midline shift or mass effect. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Diffuse mucosal thickening of left maxillary sinus and anterior ethmoid air cells. Mild mucosal thickening of right maxillary sinus and sphenoid sinuses. SOFT TISSUES: Frontal scalp superficial hematoma. No acute maxillofacial fracture. No temporomandibular joint fracture or dislocation. Left maxillary molar periapical lucency with involvement of the left maxillary sinus floor. CONCLUSION: 1. No acute intracranial process. 2. No acute maxillofacial fracture. 3. Small frontal scalp hematoma. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.

FINDINGS: BRAIN PARENCHYMA: No hemorrhage, acute infarct, or cerebral edema. No midline shift or mass effect. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Diffuse mucosal thickening of left maxillary sinus and anterior ethmoid air cells. Mild mucosal thickening of right maxillary sinus and sphenoid sinuses. SOFT TISSUES: Frontal scalp superficial hematoma. No acute maxillofacial fracture. No temporomandibular joint fracture or dislocation. Left maxillary molar periapical lucency with involvement of the left maxillary sinus floor.

FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis CT chest findings are reported separately. ABDOMEN and PELVIS: LIVER: No suspicious hepatic lesion. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.

Number RADIOLOGIC EXAM: CT Cervical Spine wo contrast CLINICAL INFORMATION: Fall, agonal breathing COMPARISON: None. TECHNIQUE: CT Cervical Spine wo contrast Scan field of view: 220 mm. DLP: 1494 mGy cm. STRUCTURED REPORT: CT Cervical Spine Trauma, FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (

FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (

FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Pelvis LOWER ABDOMEN: Visualized BOWEL: No abnormality. PERITONEUM: No ascites. OTHER: No other abnormality. PELVIS: VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostate is mildly enlarged. BODY WALL: Small fat-containing periumbilical hernia. Mild right inguinal subcutaneous soft tissue stranding/scarring with possible tiny right inguinal hernia. OTHER: Transplanted kidney in the left pelvis appears unremarkable. MUSCULOSKELETAL: No destructive osseous lesion.

EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Leiomyosarcoma COMPARISON: CT 10/25/2021, CT 09/23/2021. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 198 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: 72 sec Scan field of view: 450 mm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Chest CT is reported separately. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Stable left adrenal nodules.. KIDNEYS: Stable nonobstructing left renal calculus. No hydronephrosis.. LYMPH NODES: Stable nonspecific mildly enlarged periportal lymph nodes.. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Uncomplicated colonic diverticulosis. PERITONEUM / MESENTERY: No ascites or pneumoperitoneum. Stable small enhancing lobulated peritoneal nodule in the right upper quadrant, measuring 1.6 cm (series 2/image 288). RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Partially distended REPRODUCTIVE ORGANS: Enlarged prostate BODY WALL: Numerous scattered intramuscular metastatic deposits are again visualized, most of these lesions have mildly enlarged in size compared to CT from 09/20/2021. The larger mass within the right obturator internus, measures about 4.5 x 2.2 cm (series 2/image 481), previously about 3.9 x 1.8 cm. Multiple enhancing nodules in the periumbilical soft tissue, rectus abdominis, bilateral gluteal and paraspinal musculature. MUSCULOSKELETAL: Stable osseous structures. No acute osseous findings. L4-L5 interbody fusion. L5-S1 moderate degenerative changes. Lumbar vertebrae demonstrate normal height. No destructive osseous lesions.. CONCLUSION: 1. Compared to prior CT from 10/25/2021, overall mild interval enlargement of several scattered intermuscular metastatic nodules in the abdomen and pelvis. 2. Stable left adrenal nodules. Stable small peritoneal nodule. Other stable findings as described above. Chest CT is reported separately.

FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Chest CT is reported separately. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Stable left adrenal nodules.. KIDNEYS: Stable nonobstructing left renal calculus. No hydronephrosis.. LYMPH NODES: Stable nonspecific mildly enlarged periportal lymph nodes.. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Uncomplicated colonic diverticulosis. PERITONEUM / MESENTERY: No ascites or pneumoperitoneum. Stable small enhancing lobulated peritoneal nodule in the right upper quadrant, measuring 1.6 cm (series 2/image 288). RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Partially distended REPRODUCTIVE ORGANS: Enlarged prostate BODY WALL: Numerous scattered intramuscular metastatic deposits are again visualized, most of these lesions have mildly enlarged in size compared to CT from 09/20/2021. The larger mass within the right obturator internus, measures about 4.5 x 2.2 cm (series 2/image 481), previously about 3.9 x 1.8 cm. Multiple enhancing nodules in the periumbilical soft tissue, rectus abdominis, bilateral gluteal and paraspinal musculature. MUSCULOSKELETAL: Stable osseous structures. No acute osseous findings. L4-L5 interbody fusion. L5-S1 moderate degenerative changes. Lumbar vertebrae demonstrate normal height. No destructive osseous lesions..

FINDINGS: Scouts: No additional findings. A - Vascular structures: Thoracic aorta: Redemonstration of mild dilation of the ascending aorta and aortic root. No aortic dissection or intramural hematoma. Atherosclerotic calcifications and plaques involving the thoracic aorta, and aortic arch sidebranches with no high-grade stenosis. Mildly tortuous aortic arch branch vessels as before. Aortic measurements are as follows: Aortic root: level of the sinuses: 43 x 44 x 42 mm. Mid-ascending thoracic aorta: 44.42 mm. Aortic arch: 38 x 35 mm. Proximal descending thoracic aorta: 39 x 37 mm. Mid descending thoracic aorta: 33 x 30 mm. Distal descending thoracic aorta: 30 x 29 mm. Pulmonary arteries: Exam not tailored for detailed evaluation of pulmonary arteries however no large central pulmonary embolism identified. Heart and pericardium: Biatrial dilation. No pericardial effusion. Persistent hypodensity in the left atrial appendage. Coronary artery atherosclerotic calcification: Moderate amount. B - Nonvascular structures: Lines and tubes: None. Lungs and pleura: Mild bronchial wall thickening bilaterally. Scattered calcified pulmonary nodules bilaterally. No pleural effusion. No pneumothorax. Esophagus, Mediastinum and neck: Esophagus is normal. No abnormality in the mediastinum. The thyroid gland is normal. Lymph Nodes: None enlarged. Small calcified mediastinal lymph nodes. Abdomen: Partially visualized bilateral renal cortical hypodensities are incompletely evaluated. Small calcified granulomas in the spleen. Musculoskeletal/Body Wall: No soft tissue masses. Gynecomastia. No aggressive appearing skeletal lesions. Unchanged hypodensity in the T11 vertebral body. Mild degenerative changes in spine.

CT Chest with contrast CLINICAL INFORMATION: 75-year-old male with leiomyosarcoma, C49.0 Malignant neoplasm of connective and soft tissue of head, face and neck TECHNIQUE: Scout images were obtained for localization. Helical CT examination of the chest was then performed after IV injection of nonionic contrast. Axial, sagittal and Coronal reformatted images were reconstructed at 2.5 mm and reviewed. Patient weight: 198 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: 72 sec Scan field of view: 450 mm. DLP: 1185.17 mGy cm. COMPARISON: Prior chest CT dated 9/23/2021. FINDINGS: Scouts: Sternotomy wires are intact. Lower neck and Mediastinum: Thyroid gland is unremarkable. Mildly patulous upper esophagus with retained small amount of fluid is similar to prior. Lymph nodes: Multiple prominent and mildly enlarged mediastinal and hilar lymph nodes appear unchanged when compared to prior, the previously indexed right hilar lymph node now measures up to 16 mm (series 2 oh, image 94), previously measured 17 mm. No new pathologically enlarged supraclavicular or axillary lymph nodes. Heart and great arteries: Cardiac chambers appear normal in size. Redemonstrated right sided aortic arch and descending thoracic aorta and arthritic proximal segment of the aberrant left subclavian artery. Coronary arterial stents and post CABG changes are again noted. Mediastinal great arteries are normal in caliber. No evidence of large central pulmonary thromboembolic disease. Airways: There is interval increase in size of the nondependent anterior upper tracheal wall nodule (series 2, image 33). Trachea and central bronchi are otherwise patent and clear. Lungs : There is interval increase in size of the into bronchial nodule within the basal anterior segmental bronchus to the right lower lobe (series 2, image 140, with associated subsegmental atelectasis. Otherwise, interval mixed response of the previously noted bilateral diffuse multiple metastatic pulmonary nodules, some of which are smaller, for example the previously indexed right upper lobe nodule now measures 11 x 15 mm (series 2, image 68), previously measured 15 x 16 mm, some nodules are stable, for example the pulmonary nodule within the left lower lobe which now measuring up to 17 x 21 mm (series 2, image 137), previously measured the same. Pleura: No pleural effusion or pneumothorax. Upper abdomen: The CT of the abdomen and pelvis will be reported separately. Bones and soft tissues: The visualized chest wall soft tissues are unremarkable. Well healed median sternotomy second noted. Degenerative bony changes are again noted, without evidence of aggressive or destructive intrathoracic osseous lesions. CONCLUSION: Overall interval mixed response of the metastatic disease to the chest: 1. Interval increase in size of the nondependent anterior wall tracheal nodule as well as the endobronchial nodule within the basal anterior segment of the right lower lobe, with associated new distal subsegmental atelectasis. 2. Multiple metastatic pulmonary nodules are either smaller or stable in size as detailed above. 3. Stable multiple mildly enlarged mediastinal and hilar lymph nodes. 4. No new intrathoracic metastatic disease. 5. Other incidental findings as described.

FINDINGS: Scouts: Sternotomy wires are intact. Lower neck and Mediastinum: Thyroid gland is unremarkable. Mildly patulous upper esophagus with retained small amount of fluid is similar to prior. Lymph nodes: Multiple prominent and mildly enlarged mediastinal and hilar lymph nodes appear unchanged when compared to prior, the previously indexed right hilar lymph node now measures up to 16 mm (series 2 oh, image 94), previously measured 17 mm. No new pathologically enlarged supraclavicular or axillary lymph nodes. Heart and great arteries: Cardiac chambers appear normal in size. Redemonstrated right sided aortic arch and descending thoracic aorta and arthritic proximal segment of the aberrant left subclavian artery. Coronary arterial stents and post CABG changes are again noted. Mediastinal great arteries are normal in caliber. No evidence of large central pulmonary thromboembolic disease. Airways: There is interval increase in size of the nondependent anterior upper tracheal wall nodule (series 2, image 33). Trachea and central bronchi are otherwise patent and clear. Lungs : There is interval increase in size of the into bronchial nodule within the basal anterior segmental bronchus to the right lower lobe (series 2, image 140, with associated subsegmental atelectasis. Otherwise, interval mixed response of the previously noted bilateral diffuse multiple metastatic pulmonary nodules, some of which are smaller, for example the previously indexed right upper lobe nodule now measures 11 x 15 mm (series 2, image 68), previously measured 15 x 16 mm, some nodules are stable, for example the pulmonary nodule within the left lower lobe which now measuring up to 17 x 21 mm (series 2, image 137), previously measured the same. Pleura: No pleural effusion or pneumothorax. Upper abdomen: The CT of the abdomen and pelvis will be reported separately. Bones and soft tissues: The visualized chest wall soft tissues are unremarkable. Well healed median sternotomy second noted. Degenerative bony changes are again noted, without evidence of aggressive or destructive intrathoracic osseous lesions.

FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Consolidation within the dependent right lower lobe. Additional few ground glass opacities scattered throughout both lower lungs. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Steatotic but otherwise normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: The pancreas is homogenous in attenuation without ductal dilation or peripancreatic fluid collection. SPLEEN: Normal. ADRENALS: Unremarkable KIDNEYS: Bilateral polycystic cystic kidneys with numerous cysts of varying size and complexity including scattered hyperdense cyst and few with calcified septa. Additional bilateral indeterminate renal lesions. No hydronephrosis. 4 mm nonobstructing left lower pole renal stone. Otherwise normal aside from minimal nonspecific perinephric stranding bilaterally. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: A few noninflamed colonic diverticula. PERITONEUM / MESENTERY: No free fluid or free air. RETROPERITONEUM: Normal. VESSELS: Mild. Discogenic disease without aneurysm. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.

RADIOLOGIC EXAM: CT Head wo contrast, CT Maxillofacial wo contrast CLINICAL INFORMATION: fall, agonal breathing COMPARISON: None. TECHNIQUE: CT of the head without intravenous contrast. Scan field of view: 230 mm. DLP: 1434.30 mGy cm. (accession CT220002411), Scan field of view: 234 mm. DLP: 1071.30 mGy cm. (accession CT220002415) FINDINGS: BRAIN PARENCHYMA: No hemorrhage, acute infarct, or cerebral edema. No midline shift or mass effect. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Diffuse mucosal thickening of left maxillary sinus and anterior ethmoid air cells. Mild mucosal thickening of right maxillary sinus and sphenoid sinuses. SOFT TISSUES: Frontal scalp superficial hematoma. No acute maxillofacial fracture. No temporomandibular joint fracture or dislocation. Left maxillary molar periapical lucency with involvement of the left maxillary sinus floor. CONCLUSION: 1. No acute intracranial process. 2. No acute maxillofacial fracture. 3. Small frontal scalp hematoma. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.

FINDINGS: BRAIN PARENCHYMA: No hemorrhage, acute infarct, or cerebral edema. No midline shift or mass effect. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Diffuse mucosal thickening of left maxillary sinus and anterior ethmoid air cells. Mild mucosal thickening of right maxillary sinus and sphenoid sinuses. SOFT TISSUES: Frontal scalp superficial hematoma. No acute maxillofacial fracture. No temporomandibular joint fracture or dislocation. Left maxillary molar periapical lucency with involvement of the left maxillary sinus floor.

Findings: There is moderate mucosal thickening of the maxillary sinuses, with mild improvement on the left. Persistent small volume fluid within the maxillary sinuses. Adjacent hyperostosis similar to prior. The retromaxillary fat is clear. There are aerated secretions within the frontal, sphenoid sinuses and ethmoid air cells. There is mild increased mucosal thickening in the right frontal recess. Slightly improved mucosal thickening in the left ethmoid air cells with increase in mucosal thickening in the right ethmoid air cells. There is slightly improved mucosal thickening in the left sphenoid sinus. Interval placement of bilateral tympanostomy tubes. Near complete resolution of bilateral mastoid air cell effusions with trace effusions remaining bilaterally. The middle ears are clear. The olfactory grooves are symmetric in depth (Keros II). Ethmoidal air cells do not extend above the anterior ethmoidal artery canal. No periapical maxillary dental disease. Soft tissues appear normal. The visualized brain is normal.

CT Head wo contrast 1/5/2022 7:56 PM Clinical information: VPS placement Spec Inst: STEALTH PROTOCOL Comparison: CT head 1/5/2022 Technique: 5 mm axial images were obtained without contrast from the base of the skull to the vertex with sagittal and coronal reformats. Scan field of view: 239 mm. DLP: 1522 mGy cm. Findings: There is been interval conversion to a right frontal approach ventricular shunt catheter with its tip in the frontal horn of right lateral ventricle, unchanged. Ventricular size is overall stable. Multifocal intraparenchymal hemorrhages remain unchanged. No new hemorrhage. Impression: Interval conversion to a right frontal approach ventricular shunt catheter with unchanged ventricular size. Stable evolving multifocal parenchymal hemorrhages. No new hemorrhage.

Findings: There is been interval conversion to a right frontal approach ventricular shunt catheter with its tip in the frontal horn of right lateral ventricle, unchanged. Ventricular size is overall stable. Multifocal intraparenchymal hemorrhages remain unchanged. No new hemorrhage.

FINDINGS: Evaluation is slightly limited due to poor contrast enhancement, could be due to contrast timing and also due to motion artifact. SOFT TISSUES: Postsurgical appearance of the left mandible with reconstruction and left-sided neck dissection. Metallic hardware in the left mandible without evidence of hardware complications. Scattered surgical clips throughout the soft tissue of the neck. Within limitations from streak artifact and above-described technical issues, no obvious enhancement at the resection bed is noted. LYMPH NODES: Within limitations, no definite pathologic adenopathy by imaging size criteria. Again the left parotid gland lymph node seen at the junction of the deep and superficial lobes measuring 1.5 x 0.7 cm (series 3, image 204), previously 1.4 x 0.5 cm. AERODIGESTIVE STRUCTURES: There is relatively poor enhancement of the mucosa due to motion artifact and above described limitations. Evaluation of the oral cavity is limited due to streak artifact from the clips as well as motion artifact. In presence of patchy technique, there is mucosal thickening along the posterior left maxillary gingival buccal mucosa, extending to the adjacent mandible (axial series 3, image 163). A clearly definable mass cannot be measured given the limitations. PAROTID GLANDS: Other than above described lymph node, unremarkable. SUBMANDIBULAR GLANDS: Surgically absent left submandibular gland. No significant abnormality of the right submandibular gland. THYROID GLAND: Normal. VASCULAR STRUCTURES: Prominent atherosclerotic calcifications of the carotid bifurcations and cavernous portions of the internal carotid artery. OSSEOUS STRUCTURES: Mild multilevel degenerative changes of the spine most prominent at C5-C6 and advanced facet hypertrophy C4-C5. ORBITS: Right lens replacement. PARANASAL SINUSES AND MASTOID AIR CELLS: Increased aerated secretions with a small amount of fluid in the right maxillary sinus, right anterior ethmoid air cells and right frontal sinus. No hyperdense material within the fluid or underlying osseous changes. Dental caries of the right maxillary first premolar. Interval resolution of left frontal and left ethmoidal sinus mucosal thickening. PARTIALLY VISUALIZED INTRACRANIAL STRUCTURES: Normal. LUNG APICES: Normal. Main pulmonary artery is dilated, suggesting pulmonary arterial hypertension.

EXAM: CT Angio Chest wo+w contrast CLINICAL INFORMATION: Evaluate for PTE COMPARISON: None. TECHNIQUE: CT Angio Chest wo+w contrast. Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 180 lbs. IV contrast: Omnipaque 350, 60 ml, per protocol. Saline flush: 90 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 295 mm. KVP: 120 DLP: 356.50 mGy cm. FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: ET tube tip terminates approximately 1.5 cm above the carina. There is patchy, nodular appearing consolidations and groundglass opacity within the peripheral right upper lobe. Small region of pulmonary vascular prominence in the area of nodular consolidation on image 51, series 401. Mild dependent atelectasis. No pneumothorax or pleural effusion. HEART / OTHER VESSELS: Hypertrophic left ventricular wall thickening in the left ventricular apex. Trace pericardial effusion. MEDIASTINUM / ESOPHAGUS: Esophagogastric tube courses through the esophagus with tip at the gastric body. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. No pulmonary thromboembolism identified. 2. Nodular region of consolidation and surrounding groundglass in the right upper is nonspecific and could be infectious in etiology although bronchoalveolar carcinoma can have a similar appearance and short-term follow-up chest CT following resolution of acute symptoms recommended.

FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: ET tube tip terminates approximately 1.5 cm above the carina. There is patchy, nodular appearing consolidations and groundglass opacity within the peripheral right upper lobe. Small region of pulmonary vascular prominence in the area of nodular consolidation on image 51, series 401. Mild dependent atelectasis. No pneumothorax or pleural effusion. HEART / OTHER VESSELS: Hypertrophic left ventricular wall thickening in the left ventricular apex. Trace pericardial effusion. MEDIASTINUM / ESOPHAGUS: Esophagogastric tube courses through the esophagus with tip at the gastric body. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No significant abnormality.

FINDINGS: Limitations: None. Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: A tiny 3 mm right middle lobe nodule (image 49, series 2) is unchanged. No new or enlarging suspicious pulmonary nodule. Redemonstrated right lower lobe calcified granuloma/broncholith and right basilar subsegmental atelectasis/scarring. No focal consolidation. The trachea and main bronchi are patent. No pleural effusion. Thoracic inlet, heart, and mediastinum: No lymphadenopathy in the axillary, mediastinal, or hilar regions. Calcified right hilar and right infrahilar lymph nodes, likely related to prior granulomatous disease. The esophagus is nondilated. The thoracic aorta is normal in caliber. Main pulmonary artery is dilated, measures 3.8 cm. The cardiac chambers are normal in size. Severe scattered coronary artery atherosclerotic calcifications are noted, although the study is not optimized for coronary assessment. No pericardial effusion. Bones and soft tissues: No destructive bone lesion. Chest wall is unremarkable. Upper abdomen: Splenic granulomas. Hepatic steatosis. Bilateral renal cysts.

EXAM: CT Abdomen and Pelvis wo+w contrast CLINICAL INFORMATION: Breast cancer COMPARISON: CT 08/14/2021. TECHNIQUE: CT Abdomen and Pelvis wo+w contrast. Patient weight: 125 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 2.80 ml per sec. Scan delay: BOLUS TRACK, 70 SEC. sec. Scan field of view: 390 mm. GFR: 60 DLP: 774.26 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separate chest CT report. ABDOMEN and PELVIS: LIVER: Numerous hepatic metastatic lesions are redemonstrated, appear to have enlarged in size compared to prior CT from 08/14/2021. For example the larger dominant lesion in the posterior right hepatic lobe measures about 5.1 cm (series 301, image 80), previously remeasured about 3.9 cm. Numerous new metastasis is also visualized. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis PANCREAS: Mildly atrophic pancreas. Pancreatic duct is nondilated. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Kidneys demonstrate symmetric enhancement. No hydronephrosis. LYMPH NODES: Small stable nonspecific periportal lymph nodes. STOMACH / SMALL BOWEL: Stomach is partially distended. There is no abnormal dilatation of small bowel loops. COLON / APPENDIX: Large bowel loops are nondilated. There is small to moderate colonic stool burden. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Aorta is nonaneurysmal and demonstrates mild to moderate calcifications. Main portal vein, splenic and superior mesenteric veins and hepatic veins are patent. URINARY BLADDER: Partially distended REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Diffuse body wall edema. MUSCULOSKELETAL: Extensive osseous metastatic disease, grossly unchanged compared to prior CT. Unchanged multiple vertebral compression deformities of L1, L2, L4 and L5 vertebral bodies. Mild retropulsion of L1-L2 vertebral bodies with thecal sac compression. CONCLUSION: 1. Interval enlargement of hepatic metastasis with several new lesions concerning for worsening disease. 2. Grossly stable osseous metastatic disease. Multiple vertebral compression deformities, unchanged. 2. Other stable findings as described above. Chest CT is reported separately.

FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separate chest CT report. ABDOMEN and PELVIS: LIVER: Numerous hepatic metastatic lesions are redemonstrated, appear to have enlarged in size compared to prior CT from 08/14/2021. For example the larger dominant lesion in the posterior right hepatic lobe measures about 5.1 cm (series 301, image 80), previously remeasured about 3.9 cm. Numerous new metastasis is also visualized. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis PANCREAS: Mildly atrophic pancreas. Pancreatic duct is nondilated. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Kidneys demonstrate symmetric enhancement. No hydronephrosis. LYMPH NODES: Small stable nonspecific periportal lymph nodes. STOMACH / SMALL BOWEL: Stomach is partially distended. There is no abnormal dilatation of small bowel loops. COLON / APPENDIX: Large bowel loops are nondilated. There is small to moderate colonic stool burden. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Aorta is nonaneurysmal and demonstrates mild to moderate calcifications. Main portal vein, splenic and superior mesenteric veins and hepatic veins are patent. URINARY BLADDER: Partially distended REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Diffuse body wall edema. MUSCULOSKELETAL: Extensive osseous metastatic disease, grossly unchanged compared to prior CT. Unchanged multiple vertebral compression deformities of L1, L2, L4 and L5 vertebral bodies. Mild retropulsion of L1-L2 vertebral bodies with thecal sac compression.

FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately dictated CT chest. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Unchanged mild intrahepatic and extrahepatic biliary ductal dilation. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Indeterminately mildly hyperattenuating left lower pole lesion is unchanged since 2019, likely debris-filled cyst. Subcentimeter foci of hypoattenuation are too small for accurate characterization. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. The appendix is not seen and may be absent. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Advanced calcified and noncalcified atherosclerotic plaque of the abdominal aorta and branch vessels. Infrarenal abdominal aortic aneurysm measuring 4.7 x 3.9 cm (image 325 series 202), previously 4.8 cm (image 314 series 2). URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat containing umbilical hernia. MUSCULOSKELETAL: Advanced lumbar spine degenerative changes. No destructive osseous lesion.

CT Chest with contrast CLINICAL INFORMATION: 62-year-old female with Invasive breast cancer, stage IV, assess treatment response, C50.919 Malignant neoplasm of unspecified site of unspecified female breast Spec Inst: metastatic breast cancer, eval response to treatment TECHNIQUE: Scout images were obtained for localization. Helical CT examination of the chest was then performed after IV injection of nonionic contrast. Axial, sagittal and Coronal reformatted images were reconstructed at 2.5 mm and reviewed. Patient weight: 125 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 2.80 ml per sec. Scan delay: 70 SEC. sec. Scan field of view: 390 mm. DLP: 774.26 mGy cm. COMPARISON: Prior chest CT dated 11/20/2021. FINDINGS: Scouts: No additional findings. Lower neck and Mediastinum: The left Port-A-Cath tip terminates within the right atrium, in appropriate position. Thyroid gland is unremarkable. There is mild circumferential diffuse thickening of the esophagus, which could be seen with esophagitis. Lymph nodes: Multiple enlarged mediastinal and bilateral hilar lymph nodes are again noted, which appear increased in size when compared to prior, for example: The previously indexed right superior paratracheal lymph node now measures up to 14 mm in short axis (series 306, image 35), previously measured up to 11 mm in short axis, while the previously indexed right hilar lymph node now measures up to 16 x 19 mm (series 306, image 48), previously measured 16 x 17 mm. Enlarged bilateral axillary lymph nodes are also slightly larger when compared to prior, for example: A right axillary lymph node measures up to 11 mm in short axis (series 306, image 31), previously measured up to 9 mm in short axis while the left axillary lymph node measures up to 13 mm in short axis (series 306, image 26), previously measured up to 11 mm in short axis. No new pathologically enlarged supraclavicular lymph nodes. Heart and great arteries: Cardiac chambers are normal in size. No pericardial effusion. Mediastinal great arteries are normal in caliber. Airways: The trachea and central bronchi are patent and clear. Lungs and pleura: Interval resolution of the previously noted small right pleural effusion with decreased amount of the small left pleural effusion, with decreased/resolved associated bibasilar pulmonary atelectasis. Diffuse bilateral multiple pulmonary nodules are more conspicuous when compared to prior, although comparison to the prior study is difficult secondary to multiple respiratory motion artifacts on the prior exam. Multiple tiny pulmonary nodules along the bilateral major and minor fissures with associated septal thickening, raising suspicion for lymphangitis carcinomatosis.. Upper abdomen: The CT of the abdomen and pelvis will be reported separately. Bones and soft tissues: Left breast and multiple subcutaneous calcified lesions within the bilateral breasts are again noted, similar to prior. Diffuse subcutaneous fat stranding within the patient's back is noted. Diffuse intrathoracic skeletal heterogeneity with multiple lytic and sclerotic lesions are again noted, similar to prior. CONCLUSION: 1. Multiple enlarged mediastinal, hilar and bilateral axillary lymph nodes are slightly larger when compared to prior, most consistent with worsening nodal metastatic disease. 2. Multiple small pulmonary nodules are more conspicuous when compared to prior, some of which are seen in the perilymphatic distribution, suspicious for lymphangitis carcinomatosis. 3. Interval resolution of the right small pleural effusion and decrease of the left pleural effusion, with resultant associated atelectasis. 4. Stable diffuse mixed lytic and sclerotic osseous metastasis. 5. Other findings as described.

FINDINGS: Scouts: No additional findings. Lower neck and Mediastinum: The left Port-A-Cath tip terminates within the right atrium, in appropriate position. Thyroid gland is unremarkable. There is mild circumferential diffuse thickening of the esophagus, which could be seen with esophagitis. Lymph nodes: Multiple enlarged mediastinal and bilateral hilar lymph nodes are again noted, which appear increased in size when compared to prior, for example: The previously indexed right superior paratracheal lymph node now measures up to 14 mm in short axis (series 306, image 35), previously measured up to 11 mm in short axis, while the previously indexed right hilar lymph node now measures up to 16 x 19 mm (series 306, image 48), previously measured 16 x 17 mm. Enlarged bilateral axillary lymph nodes are also slightly larger when compared to prior, for example: A right axillary lymph node measures up to 11 mm in short axis (series 306, image 31), previously measured up to 9 mm in short axis while the left axillary lymph node measures up to 13 mm in short axis (series 306, image 26), previously measured up to 11 mm in short axis. No new pathologically enlarged supraclavicular lymph nodes. Heart and great arteries: Cardiac chambers are normal in size. No pericardial effusion. Mediastinal great arteries are normal in caliber. Airways: The trachea and central bronchi are patent and clear. Lungs and pleura: Interval resolution of the previously noted small right pleural effusion with decreased amount of the small left pleural effusion, with decreased/resolved associated bibasilar pulmonary atelectasis. Diffuse bilateral multiple pulmonary nodules are more conspicuous when compared to prior, although comparison to the prior study is difficult secondary to multiple respiratory motion artifacts on the prior exam. Multiple tiny pulmonary nodules along the bilateral major and minor fissures with associated septal thickening, raising suspicion for lymphangitis carcinomatosis.. Upper abdomen: The CT of the abdomen and pelvis will be reported separately. Bones and soft tissues: Left breast and multiple subcutaneous calcified lesions within the bilateral breasts are again noted, similar to prior. Diffuse subcutaneous fat stranding within the patient's back is noted. Diffuse intrathoracic skeletal heterogeneity with multiple lytic and sclerotic lesions are again noted, similar to prior.

FINDINGS: Index lesions are measured on series 202: 1. 4 mm right upper lobe nodule adjacent to the minor fissure on image 140, measured 4 mm on 10/1/2021. 2. 5 mm superior segment right lower lobe nodule on image 142 measured 6 mm on 10/1/2021. Surgical changes of left lower lobectomy are noted with interval decrease in the left pleural fluid collection. Previously seen consolidative opacities in the lung have resolved with some residual groundglass opacities remaining. Upper lobe predominant centrilobular and paraseptal emphysema is again seen. A few other noncalcified lung nodules appear unchanged, for example in the right lower lobe on images 138 and 139 series 202. No new or enlarging lung nodules. Right chest port is present with its catheter tip extending to the lower superior vena cava. Unchanged right thyroid nodule. The central airways are patent. There are linear secretions within the right main bronchus. The thoracic aorta is nonaneurysmal. The main pulmonary artery is dilated measuring up to 2.9 cm, similar to prior. Moderate three-vessel coronary calcifications. The heart is not enlarged. No pericardial effusion. Multiple subcentimeter mediastinal lymph nodes are not significant changed from the prior examination. Enlarged calcified and noncalcified hilar lymph nodes are again seen. The largest measures 20 x 27 mm on image 134 series 202, unchanged from 10/1/2021. A tiny lymph nodes measuring up to 14 mm in short axis on image 139 are also unchanged. The esophagus is not dilated. The CT of the abdomen and pelvis will be dictated separately. No acute or aggressive osseous abnormality.

RADIOLOGIC EXAM: CT Head wo contrast CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Head wo contrastScan field of view: 252 mm. DLP: 1604.70 mGy cm. STRUCTURED REPORT: CT Head FINDINGS: BRAIN PARENCHYMA: There is no acute intracranial hemorrhage or acute infarct. No brain edema or mass effect. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. CONCLUSION: No acute intracranial abnormality. No acute intracranial process.

FINDINGS: BRAIN PARENCHYMA: There is no acute intracranial hemorrhage or acute infarct. No brain edema or mass effect. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal.

Findings: Comparison: 5/17/2019 Lungs and Pleura: Patchy peripheral and peribronchovascular opacities are increased in the middle lobe associated with mild bronchiectasis. Linear opacities in the right lower lobe lateral segment are increased. Volume loss, parenchymal opacities, and mild bronchiectasis in the left lower lobe are similar. Mosaic attenuation is present, most notable on the right. Small left upper lobe nodule image 49 series 2 is unchanged. Dense pleural thickening is present at the left lung base. Lymph Nodes, Mediastinum and Neck: No axillary adenopathy. A few shotty mediastinal lymph nodes are present. Cardiovascular: The heart is moderately enlarged. TAVR is present. No large pericardial effusion. Mild coronary artery atherosclerotic calcifications are present. The pulmonary arteries in the right lower lobe are larger than those in the left, possibly due to decreased perfusion of the left hemothorax, especially the left lower lobe from restrictive changes. Body Wall and Abdomen: No destructive osseous lesions.

CT head without contrast Clinical Information: Catheter. Comparison: None. Technique: Axial helical images of the head were obtained. Coronal and sagittal reformatted images were obtained from the axial data set. DLP: 1399.70 mGy cm. Findings: The parenchyma appears normal with no mass, hemorrhage, visible infarct or extracerebral collection. There is preservation of gray-white margins. No hypodensity seen in the white matter. The posterior fossa contents are unremarkable. There is mucosal thickening in the paranasal sinuses diffusely. The mastoids and middle ears are clear. ---------------- Conclusion: Essentially negative cranial CT scan.

Findings: The parenchyma appears normal with no mass, hemorrhage, visible infarct or extracerebral collection. There is preservation of gray-white margins. No hypodensity seen in the white matter. The posterior fossa contents are unremarkable. There is mucosal thickening in the paranasal sinuses diffusely. The mastoids and middle ears are clear. ----------------

Findings: Cardiac and Vascular Measurements: Aortic annulus average diameter: 26.7 mm Aortic annulus diameter pair: 28.4 x 25.0 mm Aortic annulus area: 545.9 mm2 Sinus of Valsalva diameter: 34.8 x 30.0 (sinus to sinus x commissure to commissure) Sinotubular junction diameter: 35.5 x 35.2 mm Aortic annulus to left coronary artery distance: 9.9 mm Aortic annulus to right coronary artery distance: 12.5 mm Caudal angulation: LAO 8 CRA 4 Left atrial diameter: 52 mm Pulmonary artery diameter: 28 mm Ascending thoracic aorta diameter: 44.5 x 44.1 mm Aortic valve calcium score: 1746 Cardiac Function: Left ventricular end-diastolic volume (ml): 93 Left ventricular end-systolic volume (ml): 17 Left ventricular stroke volume (ml): 76 Left ventricular ejection fraction (%): 81 Wall motion: No regional wall motion abnormalities. Non-Coronary Cardiac Findings: Moderate to severe calcification of the aortic valve leaflets. Probable functioning bicuspid aortic valve. Mild mitral annular calcification. Biatrial dilation to No intracardiac mass, thrombus, or other structural abnormality. No pericardial effusion. Dilation of the mid ascending aorta. Mild atherosclerotic calcifications involving the thoracic aorta, aortic arch sidebranches. Mild stenosis of the proximal left subclavian artery. The pulmonary veins are unremarkable. Please note this examination was not tailored for assessment of the coronary arteries. Coronary artery atherosclerotic calcification: Small amount. Non Cardiac Findings: Lines and tubes: None. Lungs and pleura: Right fissural nodule measures 5 mm, also seen previously when it measured 3 mm, nonspecific. Areas of linear/subsegmental atelectasis in both lower, left upper lobes and lingula. Biapical lung scarring. Bronchial wall thickening bilaterally. No pulmonary consolidation. No pleural effusion. No pneumothorax. Esophagus, Mediastinum and neck: Esophagus is normal. No abnormality in the mediastinum. The thyroid gland is enlarged with retrosternal extension, contains multiple nodules. Please refer to same-day CT neck report for detailed findings. Lymph Nodes: Borderline enlarged AP window lymph node measures 10 mm in short axis. Abdomen: Please refer to same day CT abdomen report for detailed findings below the diaphragm. Musculoskeletal/Body Wall: No soft tissue masses. Mild nodularity in the right breast is unchanged, nonspecific. No aggressive appearing skeletal lesions. Degenerative changes in spine.

CT Angio Head wo+w contrast 1/5/2022 10:25 AM Clinical Information: Intracranial aneurysm. Cerebral aneurysm, follow-up, I67.1 Cerebral aneurysm, nonruptured Comparison: 12/22/2021 Technique: 5 mm axial images were obtained without contrast from the base of the skull to the vertex. During the IV infusion of contrast, [] mm images were obtained from the base of skull through the vertex. Delayed contrast enhanced 5 mm axial images were then performed from the base of the skull to the vertex. 3D post-processing was performed with 3D CT angiographic images, "Sliding MIP", and additional MIP images being obtained, which were reviewed for interpretation. "Sliding MIP" images were generated in the sagittal, axial, and coronal planes. Patient weight: 119 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 3 ml per sec. Scan delay: Bolus Tracked. Scan field of view: 220 mm. DLP: 2877 mGy cm. Findings There is a right frontal approach VP shunt catheter, tip is in the right lateral ventricle. There is stable ventriculomegaly when compared to head CT dated 12/28/2021. There are also right frontal temporal craniotomy changes with decreasing size of underlying small mainly hypodense extra-axial fluid collection and small amount of packing material. There is aneurysm clip in the expected location of the a comm segment. There is hypoattenuation within the right frontal lobe and also right anterior temporal lobe without interval change.. There is also significant hypoattenuation within the body of the corpus callosum without interval change There is no acute hemorrhage or infarction. There is no abnormal parenchymal enhancement. There is mild dural enhancement underlying the craniotomy defect. CTA: The distal ICAs within the neck and skull base appear within normal limits.. The left A1 segment appears normal. Proximal right A1 segment is small, distal right A1 segment is not well seen, possibly secondary to artifact from adjacent aneurysm clip.. There is no residual/recurrent aneurysm identified at site of the aneurysm clip. Both distal anterior cerebral arteries appear within normal limits. Both MCAs are unremarkable. The distal right vertebral artery is small, probably on developmental basis. The distal left vertebral artery, basilar artery and both PCAs are unremarkable. Conclusion: 01. Expected evolution of postsurgical changes related to a comm aneurysm clipping. No acute hemorrhage or infarction. 02. There is stable hypoattenuation within the right frontal and temporal lobes. There is also significant chronic hypoattenuation within the body of the corpus callosum 03. No residual aneurysm is identified at site of the clipped a comm aneurysm. 04. Stable shunted ventricles..

Findings There is a right frontal approach VP shunt catheter, tip is in the right lateral ventricle. There is stable ventriculomegaly when compared to head CT dated 12/28/2021. There are also right frontal temporal craniotomy changes with decreasing size of underlying small mainly hypodense extra-axial fluid collection and small amount of packing material. There is aneurysm clip in the expected location of the a comm segment. There is hypoattenuation within the right frontal lobe and also right anterior temporal lobe without interval change.. There is also significant hypoattenuation within the body of the corpus callosum without interval change There is no acute hemorrhage or infarction. There is no abnormal parenchymal enhancement. There is mild dural enhancement underlying the craniotomy defect. CTA: The distal ICAs within the neck and skull base appear within normal limits.. The left A1 segment appears normal. Proximal right A1 segment is small, distal right A1 segment is not well seen, possibly secondary to artifact from adjacent aneurysm clip.. There is no residual/recurrent aneurysm identified at site of the aneurysm clip. Both distal anterior cerebral arteries appear within normal limits. Both MCAs are unremarkable. The distal right vertebral artery is small, probably on developmental basis. The distal left vertebral artery, basilar artery and both PCAs are unremarkable.

Findings: Thorax: Heart is normal is size without pericardial effusion. Visualized lungs are clear. Visualized portions of the descending aorta are normal. Abdomen/pelvis: There is no biliary dilatation. A small 9 mm hyperenhancing mass is seen in the periphery of the right lobe of the liver on image #145, series 11. This was not present on the patient's previous scan from 2005. Further evaluation with either multiphase CT or MRI is recommended to exclude malignancy. A hepatic calcification likely representing a granuloma is seen within the right lobe as well. This is best identified on image 147, series 11. The hepatic parenchyma is otherwise unremarkable. Gallbladder is unremarkable. Spleen, pancreas, and adrenals are normal. Kidneys reveal no hydronephrosis, nephrolithasis, or masses. A simple appearing cyst is present in the mid left kidney. It measures approximately 4 x 4 and 0.5 cm in greatest dimension and is substantially enlarged when compared with the patient's old study. Ureters and urinary bladder are normal. Gastrointestinal tract is normal. Osseous structures reveal no lesions. The uterus is absent. The ovaries are not well visualized. Postoperative changes in the anterior abdominal wall are not substantially changed from previous studies Vasculature: Aorta: Patent without dissection, stenosis or aneurysm. Overall the abdominal aorta is small in caliber with heavy circumferential calcification. Celiac axis: The origin of the celiac axis has a severe stenosis some poststenotic dilatation is identified. The anatomy of the celiac axis is normal. SMA: There is moderate stenosis in calcification at the origin of the superior mesenteric artery the distal SMA is unremarkable. IMA: Patent without stenosis. Renal: Single renal arteries and veins bilaterally with a preaortic left renal vein. There is heavy calcification and moderate stenosis at the origin of both renal arteries Left: Patent common iliac artery. Patent internal iliac artery. External iliac artery is patent to the inguinal canal. Patent common, deep, and superficial femoral arteries. Common iliac dimensions: Max = 8.36, min = 6.02, avg = 7.26 mm External iliac dimensions: Max = 5.5, min = 5.1, avg = 5.3 mm Common femoral dimensions: Max = 6.45, min = 4.95, avg = 5.53 mm Right: Patent common iliac artery. Patent internal iliac artery. External iliac artery is patent to the inguinal canal. Patent common, deep, and superficial femoral arteries. Common iliac dimensions: Max = 10, min = 5.2, avg = 8.09 mm External iliac dimensions: Max = 5.5, min = 5.0, avg = 5.3 mm Common femoral dimensions: Max = 7.6, min = 6.99, avg = 7.3 mm

EXAM: CT Abdomen wo+w contrast CLINICAL INFORMATION: 64-year-old male with cirrhosis and pancreatic cyst. COMPARISON: CT abdomen and pelvis 1/20/2021 TECHNIQUE: CT Abdomen wo+w contrast. Patient weight: 180 lbs. IV contrast: Omnipaque 350, 143 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3 ml per sec. Scan delay: bt/82 sec. Scan field of view: 430 mm. DLP: 3124.63 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen LOWER CHEST: LUNG BASES / PLEURA: Redemonstration of extensive subpleural reticulations, right greater than left. DISTAL ESOPHAGUS: Large esophagogastric varices. Small hiatal hernia. HEART / VESSELS: Normal in size without pericardial effusion. Significant coronary artery atherosclerotic calcification. ABDOMEN: LIVER: Cirrhotic. No arterial hyperenhancement or regions of delayed washout are definitively visualized. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: The pancreas enhances uniformly without pancreatic ductal dilation. Redemonstration of multiple cystic lesions without internal septations throughout the pancreatic head, body, and tail. For example, a lesion of the pancreatic tail measures 1.5 cm (series 11 image 109), unchanged. There is been mild interval enlargement of the exophytic cystic lesion arising from the pancreatic head measuring 1.8 x 1.7 cm (series 11 image 139 similar in size compared to prior when allowing for interobserver variability. The remaining cystic lesions throughout the pancreas appear grossly stable in size. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. No hydronephrosis or renal calculi. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: Similar appearance of the moderate mural thickening and edema surrounding the ascending colon. Diverticulosis without evidence of diverticulitis. The appendix is not well visualized. Additionally, there is mild mucosal thickening of the ascending colon which is unchanged compared to prior exam and likely secondary to portal colopathy. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Perigastric varices as well as mesenteric and right retroperitoneal venous collaterals are noted. The right, left, and main portal veins are patent. BODY WALL: No abnormality. MUSCULOSKELETAL: Multilevel discogenic degenerative changes. No aggressive osseous lesions. CONCLUSION: 1. Multiple cystic lesions are again seen in the pancreas without enhancing septations or nodularity, most likely representing side branch IPMNs, similar in size and number compared to prior. Continued annual follow up is recommended. 2. Cirrhosis with sequela of portal hypertension. No suspicious hepatic lesion. 3. Mild mucosal thickening of the ascending colon, likely secondary to portal hypertension. 4. Subpleural reticulations of the bilateral visualized lung bases, consistent with patient's history of interstitial lung disease, worsened compared to prior examination. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.

FINDINGS: STRUCTURED REPORT: CT Abdomen LOWER CHEST: LUNG BASES / PLEURA: Redemonstration of extensive subpleural reticulations, right greater than left. DISTAL ESOPHAGUS: Large esophagogastric varices. Small hiatal hernia. HEART / VESSELS: Normal in size without pericardial effusion. Significant coronary artery atherosclerotic calcification. ABDOMEN: LIVER: Cirrhotic. No arterial hyperenhancement or regions of delayed washout are definitively visualized. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: The pancreas enhances uniformly without pancreatic ductal dilation. Redemonstration of multiple cystic lesions without internal septations throughout the pancreatic head, body, and tail. For example, a lesion of the pancreatic tail measures 1.5 cm (series 11 image 109), unchanged. There is been mild interval enlargement of the exophytic cystic lesion arising from the pancreatic head measuring 1.8 x 1.7 cm (series 11 image 139 similar in size compared to prior when allowing for interobserver variability. The remaining cystic lesions throughout the pancreas appear grossly stable in size. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. No hydronephrosis or renal calculi. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: Similar appearance of the moderate mural thickening and edema surrounding the ascending colon. Diverticulosis without evidence of diverticulitis. The appendix is not well visualized. Additionally, there is mild mucosal thickening of the ascending colon which is unchanged compared to prior exam and likely secondary to portal colopathy. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Perigastric varices as well as mesenteric and right retroperitoneal venous collaterals are noted. The right, left, and main portal veins are patent. BODY WALL: No abnormality. MUSCULOSKELETAL: Multilevel discogenic degenerative changes. No aggressive osseous lesions.

FINDINGS: The study is moderately degraded due to motion artifact as well as metallic streak artifact from postsurgical clips and dental amalgam. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Conventional three-vessel branching pattern. Mild aortic arch mixed-type calcified and noncalcified atherosclerotic plaque. Mixed atherosclerosis of the proximal great vessels, with moderate stenosis of the proximal left common carotid and moderate stenosis of the proximal left subclavian artery. Trace atherosclerotic calcification at the carotid bifurcations and siphons. RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There are atherosclerotic changes in the distal left common carotid artery with mild narrowing. Portions of the left ICA are obscured due to streak artifact from adjacent extensive surgical clips. There is no evidence of stenosis, occlusion, or aneurysmal dilation. RIGHT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. SOFT TISSUES: Stable extensive left facial postsurgical changes, including left orbital enucleation, maxillectomy, ethmoidectomy, turbinectomy, sphenoidotomy, and fat flap reconstruction. Numerous postsurgical clips from prior left neck dissection. No focal masslike enhancement. Asymmetric atrophy of the left masticator musculature, unchanged. LYMPH NODES: No pathologic adenopathy by imaging size criteria. AERODIGESTIVE STRUCTURES: No asymmetric contrast enhancement or asymmetric soft tissue nodularity. Incidental right-sided vallecular cyst. PAROTID GLANDS: The right parotid gland is normal. The left parotid gland is partially surgically absent. SUBMANDIBULAR GLANDS: The right submandibular gland is normal. The left mandibular gland is surgically absent. THYROID GLAND: Multinodular goiter involving the right thyroid lobe with scattered punctate calcifications and extension into the superior mediastinum, overall unchanged. Subcentimeter left thyroid lobe hypoattenuating nodule. OSSEOUS STRUCTURES: No fracture, dislocation, or destructive lesion. ORBITS: Right ocular lens replacement. The left globe is surgically absent. PARANASAL SINUSES AND MASTOID AIR CELLS: Persistent complete opacification of a left anterior ethmoid air cell. Interval increase in partial opacification of the left posterior ethmoid air cell and left sphenoid sinus. Persistent trace bilateral mastoid effusions. VISUALIZED INTRACRANIAL STRUCTURES: Normal. LUNG APICES: Biapical pleuroparenchymal scarring. CERVICAL SPINE: Multilevel degenerative changes, most prominently at C4-C5 with sclerotic endplate changes. Mild degenerative anterolisthesis of C5 on C6 and T2 on T3, unchanged. No aggressive osseous lesion.

EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Rectal cancer restaging. COMPARISON: MR pelvis performed same day and prior performed 8/25/2021. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 171 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 78 sec. Scan field of view: 352 mm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Multiple left renal cysts. Otherwise, bilateral kidneys are normal without hydronephrosis. LYMPH NODES: Multiple prominent superior mesorectal nodes are noted which are improved compared to prior MR. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Irregular thickening of the rectosigmoid colon is visualized, better evaluated on same day MR pelvis. There is associated mesorectal fat stranding. The remainder of the colon, including the appendix, is otherwise normal. PERITONEUM / MESENTERY: Soft tissue lesion at the level of the left iliac bifurcation is redemonstrated which measures 1.7 x 1.6 cm (series 302, image 358), previously 2.0 x 1.6 cm. There is mild associated stranding. No free and peritoneal fluid or air. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic calcification of the abdominal aorta which is normal in caliber. URINARY BLADDER: Contains excreted contrast. REPRODUCTIVE ORGANS: Enhancing lesion in the posterior left myometrium may represent small uterine fibroid. Otherwise, the uterus and bilateral adnexa are normal. BODY WALL: Soft tissue lesion containing multiple internal calcifications is again seen within the right inguinal region. This measures approximately 2.6 x 2.0 cm (series 302, image 421), previously 2.1 x 1.9 cm on prior MR. MUSCULOSKELETAL: No aggressive osseous lesions. CONCLUSION: 1. Rectal mass is better evaluated on same day pelvic MR. Redemonstrated mesorectal nodes are improved compared to prior. 2. Soft tissue tumor deposit at the level of the left iliac bifurcation is minimally decreased in size compared to prior. 3. Soft tissue lesion within the right inguinal region containing internal calcifications, again indeterminant, mildly increased in size compared to prior. Tissue sampling may be of benefit, if clinically indicated. 4. Probable uterine fibroid and additional findings as above. Please see separately dictated report for dedicated chest findings.

FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Multiple left renal cysts. Otherwise, bilateral kidneys are normal without hydronephrosis. LYMPH NODES: Multiple prominent superior mesorectal nodes are noted which are improved compared to prior MR. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Irregular thickening of the rectosigmoid colon is visualized, better evaluated on same day MR pelvis. There is associated mesorectal fat stranding. The remainder of the colon, including the appendix, is otherwise normal. PERITONEUM / MESENTERY: Soft tissue lesion at the level of the left iliac bifurcation is redemonstrated which measures 1.7 x 1.6 cm (series 302, image 358), previously 2.0 x 1.6 cm. There is mild associated stranding. No free and peritoneal fluid or air. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic calcification of the abdominal aorta which is normal in caliber. URINARY BLADDER: Contains excreted contrast. REPRODUCTIVE ORGANS: Enhancing lesion in the posterior left myometrium may represent small uterine fibroid. Otherwise, the uterus and bilateral adnexa are normal. BODY WALL: Soft tissue lesion containing multiple internal calcifications is again seen within the right inguinal region. This measures approximately 2.6 x 2.0 cm (series 302, image 421), previously 2.1 x 1.9 cm on prior MR. MUSCULOSKELETAL: No aggressive osseous lesions.

Findings: Redemonstration of shunt graft from the ascending aorta laterally coursing along the right atrium posterior laterally with somewhat increased kinking/angulation (series 7 image 85). Proximal graft limb and measures 19 mm in diameter as before (series 5 image 324). Communicates with the descending thoracic aorta anteriorly at as before, widely patent. Redemonstration of short segment coarctation in the distal aortic arch, measuring 22 x 15 mm, previously 21 x 16 mm, with mild poststenotic dilation. Mild dilation of the aortic root as before. No evidence of aortic dissection or intramural hematoma. Normal aortic arch branching pattern, patent. AORTIC MEASUREMENTS: AORTIC ROOT AT THE SINUSES: 5.4 x 4.1 cm. MID-ASCENDING THORACIC AORTA: 3.4 x 3.2 cm. AORTIC ARCH: 2.7 x 2.3 cm. PROXIMAL DESCENDING THORACIC AORTA: 3.8 x 3.5 cm. MID DESCENDING THORACIC AORTA: 2.7 x 2.5 cm. DISTAL DESCENDING THORACIC AORTA: 2.5 x 2.4 cm. Please note this examination was not tailored for assessment of the coronary arteries. Left dominant coronary arterial system. Coronary artery atherosclerotic calcification: Small amount. Non-Coronary Cardiac Findings: Postsurgical changes from prior aortic valve replacement. Borderline right ventricular dilation. No pericardial effusion. The pulmonary veins are unremarkable. Borderline dilated main pulmonary artery measuring 33 mm in diameter. Cardiac Function: Left ventricular end-diastolic volume (ml): 144.35 Left ventricular end-systolic volume (ml): 59.07 Left ventricular stroke volume (ml): 85.27 Left ventricular ejection fraction (%): 59.07 Right ventricular end-diastolic volume (ml): 191 Right ventricular end-systolic volume (ml): 108 Right ventricular stroke volume (ml): 83 Right ventricular ejection fraction (%): 44 Extracardiac Findings: Lines and tubes: None. Lungs and pleura: Areas of subsegmental and dependent atelectasis in both lower, right middle lobes and lingula are improved on comparison. Mild centrilobular nodularity in both upper lobes, mildly increased in conspicuity on comparison (series 7 image 32 for example). Mild bronchial wall thickening. No pulmonary consolidation. No central endobronchial masses. No pleural effusion. No pneumothorax. Left lingular calcified granuloma with adjacent atelectasis. Esophagus, Mediastinum and neck: Esophagus is normal. Residual thymus in the anterior mediastinum. The thyroid gland is normal. Lymph Nodes: None enlarged. Small left hilar calcified lymph nodes are unchanged. Upper Abdomen: Splenic calcific granulomas. Upper abdominal structures are otherwise unremarkable allowing for limitations due to partial visualization and suboptimal contrast. Musculoskeletal/Body Wall: Median sternotomy changes. Mild bilateral gynecomastia. No aggressive osseous lesion with mild unchanged compression of T9, T11 vertebral bodies.

EXAM: CT Chest with contrast CLINICAL INFORMATION: Rectal cancer, restaging. COMPARISON: MRI pelvis CT abdomen and pelvis same day. TECHNIQUE: CT Chest with contrast. Patient weight: 171 lbs. IV contrast: Omnipaque 350, 115 ml, per protoc5ol. Saline flush: 75 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 78 sec. Scan field of view: 352 mm. DLP: 802.30 mGy cm. FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: No suspicious nodule or mass. Tiny pleural based nodule identified on image 82 series 302 in the left upper lobe. No focal consolidation, pleural effusion, or pneumothorax. HEART / VESSELS: Normal heart size. No pericardial effusion. Minimal atherosclerosis of the aortic arch. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Please see separately reported same day CT abdomen and pelvis. MUSCULOSKELETAL: No aggressive osseous lesions. Mild multilevel discogenic degenerative changes. Prominent posterior right paracentral disc osteophyte complex at T6-T7 results in mild to moderate spinal canal narrowing. CONCLUSION: 1. No evidence of intrathoracic metastatic disease. Tiny pleural based nodule as described above is likely benign. Attention on follow up is recommended. 2. Posterior disc osteophyte complex at T6-T7 resulting in mild to moderate spinal canal narrowing. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.

FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: No suspicious nodule or mass. Tiny pleural based nodule identified on image 82 series 302 in the left upper lobe. No focal consolidation, pleural effusion, or pneumothorax. HEART / VESSELS: Normal heart size. No pericardial effusion. Minimal atherosclerosis of the aortic arch. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Please see separately reported same day CT abdomen and pelvis. MUSCULOSKELETAL: No aggressive osseous lesions. Mild multilevel discogenic degenerative changes. Prominent posterior right paracentral disc osteophyte complex at T6-T7 results in mild to moderate spinal canal narrowing.

FINDINGS: The left ICA endarterectomy maintains luminal patency. No intimal hyperplasia or stricture is noted. Calcified atherosclerotic disease with mild stenosis of the right ICA bulb shows no interval change. Severe luminal irregularity in the V3 segment of the hypoplastic left vertebral artery is again noted. Variant basilar artery hypoplasia with multifocal irregular stenosis is again noted. There is a irregularly marginated saccular aneurysm measuring 9 mm in sac height near the right vertebral-basilar artery confluence on the left side, stable when compared with previous exam. The left MCA distal M1 shows short segmental high-grade stenosis.

Radiologic Exam: CT Angio Head Code Stroke, CT Head wo contrast, CT Angio Neck Clinical Information: stroke Comparison: None. TECHNIQUE: CT Angio Head Code Stroke, CT Head wo contrast, CT Angio Neck. 3-D CT MIP and volume rendered angiographic images were generated in post processing. Patient weight: 262 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 271 mm. DLP: 3218 mGy cm. (accession CT220002426), Scan field of view: 246 mm. DLP: 1246 mGy cm. (accession CT220002428), Patient weight: 262 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 271 mm. DLP: 3218 mGy cm. (accession CT220002427) FINDINGS: CT OF THE HEAD WITH AND WITHOUT CONTRAST: Gray-white matter differentiation is maintained. No intracranial hemorrhage. No brain edema or brain mass. No abnormal intracranial enhancement. No hydrocephalus. Orbits are unremarkable. No aggressive osseous lesion. Paranasal sinuses and ostiomeatal cells are clear. CT ANGIOGRAM OF THE HEAD AND NECK: AORTIC ARCH AND PROXIMAL GREAT VESSELS: Normal. RIGHT CAROTID: Normal. LEFT CAROTID: Normal. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Normal. RIGHT VERTEBRAL ARTERY: Hypoplastic right vertebral artery and V4 segment. LEFT VERTEBRAL ARTERY: Normal. BASILAR ARTERY: Normal. NECK SOFT TISSUES: No significant abnormality. CERVICAL SPINE: No acute abnormality or aggressive osseous lesion. CONCLUSION: 1. No acute intracranial process. 2. No cervical or intracranial arterial abnormality. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.

FINDINGS: CT OF THE HEAD WITH AND WITHOUT CONTRAST: Gray-white matter differentiation is maintained. No intracranial hemorrhage. No brain edema or brain mass. No abnormal intracranial enhancement. No hydrocephalus. Orbits are unremarkable. No aggressive osseous lesion. Paranasal sinuses and ostiomeatal cells are clear. CT ANGIOGRAM OF THE HEAD AND NECK: AORTIC ARCH AND PROXIMAL GREAT VESSELS: Normal. RIGHT CAROTID: Normal. LEFT CAROTID: Normal. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Normal. RIGHT VERTEBRAL ARTERY: Hypoplastic right vertebral artery and V4 segment. LEFT VERTEBRAL ARTERY: Normal. BASILAR ARTERY: Normal. NECK SOFT TISSUES: No significant abnormality. CERVICAL SPINE: No acute abnormality or aggressive osseous lesion.

FINDINGS: The left ICA endarterectomy maintains luminal patency. No intimal hyperplasia or stricture is noted. Calcified atherosclerotic disease with mild stenosis of the right ICA bulb shows no interval change. Severe luminal irregularity in the V3 segment of the hypoplastic left vertebral artery is again noted. Variant basilar artery hypoplasia with multifocal irregular stenosis is again noted. There is a irregularly marginated saccular aneurysm measuring 9 mm in sac height near the right vertebral-basilar artery confluence on the left side, stable when compared with previous exam. The left MCA distal M1 shows short segmental high-grade stenosis.

Radiologic Exam: CT Angio Head Code Stroke, CT Head wo contrast, CT Angio Neck Clinical Information: stroke Comparison: None. TECHNIQUE: CT Angio Head Code Stroke, CT Head wo contrast, CT Angio Neck. 3-D CT MIP and volume rendered angiographic images were generated in post processing. Patient weight: 262 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 271 mm. DLP: 3218 mGy cm. (accession CT220002426), Scan field of view: 246 mm. DLP: 1246 mGy cm. (accession CT220002428), Patient weight: 262 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 271 mm. DLP: 3218 mGy cm. (accession CT220002427) FINDINGS: CT OF THE HEAD WITH AND WITHOUT CONTRAST: Gray-white matter differentiation is maintained. No intracranial hemorrhage. No brain edema or brain mass. No abnormal intracranial enhancement. No hydrocephalus. Orbits are unremarkable. No aggressive osseous lesion. Paranasal sinuses and ostiomeatal cells are clear. CT ANGIOGRAM OF THE HEAD AND NECK: AORTIC ARCH AND PROXIMAL GREAT VESSELS: Normal. RIGHT CAROTID: Normal. LEFT CAROTID: Normal. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Normal. RIGHT VERTEBRAL ARTERY: Hypoplastic right vertebral artery and V4 segment. LEFT VERTEBRAL ARTERY: Normal. BASILAR ARTERY: Normal. NECK SOFT TISSUES: No significant abnormality. CERVICAL SPINE: No acute abnormality or aggressive osseous lesion. CONCLUSION: 1. No acute intracranial process. 2. No cervical or intracranial arterial abnormality. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.

FINDINGS: CT OF THE HEAD WITH AND WITHOUT CONTRAST: Gray-white matter differentiation is maintained. No intracranial hemorrhage. No brain edema or brain mass. No abnormal intracranial enhancement. No hydrocephalus. Orbits are unremarkable. No aggressive osseous lesion. Paranasal sinuses and ostiomeatal cells are clear. CT ANGIOGRAM OF THE HEAD AND NECK: AORTIC ARCH AND PROXIMAL GREAT VESSELS: Normal. RIGHT CAROTID: Normal. LEFT CAROTID: Normal. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Normal. RIGHT VERTEBRAL ARTERY: Hypoplastic right vertebral artery and V4 segment. LEFT VERTEBRAL ARTERY: Normal. BASILAR ARTERY: Normal. NECK SOFT TISSUES: No significant abnormality. CERVICAL SPINE: No acute abnormality or aggressive osseous lesion.

FINDINGS: There are interval decompression of the bilateral ventricles and resolved left intraventricular hemorrhage. Periventricular interstitial edema is also significantly reduced. There is subsequently increased subdural hygroma over the frontoparietal convexity measuring 6 mm in thickness bilaterally. Bilateral inferior cerebellar encephalomalacia and internal shunt catheter between the left lateral ventricle and left cerebellomedullary cistern are unchanged. There is no evidence of intracranial hemorrhage, cerebral edema or acute vascular territory ischemia.

Radiologic Exam: CT Angio Head Code Stroke, CT Head wo contrast, CT Angio Neck Clinical Information: stroke Comparison: None. TECHNIQUE: CT Angio Head Code Stroke, CT Head wo contrast, CT Angio Neck. 3-D CT MIP and volume rendered angiographic images were generated in post processing. Patient weight: 262 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 271 mm. DLP: 3218 mGy cm. (accession CT220002426), Scan field of view: 246 mm. DLP: 1246 mGy cm. (accession CT220002428), Patient weight: 262 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 271 mm. DLP: 3218 mGy cm. (accession CT220002427) FINDINGS: CT OF THE HEAD WITH AND WITHOUT CONTRAST: Gray-white matter differentiation is maintained. No intracranial hemorrhage. No brain edema or brain mass. No abnormal intracranial enhancement. No hydrocephalus. Orbits are unremarkable. No aggressive osseous lesion. Paranasal sinuses and ostiomeatal cells are clear. CT ANGIOGRAM OF THE HEAD AND NECK: AORTIC ARCH AND PROXIMAL GREAT VESSELS: Normal. RIGHT CAROTID: Normal. LEFT CAROTID: Normal. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Normal. RIGHT VERTEBRAL ARTERY: Hypoplastic right vertebral artery and V4 segment. LEFT VERTEBRAL ARTERY: Normal. BASILAR ARTERY: Normal. NECK SOFT TISSUES: No significant abnormality. CERVICAL SPINE: No acute abnormality or aggressive osseous lesion. CONCLUSION: 1. No acute intracranial process. 2. No cervical or intracranial arterial abnormality. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.

FINDINGS: CT OF THE HEAD WITH AND WITHOUT CONTRAST: Gray-white matter differentiation is maintained. No intracranial hemorrhage. No brain edema or brain mass. No abnormal intracranial enhancement. No hydrocephalus. Orbits are unremarkable. No aggressive osseous lesion. Paranasal sinuses and ostiomeatal cells are clear. CT ANGIOGRAM OF THE HEAD AND NECK: AORTIC ARCH AND PROXIMAL GREAT VESSELS: Normal. RIGHT CAROTID: Normal. LEFT CAROTID: Normal. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Normal. RIGHT VERTEBRAL ARTERY: Hypoplastic right vertebral artery and V4 segment. LEFT VERTEBRAL ARTERY: Normal. BASILAR ARTERY: Normal. NECK SOFT TISSUES: No significant abnormality. CERVICAL SPINE: No acute abnormality or aggressive osseous lesion.

FINDINGS: Head CT: The calvarium and skull base are intact. Intracranially there is no evidence of cerebral contusion, hemorrhage, edema or mass effect. No evidence of acute cerebral ischemic pathology is noted. The ventricles are normal in size and configuration. The cortical sulci and subarachnoid cisterns are symmetric and age-appropriate. There is no extra-axial pathology. Visualized paranasal sinus, orbits and maxillofacial bones are unremarkable. C-spine CT: Mild degenerative anterolisthesis of C4 on C5 is noted. No acute cervical spine fracture or traumatic malalignment is identified. The vertebral body height and posterior column integrity are maintained. The cervicovertebral junction and atlantoaxial joint relationships are normal. Spondylosis with disc-osteophyte complex cause mild spinal canal narrowing at C4-C5 and C5-C6.

CT Perfusion 1/5/2022 9:39 AM Clinical Information: stroke Comparison: No prior perfusion studies are available for comparison. Technique: A CT perfusion study was performed during single pass of 50 cc contrast bolus. Axial images were acquired at 8 axial locations and time-attenuation curves generated from this dataset were utilized to calculate cerebral blood flow, mean transit time, time to peak, and cerebral blood volume maps as well as region of interest specific quantitative data. "Prognostic" color maps were also generated using RAPID processing software Patient weight: 262 lbs. IV contrast: Omnipaque 350, 40 ml, per protocol. IV contrast injection rate: 4 ml per sec. Scan delay: 0 sec. Scan field of view: 218 mm. DLP: 1946 mGy cm. Findings: RAPID images demonstrate CBF less than 30% volume: 0 ml and T Max greater than 6 seconds volume: 0 ml . Mismatch volume is 0 ml. Bilateral areas of increased Tmax > 4 seconds. There is no significant abnormal MTT, T max, CBV and CBF to suggest significant ischemia or infarction at the territory of the major intracranial arteries. Conclusion: No significant ischemia or infarction at the territory of major intracranial arteries. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.

Findings: RAPID images demonstrate CBF less than 30% volume: 0 ml and T Max greater than 6 seconds volume: 0 ml . Mismatch volume is 0 ml. Bilateral areas of increased Tmax > 4 seconds. There is no significant abnormal MTT, T max, CBV and CBF to suggest significant ischemia or infarction at the territory of the major intracranial arteries.

FINDINGS: Head CT: The calvarium and skull base are intact. Intracranially there is no evidence of cerebral contusion, hemorrhage, edema or mass effect. No evidence of acute cerebral ischemic pathology is noted. The ventricles are normal in size and configuration. The cortical sulci and subarachnoid cisterns are symmetric and age-appropriate. There is no extra-axial pathology. Visualized paranasal sinus, orbits and maxillofacial bones are unremarkable. C-spine CT: Mild degenerative anterolisthesis of C4 on C5 is noted. No acute cervical spine fracture or traumatic malalignment is identified. The vertebral body height and posterior column integrity are maintained. The cervicovertebral junction and atlantoaxial joint relationships are normal. Spondylosis with disc-osteophyte complex cause mild spinal canal narrowing at C4-C5 and C5-C6.

RADIOLOGIC EXAM: CT Head wo contrast CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Head wo contrastScan field of view: 230 mm. DLP: 1507.70 mGy cm. STRUCTURED REPORT: CT Head FINDINGS: BRAIN PARENCHYMA: There is no acute intracranial hemorrhage or acute infarct. No brain edema or mass effect. Diffuse cerebral volume loss most prominent within the parietal lobe. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. CONCLUSION: No acute intracranial process.

FINDINGS: BRAIN PARENCHYMA: There is no acute intracranial hemorrhage or acute infarct. No brain edema or mass effect. Diffuse cerebral volume loss most prominent within the parietal lobe. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal.

FINDINGS/CONCLUSION: Comminuted, nondisplaced fracture of the lateral patella. The distal femur and proximal tibia and fibula are intact and unremarkable. Decreased bone mineralization. There is a small lipohemarthrosis. No pneumarthrosis is seen to suggest traumatic arthrotomy. Soft tissue defect overlies the patella. Soft tissue swelling of the knee.

RADIOLOGIC EXAM: CT Head wo contrast CLINICAL INFORMATION: Fall COMPARISON: None. TECHNIQUE: CT Head wo contrastScan field of view: 215 mm. DLP: 1218 mGy cm. STRUCTURED REPORT: CT Head FINDINGS: BRAIN PARENCHYMA: There is no acute intracranial hemorrhage or acute infarct. No brain edema or mass effect. Mild chronic white matter microangiopathic changes and cerebral volume loss. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. CONCLUSION: No acute intracranial process.

FINDINGS: BRAIN PARENCHYMA: There is no acute intracranial hemorrhage or acute infarct. No brain edema or mass effect. Mild chronic white matter microangiopathic changes and cerebral volume loss. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal.

FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: See separate chest CT report. ABDOMEN and PELVIS: LIVER: Cirrhosis without focal lesion, unchanged. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. Small accessory spleen. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Previously described rectal mass is grossly unchanged with persistent wall thickening. Mesorectal fat stranding is decreased without definitive invasion of the prostate, bladder, or perirectal fascial planes. No new areas of local or regional involvement are identified. Normal appendix. PERITONEUM / MESENTERY: Normal. No free fluid. RETROPERITONEUM: Presacral stranding is unchanged. No new abnormality. VESSELS: No significant abnormality. Small accessory left hepatic artery arising from left gastric. URINARY BLADDER: Decreased urinary bladder wall thickening. No focal mass. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: Osteopenia. No significant abnormality.

RADIOLOGIC EXAM: CT Cervical Spine wo contrast CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Cervical Spine wo contrastScan field of view: 200 mm. DLP: 942 mGy cm. Following CT of the neck, reformatted images were produced to optimize visualization of the osseous structures of the cervical spine. STRUCTURED REPORT: CT Cervical Spine Trauma FINDINGS: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (

FINDINGS: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (

Findings: Lines and Tubes: Left-sided port tip terminates in the right atrium, similar. Body Wall and Abdomen: No destructive osseous lesions. Abdomen and pelvis will be reported separately. Lymph Nodes, Mediastinum and Neck: No axillary adenopathy. No mediastinal adenopathy. Small mediastinal lymph nodes have a similar appearance. Lungs and Pleura: No pleural effusion. Patchy, peripheral and peribronchovascular opacities are present bilaterally, most notable in the upper lobes, similar in magnitude and distribution compared to the previous associated with mild bronchiectasis and mild upper lobe volume loss bilaterally. Several scattered nodules bilaterally have a similar appearance. Cardiovascular: Mild cardiomegaly. No large pericardial effusion or central PTE. No dense coronary artery atherosclerotic calcifications.

EXAM: CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: 64-year-old male with renal cell carcinoma follow-up. COMPARISON: CT abdomen and pelvis 10/22/2021 TECHNIQUE: CT Abdomen and Pelvis wo IV contrast. Scan field of view: 446 mm. DLP: 675 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Noncalcified pulmonary nodule at the left lung base measuring approximately 11 mm (series 303 image 61), unchanged. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Coronary artery calcifications. The heart is normal in size. ABDOMEN and PELVIS: LIVER: Stable appearing subcentimeter hypodense lesion within the medial aspect of the right liver lobe. An additional subcentimeter hypodense lesion is seen more medially. These lesions are too small to characterize; however, likely representing cysts. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: The left adrenal gland is normal. The right adrenal gland is surgically absent. KIDNEYS: Postsurgical changes from a prior right nephrectomy and adrenalectomy. No soft tissue abnormality is seen within the nephrectomy bed. Punctate nonobstructing calculi within the left kidney interpolar region is unchanged. No left hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis without evidence of diverticulitis. The appendix is not well visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerotic calcifications of the abdominal aorta which is normal in caliber. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostatomegaly. BODY WALL: Bilateral small fat-containing inguinal hernias, right greater than left. Small fat-containing periumbilical hernia. MUSCULOSKELETAL: Multilevel discogenic degenerative changes. No aggressive osseous lesions. CONCLUSION: 1. Postsurgical changes from a prior right nephrectomy and adrenalectomy without evidence of recurrent or metastatic disease within the abdomen or pelvis, within the limitations of noncontrast technique. 2. Additional stable chronic and incidental findings as described above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.

FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Noncalcified pulmonary nodule at the left lung base measuring approximately 11 mm (series 303 image 61), unchanged. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Coronary artery calcifications. The heart is normal in size. ABDOMEN and PELVIS: LIVER: Stable appearing subcentimeter hypodense lesion within the medial aspect of the right liver lobe. An additional subcentimeter hypodense lesion is seen more medially. These lesions are too small to characterize; however, likely representing cysts. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: The left adrenal gland is normal. The right adrenal gland is surgically absent. KIDNEYS: Postsurgical changes from a prior right nephrectomy and adrenalectomy. No soft tissue abnormality is seen within the nephrectomy bed. Punctate nonobstructing calculi within the left kidney interpolar region is unchanged. No left hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis without evidence of diverticulitis. The appendix is not well visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerotic calcifications of the abdominal aorta which is normal in caliber. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostatomegaly. BODY WALL: Bilateral small fat-containing inguinal hernias, right greater than left. Small fat-containing periumbilical hernia. MUSCULOSKELETAL: Multilevel discogenic degenerative changes. No aggressive osseous lesions.

FINDINGS: Interval dilatation of the bilateral ventricles, left greater than right, is noted. The left-sided hydrocephalus shows colpocephalic configuration. The right posterior temporal access shunt catheter appears stable in course and tip terminus. The posterior fossa metallic wires and occipital craniectomy changes are again noted. There is no cerebral edema, intracranial hemorrhage, or extra-axial collection.

EXAM: CT Chest wo contrast CLINICAL INFORMATION: Renal cell carcinoma followup, C64.9 Malignant neoplasm of unspecified kidney, except renal pelvis COMPARISON: Multiple priors most recently 9/22/2021. TECHNIQUE: Helical multidetector noncontrast CT of the chest was performed. Axial, sagittal, and coronal multiplanar reformats were subsequently obtained.. Scan field of view: 446 mm. DLP: 675 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. LINES AND TUBES: None. LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Previously identified focal groundglass opacity has resolved. Several pulmonary nodules including a 9 mm left lower lobe nodule best seen on image #103 series #301 are stable. No new nodules, consolidation, or effusions are identified. HEART / VESSELS: Severe coronary artery calcifications. The aorta is normal in caliber with scattered areas describes disease. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged by CT criteria. CHEST WALL: Sternotomy changes. UPPER ABDOMEN: See separate same day abdominal dictation. MUSCULOSKELETAL: No significant abnormality. IMPRESSION: 1. Several small bilateral pulmonary nodules are stable. Attention on follow-up is recommended. 2. Resolution of focal groundglass opacity in the right lower lobe. 3. See separate abdominal dictation.

FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. LINES AND TUBES: None. LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Previously identified focal groundglass opacity has resolved. Several pulmonary nodules including a 9 mm left lower lobe nodule best seen on image #103 series #301 are stable. No new nodules, consolidation, or effusions are identified. HEART / VESSELS: Severe coronary artery calcifications. The aorta is normal in caliber with scattered areas describes disease. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged by CT criteria. CHEST WALL: Sternotomy changes. UPPER ABDOMEN: See separate same day abdominal dictation. MUSCULOSKELETAL: No significant abnormality.

FINDINGS: The supraclavicular region is grossly unremarkable. Central airways are widely patent. The thoracic aorta is not aneurysmal. The pulmonary arteries are normal caliber. The heart is not enlarged. No pericardial effusion. No enlarged supraclavicular, axillary or mediastinal lymph nodes are identified. Assessment of the hilar lymph nodes is limited. The esophagus is mildly patulous. Linear scarring or atelectasis seen within the bilateral lower lobes. A focal masslike opacity within the anterolateral basal left lower lobe measures 3.9 x 3.0 cm on image 431 of series 201, not significantly changed from prior comparisons were measuring up to 4.1 x 2.8 cm. No new or enlarging lung nodules are identified. No pleural effusion or pleural thickening. No acute abnormality within the imaged upper abdomen. No acute or aggressive osseous abnormalities.

EXAM: CT Abdomen and Pelvis wo+w contrast CLINICAL INFORMATION: RCC. COMPARISON: 10/13/2021. TECHNIQUE: CT Abdomen and Pelvis wo+w contrast. Patient weight: 181 lbs. IV contrast: Omnipaque 350, 143 ml, per protocol. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 438 mm. DLP: 2131 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis Chest findings to be dictated separately. ABDOMEN and PELVIS: LIVER: Hyperenhancing lesion within the anterior segment is unchanged compared to prior exam (series 305, image 72). Hypoenhancing lesion within the inferior right hepatic lobe measures 1.1 x 0.7 cm (series 305, image 116), previously 1.3 x 1.1 cm. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: The left adrenal is surgically absent. The right adrenal is normal. KIDNEYS: The left kidney is surgically absent. No soft tissue abnormalities are seen within the nephrectomy bed. The right kidney contains a simple cyst but is otherwise normal without hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered diverticulosis without evidence of diverticulitis. Otherwise, the colon, including the appendix, is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Left retroperitoneal nodule measures 1.4 x 1.2 cm (series 305, image 132), similar to prior. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing periumbilical and ventral hernias. MUSCULOSKELETAL: No aggressive osseous lesions. CONCLUSION: 1. Continued interval decrease in size of the hypoattenuating lesion within the right hepatic lobe. Multiple foci of arterial hyperenhancement are unchanged. 2. Left retroperitoneal metastatic nodule is unchanged. 3. Chronic and incidental findings as above.

FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis Chest findings to be dictated separately. ABDOMEN and PELVIS: LIVER: Hyperenhancing lesion within the anterior segment is unchanged compared to prior exam (series 305, image 72). Hypoenhancing lesion within the inferior right hepatic lobe measures 1.1 x 0.7 cm (series 305, image 116), previously 1.3 x 1.1 cm. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: The left adrenal is surgically absent. The right adrenal is normal. KIDNEYS: The left kidney is surgically absent. No soft tissue abnormalities are seen within the nephrectomy bed. The right kidney contains a simple cyst but is otherwise normal without hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered diverticulosis without evidence of diverticulitis. Otherwise, the colon, including the appendix, is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Left retroperitoneal nodule measures 1.4 x 1.2 cm (series 305, image 132), similar to prior. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing periumbilical and ventral hernias. MUSCULOSKELETAL: No aggressive osseous lesions.

FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Right upper lobectomy postsurgical changes with some residual soft tissue density along the margin of the anterior staple lines which may represent atelectasis. This is decreased from the prior examination.. Unchanged 3 to 4 mm solid pulmonary nodules (for example, series 202, images 159, 167, and 199). No new suspicious pulmonary nodule. No focal consolidation or pneumothorax. Improved right pleural effusion with trace residual effusion at the right lung base. HEART / VESSELS: Normal heart size. Trace pericardial effusion. Severe coronary atherosclerosis. Normal caliber thoracic aorta and main pulmonary artery. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No aggressive osseous lesion.

CT Chest with contrast CLINICAL INFORMATION: 59-year-old female with rcc staging, C64.9 Malignant neoplasm of unspecified kidney, except renal pelvis TECHNIQUE: Scout images were obtained for localization. Helical CT examination of the chest was then performed after IV injection of nonionic contrast. Axial, sagittal and Coronal reformatted images were reconstructed at 2.5 mm and reviewed. Patient weight: 181 lbs. IV contrast: Omnipaque 350, 143 ml, per protocol. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 438 mm. DLP: 2131 mGy cm. COMPARISON: Prior chest CT dated 10/13/2021. FINDINGS: Scouts: No additional findings. Lower neck and Mediastinum: No significant lower neck abnormality. No new focal esophageal wall abnormalities. Lymph nodes: No new pathologically enlarged supraclavicular, axillary, mediastinal or hilar lymph nodes. Heart and great arteries: Cardiac chambers are normal in size. No pericardial effusion. Mediastinal great arteries are normal in caliber. No evidence of large central pulmonary thromboembolic disease. Airways: The trachea and central bronchi are patent and clear. Lungs : The previously mentioned right middle lobe oval nodule is unchanged, now measuring up to 3 mm (series 303, image 63). The lungs are otherwise clear bilaterally without evidence of new focal pulmonary opacities or suspicious pulmonary nodules or masses. Pleura: No pleural effusion or pneumothorax. Upper abdomen: The CT of the abdomen and pelvis will be reported separately. Bones and soft tissues: The visualized chest wall soft tissues are unremarkable. Degenerative bony changes are again noted, without evidence of aggressive or destructive intrathoracic osseous lesions. CONCLUSION: 1. No convincing CT evidence of intrathoracic metastatic disease.

FINDINGS: Scouts: No additional findings. Lower neck and Mediastinum: No significant lower neck abnormality. No new focal esophageal wall abnormalities. Lymph nodes: No new pathologically enlarged supraclavicular, axillary, mediastinal or hilar lymph nodes. Heart and great arteries: Cardiac chambers are normal in size. No pericardial effusion. Mediastinal great arteries are normal in caliber. No evidence of large central pulmonary thromboembolic disease. Airways: The trachea and central bronchi are patent and clear. Lungs : The previously mentioned right middle lobe oval nodule is unchanged, now measuring up to 3 mm (series 303, image 63). The lungs are otherwise clear bilaterally without evidence of new focal pulmonary opacities or suspicious pulmonary nodules or masses. Pleura: No pleural effusion or pneumothorax. Upper abdomen: The CT of the abdomen and pelvis will be reported separately. Bones and soft tissues: The visualized chest wall soft tissues are unremarkable. Degenerative bony changes are again noted, without evidence of aggressive or destructive intrathoracic osseous lesions.

FINDINGS: STRUCTURED REPORT: CTA Abdomen Pelvis VASCULATURE: ABDOMINAL AORTA: Stable size and appearance of the thoracoabdominal aortic dissection. The abdominal aorta measures approximately 2.7 x 2.4 cm near the level of the celiac artery origin on axial series 4, image 184. Caudally, the abdominal aorta measures approximately 2.1 x 1.8 cm just above the level of the iliac bifurcation on axial series 4, image 686. CELIAC AXIS: Patent and arises from true lumen. SMA: Patent and arises from true lumen. RIGHT RENAL: Patent and arises from true lumen. LEFT RENAL: Patent and arises from false lumen. IMA: Patent and arises from true lumen. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: Redemonstration of extension of the dissection into the left common iliac artery, terminating in the proximal left internal iliac artery. ------------------------------------------------------------- CT chest findings are reported separately. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Expected postcholecystectomy prominence of the common bile duct. GALLBLADDER: Surgically absent. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Slightly diminished enhancement of the left kidney, likely related to perfusion via the false lumen. Indeterminate hypodensity within the upper pole the left kidney, grossly unchanged since prior and likely reflecting a cyst. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Small hiatal hernia. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Trace pelvic free fluid, nonspecific. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Appears surgically absent. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.

RADIOLOGIC EXAM: CT Thoracic Spine with contrast CLINICAL INFORMATION: Back pain in setting of cancer COMPARISON: None. TECHNIQUE: CT Thoracic Spine with contrastPatient weight: 180 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 300sec Scan field of view: 169 mm. DLP: 1053 mGy cm. Following CT of the chest and abdomen, reformatted images were produced to optimize visualization of the osseous structures of the thoracic and lumbar spine. FINDINGS: T-SPINE: VERTEBRA: No aggressive osseous lesion. There are a few scattered sclerotic foci in T7, T8 and T11 vertebral bodies, which are stable at least dating back to 1/7/2021, nonspecific. DISC SPACES AND FACET JOINTS: Minimal multilevel degenerative changes without significant canal stenosis or neuroforaminal stenosis at any level. PREVERTEBRAL SOFT TISSUES: Pulmonary interlobar septal thickening. Small left pleural effusion with overlying dependent opacity ALIGNMENT: Normal. L-SPINE: VERTEBRA: No aggressive osseous lesion. Tiny sclerotic focus in the L5 vertebral body, also stable from 1/7/2021 DISC SPACES AND FACET JOINTS: Mild multilevel degenerative changes. No significant canal narrowing or neuroforaminal stenosis at any level.. PREVERTEBRAL SOFT TISSUES: Hepatic steatosis in the partially visualized liver. There is mild groundglass opacity in the right upper lobe. ALIGNMENT: Normal. CONCLUSION: 1. No CT evidence of aggressive thoracolumbar osseous lesions. If there is persistent clinical concern for spinal metastases, further evaluation with MRI would be more sensitive. Few scattered small sclerotic lesions, stable dating back to 1/7/2021. 2. No canal or neuroforaminal stenosis at any thoracic or lumbar level. 3. Small left pleural effusion and overlying atelectasis. Mild groundglass opacity in the right upper lobe. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.

FINDINGS: T-SPINE: VERTEBRA: No aggressive osseous lesion. There are a few scattered sclerotic foci in T7, T8 and T11 vertebral bodies, which are stable at least dating back to 1/7/2021, nonspecific. DISC SPACES AND FACET JOINTS: Minimal multilevel degenerative changes without significant canal stenosis or neuroforaminal stenosis at any level. PREVERTEBRAL SOFT TISSUES: Pulmonary interlobar septal thickening. Small left pleural effusion with overlying dependent opacity ALIGNMENT: Normal. L-SPINE: VERTEBRA: No aggressive osseous lesion. Tiny sclerotic focus in the L5 vertebral body, also stable from 1/7/2021 DISC SPACES AND FACET JOINTS: Mild multilevel degenerative changes. No significant canal narrowing or neuroforaminal stenosis at any level.. PREVERTEBRAL SOFT TISSUES: Hepatic steatosis in the partially visualized liver. There is mild groundglass opacity in the right upper lobe. ALIGNMENT: Normal.

Findings: Comparison: 5/17/2021 Vascular Findings: Interval aortic valve replacement. Graft extending from the sinotubular junction to the distal ascending aorta has a similar appearance. Dissection flap begins just distal to this containing a similar fenestration. The dissection flap extends into the abdominal aorta, as on the previous. At the level of the ductus bump, the descending thoracic aorta measures 3.9 x 3.7 cm image 78 series 3, previously 4.1 x 3.6 cm. At the level of the left inferior pulmonary vein the descending thoracic aorta measures approximately 2.8 x 2.9 cm image 127, previously 3.1 x 2.9 cm. The great vessels have a normal appearance. No central PTE or pericardial effusion. Focal dilatation of a right lower lobe pulmonary arterial subsegmental branch image 201 has a similar appearance. Chest Wall and Abdomen: Interval median sternotomy without convincing evidence of osseous sternal fusion currently. Lower Neck, Mediastinum, and Lymph Nodes: No axillary adenopathy. Shotty and mildly enlarged mediastinal lymph nodes are more conspicuous compared to the preoperative examination, possibly reactive. Lungs and Pleura: No pleural effusion. No suspicious appearing pulmonary nodules.

EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Cholangiocarcinoma. COMPARISON: 9/13/2021. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 135 lbs. IV contrast: Omnipaque 350, 135 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3 ml per sec. Scan delay: Bolus Tracked. Scan field of view: 340 mm. DLP: 882.01 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hepatic cyst is redemonstrated within the right lobe. Hypoattenuating lesion along the inferior margin of the right hepatic lobe measures 1.2 x 0.7 cm (series 4, image 68), previously 1.5 x 1.1 cm. No new suspicious hepatic lesions are visualized. Evaluation of the liver parenchyma is somewhat limited by significant streak artifact from multiple biliary drainage catheters. BILIARY TRACT: Two right and one left percutaneous biliary drainage catheters are seen, the tips of which are curled appropriately within the second portion of the duodenum. There is unchanged mild right intrahepatic biliary ductal dilatation. No pneumobilia is visualized. GALLBLADDER: Partially collapsed containing a small focus of nondependent gas. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Duplicated IVC is incidentally noted. Mild atherosclerotic calcification of the abdominal aorta which is normal in caliber. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Borderline prostatomegaly. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous lesions. CONCLUSION: 1. Multiple biliary drainage catheters are redemonstrated with unchanged intrahepatic biliary ductal dilatation. No pneumobilia is seen to definitively confirm stent patency. 2. Continued interval decrease in size of the inferior right hepatic lobe lesion compared to prior. No new suspicious hepatic lesions. No abdominopelvic lymphadenopathy. 3. Incidental findings as above.

FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hepatic cyst is redemonstrated within the right lobe. Hypoattenuating lesion along the inferior margin of the right hepatic lobe measures 1.2 x 0.7 cm (series 4, image 68), previously 1.5 x 1.1 cm. No new suspicious hepatic lesions are visualized. Evaluation of the liver parenchyma is somewhat limited by significant streak artifact from multiple biliary drainage catheters. BILIARY TRACT: Two right and one left percutaneous biliary drainage catheters are seen, the tips of which are curled appropriately within the second portion of the duodenum. There is unchanged mild right intrahepatic biliary ductal dilatation. No pneumobilia is visualized. GALLBLADDER: Partially collapsed containing a small focus of nondependent gas. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Duplicated IVC is incidentally noted. Mild atherosclerotic calcification of the abdominal aorta which is normal in caliber. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Borderline prostatomegaly. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous lesions.

FINDINGS: Intracranially there is no evidence of acute vascular territory ischemia, hemorrhage, mass or mass effect. The ventricles are normal in size and configuration. The cortical sulci and subarachnoid cisterns are symmetric and age-appropriate. There is no extra-axial pathology. The calvarium and skull base show no focal bony abnormality. Visualized paranasal sinus and mastoid aerations are clear.

CLINICAL HISTORY: Syncope, simple, normal neuro exam, R55 Syncope and collapse EXAM: CT Head wo contrast TECHNIQUE: 5 mm thick serial axial images were obtained throughout the head without intravenous contrast. Scan field of view: 220 mm. DLP: 898.35 mGy cm. FINDINGS: There is no acute intracranial hemorrhage. There are no abnormal areas of hypoattenuation to suggest acute infarction. There are mild periventricular hypodensities reflecting microangiopathic changes. There is mild generalized atrophy with proportionate enlargement of the ventricles. There is no mass effect. Note is made of significant tortuosity of the basilar artery. There are mild atherosclerotic calcifications of both distal ICAs. The calvarium is intact. There is significant circumferential mucosal thickening within both maxillary sinuses. There is diffuse thickening of the walls of both maxillary sinuses. There is also moderate opacification of the left ethmoid air cells and complete opacification of the left frontal sinus with increased sclerosis of the walls. The sphenoid sinuses and right frontal sinus are clear.. Mastoid air cells are clear. The orbits are unremarkable. CONCLUSION: 01. No acute intracranial abnormality, specifically no acute hemorrhage or infarction. 02. Mild left periorbital soft tissue swelling 03. Chronic left pansinusitis and also right maxillary chronic sinusitis

FINDINGS: There is no acute intracranial hemorrhage. There are no abnormal areas of hypoattenuation to suggest acute infarction. There are mild periventricular hypodensities reflecting microangiopathic changes. There is mild generalized atrophy with proportionate enlargement of the ventricles. There is no mass effect. Note is made of significant tortuosity of the basilar artery. There are mild atherosclerotic calcifications of both distal ICAs. The calvarium is intact. There is significant circumferential mucosal thickening within both maxillary sinuses. There is diffuse thickening of the walls of both maxillary sinuses. There is also moderate opacification of the left ethmoid air cells and complete opacification of the left frontal sinus with increased sclerosis of the walls. The sphenoid sinuses and right frontal sinus are clear.. Mastoid air cells are clear. The orbits are unremarkable.

FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Pelvis Renal Transplant VASCULATURE: LOWER ABDOMINAL AORTA: Not included on the images. RIGHT COMMON / INTERNAL ILIAC ARTERIES: Common iliac artery and proximal portion of the internal iliac artery excluded from view. No significant calcified atherosclerotic disease. RIGHT EXTERNAL ILIAC ARTERY: Proximal portion of the external iliac artery is excluded from view. No calcified atherosclerotic disease. LEFT COMMON / INTERNAL ILIAC ARTERIES: Common iliac artery and proximal portion of the internal iliac artery excluded from view. Mild calcified atherosclerotic disease. LEFT EXTERNAL ILIAC ARTERY: Proximal portion of the external iliac artery is excluded from view. No calcified atherosclerotic disease. LOWER ABDOMEN: BOWEL: Scattered colonic diverticuli without associated inflammation. PERITONEUM: Normal. OTHER: No other abnormality. PELVIS: LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Nondistended and otherwise not well evaluated. REPRODUCTIVE ORGANS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Indeterminate but benign-appearing lucent lesion seen within the right iliac bone. This has increased in conspicuity since 2010.

RADIOLOGIC EXAM: CT Thoracic Spine with contrast CLINICAL INFORMATION: Back pain in setting of cancer COMPARISON: None. TECHNIQUE: CT Thoracic Spine with contrastPatient weight: 180 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 300sec Scan field of view: 169 mm. DLP: 1053 mGy cm. Following CT of the chest and abdomen, reformatted images were produced to optimize visualization of the osseous structures of the thoracic and lumbar spine. FINDINGS: T-SPINE: VERTEBRA: No aggressive osseous lesion. There are a few scattered sclerotic foci in T7, T8 and T11 vertebral bodies, which are stable at least dating back to 1/7/2021, nonspecific. DISC SPACES AND FACET JOINTS: Minimal multilevel degenerative changes without significant canal stenosis or neuroforaminal stenosis at any level. PREVERTEBRAL SOFT TISSUES: Pulmonary interlobar septal thickening. Small left pleural effusion with overlying dependent opacity ALIGNMENT: Normal. L-SPINE: VERTEBRA: No aggressive osseous lesion. Tiny sclerotic focus in the L5 vertebral body, also stable from 1/7/2021 DISC SPACES AND FACET JOINTS: Mild multilevel degenerative changes. No significant canal narrowing or neuroforaminal stenosis at any level.. PREVERTEBRAL SOFT TISSUES: Hepatic steatosis in the partially visualized liver. There is mild groundglass opacity in the right upper lobe. ALIGNMENT: Normal. CONCLUSION: 1. No CT evidence of aggressive thoracolumbar osseous lesions. If there is persistent clinical concern for spinal metastases, further evaluation with MRI would be more sensitive. Few scattered small sclerotic lesions, stable dating back to 1/7/2021. 2. No canal or neuroforaminal stenosis at any thoracic or lumbar level. 3. Small left pleural effusion and overlying atelectasis. Mild groundglass opacity in the right upper lobe. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.

FINDINGS: T-SPINE: VERTEBRA: No aggressive osseous lesion. There are a few scattered sclerotic foci in T7, T8 and T11 vertebral bodies, which are stable at least dating back to 1/7/2021, nonspecific. DISC SPACES AND FACET JOINTS: Minimal multilevel degenerative changes without significant canal stenosis or neuroforaminal stenosis at any level. PREVERTEBRAL SOFT TISSUES: Pulmonary interlobar septal thickening. Small left pleural effusion with overlying dependent opacity ALIGNMENT: Normal. L-SPINE: VERTEBRA: No aggressive osseous lesion. Tiny sclerotic focus in the L5 vertebral body, also stable from 1/7/2021 DISC SPACES AND FACET JOINTS: Mild multilevel degenerative changes. No significant canal narrowing or neuroforaminal stenosis at any level.. PREVERTEBRAL SOFT TISSUES: Hepatic steatosis in the partially visualized liver. There is mild groundglass opacity in the right upper lobe. ALIGNMENT: Normal.

FINDINGS: The frontal penetrating brain injury shows interval resolution of contusional edema and intraparenchymal/subdural hemorrhages with evolved encephalomalacia. Interval healing of the frontal cranioplasty related scalp hematoma and edema is also noted. Multiple bone fragments embedded within the left frontal lobe and small metallic shrapnel remain visualized. The frontal horn of the left lateral ventricle is mildly dilated in ex vacuo. There is no evidence of cerebritis/abscess, extra-axial empyema or calvarial osteomyelitis. The olfactory recess shows no leaked CSF.

EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 40-year-old male with evaluation for diaphragmatic injury. COMPARISON: CT chest and abdomen dated 1/3/2020. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast. Patient weight: 195 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 75sec Scan field of view: 390 mm. DLP: 1175 mGy cm. FINDINGS: Motion artifact limits partial evaluation of the diaphragm. STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Small left pneumothorax is similar. Left greater than right consolidations with air mammograms, slightly increased from prior. New consolidation in the lingula. Small left greater than right pleural effusions. Interval placement of surgical drain tip coiled in the left lung base. HEART / VESSELS: Mild cardiomegaly with enlarged left ventricle. Mild CAD. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. DIAPHRAGM: The posterior left hemidiaphragm demonstrates areas of decreased attenuation with defect along the left mid diaphragm below the heart (series 8044, image 52) with small left pleural effusion similar to prior exam. Limited evaluation of the right hemidiaphragm given artifactual changes. On the prior exam there is an oblique defect of the right hemidiaphragm (series 503, image 36) that is is only partially visualized on today's exam (series 8044, image 37). No abnormal thickening of the right hemidiaphragm. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. Subcentimeter hypoattenuating lesion too small characterize. No suspicious lesion. The hepatic veins and IVC are not opacified, likely secondary to bolus contrast timing. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Interval development of hypoattenuating areas with areas of contrast enhancement, the largest measuring up to 1.7 cm (series 2, image 192). ADRENALS: Normal. KIDNEYS: Grossly unchanged laceration injury to the left kidney adjacent stranding. Right kidney is unremarkable. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Trace fluid in the left paracolic gutter. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: Scattered mild atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Mild prostatomegaly. BODY WALL: Tiny fat-containing umbilical hernia. Mild anasarca. MUSCULOSKELETAL: Redemonstrated acute left rib fractures. Chronic right rib fractures. CONCLUSION: 1. Interval development of a laceration to the spleen with areas of pseudoaneurysms versus contrast extravasation contained within the splenic capsule, grade 4 injury. 2. Defect of the left hemidiaphragm on today's exam with area of contusion concerning for diaphragm injury. Small left pleural effusion with interval placement of left chest tube. 3. Oblique defect in the right hemidiaphragm is less prominent on today's exam and concerning for diaphragm injury. 4. Similar small left pneumothorax. 5. Similar grade 3 injury of the left kidney. Ancillary findings above. The findings were discussed with Dr. Pinkston by Dr. Jason Davis via telephone on 1/5/2022 10:57 PM. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.

FINDINGS: Motion artifact limits partial evaluation of the diaphragm. STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Small left pneumothorax is similar. Left greater than right consolidations with air mammograms, slightly increased from prior. New consolidation in the lingula. Small left greater than right pleural effusions. Interval placement of surgical drain tip coiled in the left lung base. HEART / VESSELS: Mild cardiomegaly with enlarged left ventricle. Mild CAD. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. DIAPHRAGM: The posterior left hemidiaphragm demonstrates areas of decreased attenuation with defect along the left mid diaphragm below the heart (series 8044, image 52) with small left pleural effusion similar to prior exam. Limited evaluation of the right hemidiaphragm given artifactual changes. On the prior exam there is an oblique defect of the right hemidiaphragm (series 503, image 36) that is is only partially visualized on today's exam (series 8044, image 37). No abnormal thickening of the right hemidiaphragm. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. Subcentimeter hypoattenuating lesion too small characterize. No suspicious lesion. The hepatic veins and IVC are not opacified, likely secondary to bolus contrast timing. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Interval development of hypoattenuating areas with areas of contrast enhancement, the largest measuring up to 1.7 cm (series 2, image 192). ADRENALS: Normal. KIDNEYS: Grossly unchanged laceration injury to the left kidney adjacent stranding. Right kidney is unremarkable. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Trace fluid in the left paracolic gutter. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: Scattered mild atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Mild prostatomegaly. BODY WALL: Tiny fat-containing umbilical hernia. Mild anasarca. MUSCULOSKELETAL: Redemonstrated acute left rib fractures. Chronic right rib fractures.

FINDINGS: Right central venous catheter is present with its tip extending to the lower superior vena cava. The supraclavicular region is unremarkable. Central airways are patent. The thoracic aorta is nonaneurysmal. The pulmonary arteries are normal caliber. The heart is nonenlarged. No pericardial effusion. No enlarged supraclavicular, axillary, mediastinal or hilar lymph nodes are identified. Residual thymic tissue seen within the anterior mediastinum. There is no acute lung abnormality. No new or enlarging lung nodules. No pleural effusion or pleural thickening. The gallbladder is surgically absent. The left chest wall lesion appears slightly decreased in size now measuring 2.6 x 1.6 cm compared to 2.9 x 1.9 cm on 7/16/2021. No new chest wall lesions identified. No acute or aggressive osseous abnormality.

EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 40-year-old male with evaluation for diaphragmatic injury. COMPARISON: CT chest and abdomen dated 1/3/2020. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast. Patient weight: 195 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 75sec Scan field of view: 390 mm. DLP: 1175 mGy cm. FINDINGS: Motion artifact limits partial evaluation of the diaphragm. STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Small left pneumothorax is similar. Left greater than right consolidations with air mammograms, slightly increased from prior. New consolidation in the lingula. Small left greater than right pleural effusions. Interval placement of surgical drain tip coiled in the left lung base. HEART / VESSELS: Mild cardiomegaly with enlarged left ventricle. Mild CAD. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. DIAPHRAGM: The posterior left hemidiaphragm demonstrates areas of decreased attenuation with defect along the left mid diaphragm below the heart (series 8044, image 52) with small left pleural effusion similar to prior exam. Limited evaluation of the right hemidiaphragm given artifactual changes. On the prior exam there is an oblique defect of the right hemidiaphragm (series 503, image 36) that is is only partially visualized on today's exam (series 8044, image 37). No abnormal thickening of the right hemidiaphragm. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. Subcentimeter hypoattenuating lesion too small characterize. No suspicious lesion. The hepatic veins and IVC are not opacified, likely secondary to bolus contrast timing. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Interval development of hypoattenuating areas with areas of contrast enhancement, the largest measuring up to 1.7 cm (series 2, image 192). ADRENALS: Normal. KIDNEYS: Grossly unchanged laceration injury to the left kidney adjacent stranding. Right kidney is unremarkable. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Trace fluid in the left paracolic gutter. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: Scattered mild atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Mild prostatomegaly. BODY WALL: Tiny fat-containing umbilical hernia. Mild anasarca. MUSCULOSKELETAL: Redemonstrated acute left rib fractures. Chronic right rib fractures. CONCLUSION: 1. Interval development of a laceration to the spleen with areas of pseudoaneurysms versus contrast extravasation contained within the splenic capsule, grade 4 injury. 2. Defect of the left hemidiaphragm on today's exam with area of contusion concerning for diaphragm injury. Small left pleural effusion with interval placement of left chest tube. 3. Oblique defect in the right hemidiaphragm is less prominent on today's exam and concerning for diaphragm injury. 4. Similar small left pneumothorax. 5. Similar grade 3 injury of the left kidney. Ancillary findings above. The findings were discussed with Dr. Pinkston by Dr. Jason Davis via telephone on 1/5/2022 10:57 PM. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.

FINDINGS: Motion artifact limits partial evaluation of the diaphragm. STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Small left pneumothorax is similar. Left greater than right consolidations with air mammograms, slightly increased from prior. New consolidation in the lingula. Small left greater than right pleural effusions. Interval placement of surgical drain tip coiled in the left lung base. HEART / VESSELS: Mild cardiomegaly with enlarged left ventricle. Mild CAD. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. DIAPHRAGM: The posterior left hemidiaphragm demonstrates areas of decreased attenuation with defect along the left mid diaphragm below the heart (series 8044, image 52) with small left pleural effusion similar to prior exam. Limited evaluation of the right hemidiaphragm given artifactual changes. On the prior exam there is an oblique defect of the right hemidiaphragm (series 503, image 36) that is is only partially visualized on today's exam (series 8044, image 37). No abnormal thickening of the right hemidiaphragm. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. Subcentimeter hypoattenuating lesion too small characterize. No suspicious lesion. The hepatic veins and IVC are not opacified, likely secondary to bolus contrast timing. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Interval development of hypoattenuating areas with areas of contrast enhancement, the largest measuring up to 1.7 cm (series 2, image 192). ADRENALS: Normal. KIDNEYS: Grossly unchanged laceration injury to the left kidney adjacent stranding. Right kidney is unremarkable. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Trace fluid in the left paracolic gutter. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: Scattered mild atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Mild prostatomegaly. BODY WALL: Tiny fat-containing umbilical hernia. Mild anasarca. MUSCULOSKELETAL: Redemonstrated acute left rib fractures. Chronic right rib fractures.

FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. Limitations: None. Chest: Lines, tubes, and devices: Right IJ port catheter with tip at the lower SVC. Lung parenchyma and pleura: Right upper lobe 4 mm nodule (image 17, series 2) is stable. No new or enlarging suspicious pulmonary nodule. No focal consolidation. The trachea and main bronchi are patent. No pleural effusion. Redemonstrated bilateral fatty containing Bochdalek hernia. Thoracic inlet, heart, and mediastinum: No lymphadenopathy in the axillary, mediastinal, or hilar regions. The esophagus is nondilated. The thoracic aorta and main pulmonary artery are normal in caliber. The cardiac chambers are normal in size. Mild coronary artery atherosclerotic calcifications are noted, although the study is not optimized for coronary assessment. No pericardial effusion. Bones and soft tissues: No destructive bone lesion. Chest wall is unremarkable. Upper abdomen: Redemonstrated multiple surgical clips in the retroperitoneum with a stable 12 x 12 mm left retroperitoneal nodule (image 96, series 2). Redemonstrated a normal configuration of the spleen/residual splenule. Relatively high attenuation of the liver, similar to prior.

EXAM: CT Abdomen wo+w contrast CLINICAL INFORMATION: 29-year-old female with history of malignancy and liver lesion greater than 1 cm. COMPARISON: Ultrasound abdomen 8/25/2021 and CT abdomen and pelvis 1/24/2020 TECHNIQUE: CT Abdomen wo+w contrast. Patient weight: 128 lbs. IV contrast: Omnipaque 350, 99 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: Bolus Tracked. Scan field of view: 330 mm. DLP: 1251.39 mGy cm. FINDINGS: STRUCTURED REPORT: CT HCC Screening IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: Calcified granuloma in the inferior left lung. Mild bibasilar atelectasis. HEART / VESSELS: No significant abnormality. Central venous catheter is seen terminating in the right atrium. ABDOMEN: LIVER: Cirrhotic. No steatosis. Ill-defined hypoattenuating lesion within the right hepatic lobe measures 1.4 x 1.0 cm (series 5, image 93). This is technically indeterminant, but has been present since 2014. No new arterial hyperenhancement or regions of delayed washout are visualized. LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: There is a DIPS stent present which appears grossly patent. There is chronic collapse and suspected occlusion of the infrarenal IVC. IVC to SMV stent is not definitively patent. - Hepatic veins: None patent. - Esophageal varices: None. - Other varices or collaterals: Numerous mesenteric, retroperitoneal, anterior abdominal and lumbar paraspinal venous collaterals are similar to prior. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: Cholelithiasis. The gallbladder is collapsed around multiple stones without wall thickening. LYMPH NODES: Prominent para-aortic and mesenteric lymph nodes, unchanged compared to prior. SPLEEN: Normal size and appearance. PERITONEUM / ASCITES: Redemonstration of multiloculated ascites throughout the abdomen and pelvis, unchanged. Several peritoneal nodules are present which appears similar to prior. Some calcifications are present within the peritoneum. OTHER FINDINGS: PANCREAS: Dense calcifications of the pancreatic head are unchanged, consistent with sequela of chronic pancreatitis. ADRENALS: Normal. KIDNEYS: Scattered punctate calcifications of the left kidney. No hydronephrosis. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: Redemonstration of the DIPS stent, patent, and a second stent connecting the infrahepatic IVC to the SMV, not definitively opacified with contrast. Numerous venous collaterals as detailed above. BODY WALL: Diffuse venous collaterals throughout. MUSCULOSKELETAL: No aggressive osseous lesions. CONCLUSION: 1. Hepatic cirrhosis consistent with patient's known Budd Chiari. No suspicious hepatic lesions are visualized. 2. Patent DIPs. IVC to SMV stent is not definitively patent. Diffuse venous collaterals throughout the abdomen and pelvis unchanged. 3. Redemonstration of multiloculated ascites which appears stable in size compared to prior. 4. Additional chronic and incidental findings as described above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.

FINDINGS: STRUCTURED REPORT: CT HCC Screening IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: Calcified granuloma in the inferior left lung. Mild bibasilar atelectasis. HEART / VESSELS: No significant abnormality. Central venous catheter is seen terminating in the right atrium. ABDOMEN: LIVER: Cirrhotic. No steatosis. Ill-defined hypoattenuating lesion within the right hepatic lobe measures 1.4 x 1.0 cm (series 5, image 93). This is technically indeterminant, but has been present since 2014. No new arterial hyperenhancement or regions of delayed washout are visualized. LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: There is a DIPS stent present which appears grossly patent. There is chronic collapse and suspected occlusion of the infrarenal IVC. IVC to SMV stent is not definitively patent. - Hepatic veins: None patent. - Esophageal varices: None. - Other varices or collaterals: Numerous mesenteric, retroperitoneal, anterior abdominal and lumbar paraspinal venous collaterals are similar to prior. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: Cholelithiasis. The gallbladder is collapsed around multiple stones without wall thickening. LYMPH NODES: Prominent para-aortic and mesenteric lymph nodes, unchanged compared to prior. SPLEEN: Normal size and appearance. PERITONEUM / ASCITES: Redemonstration of multiloculated ascites throughout the abdomen and pelvis, unchanged. Several peritoneal nodules are present which appears similar to prior. Some calcifications are present within the peritoneum. OTHER FINDINGS: PANCREAS: Dense calcifications of the pancreatic head are unchanged, consistent with sequela of chronic pancreatitis. ADRENALS: Normal. KIDNEYS: Scattered punctate calcifications of the left kidney. No hydronephrosis. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: Redemonstration of the DIPS stent, patent, and a second stent connecting the infrahepatic IVC to the SMV, not definitively opacified with contrast. Numerous venous collaterals as detailed above. BODY WALL: Diffuse venous collaterals throughout. MUSCULOSKELETAL: No aggressive osseous lesions.

FINDINGS/CONCLUSION: Status post sideplate and screw fixation of the posterior wall of the left acetabulum. There are persistent nonunited fractures of the acetabular roof and anterior acetabular wall and column. Healed fracture of the left femoral neck. Comminuted fracture of the mid femoral diaphysis status post intramedullary fixation. There is persistent fracture lucency without significant bridging osseous callus formation. Unchanged appearance of the patella. Comminuted fracture of the proximal tibia status post sideplate and screw fixation. There are persistent fracture lucencies with small amount of osseous callus formation. However, the majority of the fracture fragments demonstrate little to no osseous callus formation. No hardware complication. Again noted is a fracture deformity of the proximal fibular diaphysis with osseous ankylosis of the anterior cortex/fracture fragments. The posterior cortex as described continuous. Disuse osteopenia is noted in the foot and ankle. Os navicularis. No knee joint effusion. The soft tissues are unremarkable.