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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.

EXAM: CT Abdomen wo+w contrast CLINICAL INFORMATION: Cirrhosis. COMPARISON: 12/9/2020. TECHNIQUE: CT Abdomen wo+w contrast. Patient weight: 270 lbs. IV contrast: Omnipaque 350, 180 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3 ml per sec. Scan delay: Bolus Tracked. Scan field of view: 480 mm. DLP: 3563.38 mGy cm. FINDINGS: STRUCTURED REPORT: CT HCC Screening IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. Mild steatosis. No suspicious 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: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: None. - Other varices or collaterals: Recanalized paraumbilical vein. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: Cholelithiasis. Gallbladder is mostly collapsed. No wall thickening or pericholecystic fluid. LYMPH NODES: Borderline enlarged periportal lymph nodes. SPLEEN: Mildly enlarged. PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Normal. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. The appendix is not included within the study. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: Mild atherosclerotic calcification of the abdominal aorta which is normal in caliber. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous lesions. CONCLUSION: 1. Hepatic cirrhosis with minimal sequela of portal hypertension. No suspicious hepatic lesions. 2. Chronic and incidental findings as above.

FINDINGS: STRUCTURED REPORT: CT HCC Screening IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. Mild steatosis. No suspicious 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: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: None. - Other varices or collaterals: Recanalized paraumbilical vein. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: Cholelithiasis. Gallbladder is mostly collapsed. No wall thickening or pericholecystic fluid. LYMPH NODES: Borderline enlarged periportal lymph nodes. SPLEEN: Mildly enlarged. PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Normal. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. The appendix is not included within the study. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: Mild atherosclerotic calcification of the abdominal aorta which is normal in caliber. BODY WALL: No significant abnormality. 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.

CT Chest wo contrast CLINICAL INFORMATION: 50-year-old male with Aortic Dissection, I71.00 Dissection of unspecified site of aorta TECHNIQUE: Scout images were obtained for localization. Helical CT examination of the chest was performed without IV contrast administration. Axial, sagittal and Coronal reformatted images were reconstructed at 2.5 mm and reviewed. Scan field of view: 444 mm. DLP: 386 mGy cm. COMPARISON: Prior chest CT dated 11/30/2021 FINDINGS: Scouts: Interval placement of multiple descending thoracic aortic endovascular stents, as well as interval surgical clips seen overlying the left lung apex. Lower neck and Mediastinum: Evaluation of the mediastinal structures is limited in such a noncontrast study. Partially visualized thyroid gland is unremarkable. No evidence of focal esophageal wall abnormalities. No evidence of pneumomediastinum or mediastinal hematomas. Multiple new surgical clips within the left lower neck and superior mediastinum are noted. Lymph nodes: Multiple small mediastinal and bilateral axillary lymph nodes are similar, most likely reactive. Evaluation of the hilar lymph nodes is limited in such a noncontrast study. Heart and great arteries: The left-sided cardiac chambers are mildly dilated. The right-sided cardiac chambers appear normal in size. Small pericardial effusion, which appear similar or slightly decreased when compared to prior. Interval placement of thoracic aortic multiple overlapping endovascular stents extending from the proximal aortic arch, just beyond the origin of the right brachiocephalic artery, down to the distal descending thoracic aorta. Diffuse ectasia of the thoracic aorta is similar to prior. Persistent enlarged main pulmonary artery, which measures up to 3.5 cm. Airways: The trachea and central bronchi are patent and clear. Lungs : Multiple scattered linear opacities of subsegmental scarring/atelectasis. The lungs are otherwise clear without evidence of focal pulmonary opacities or suspicious pulmonary nodules or masses. Pleura: Interval decreased small left pleural effusion, with residual trace component. 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. No aggressive or destructive intrathoracic osseous lesions. CONCLUSION: 1. Interval placement of thoracic aortic multiple overlapping endovascular stents extending from the proximal aortic arch, just beyond the origin of the right brachiocephalic artery, down to the distal descending thoracic aorta, with persistent diffuse ectasia of the thoracic aorta. 2. Persistent enlarged main pulmonary artery, measuring up to 3.5 cm 3. No evidence of mediastinal hematomas or pneumomediastinum. 4. Small pericardial effusion is similar or slightly smaller when compared to prior. 5. Interval decrease in size of the small left pleural effusion, with residual trace component. 6. Other findings as described.

FINDINGS: Scouts: Interval placement of multiple descending thoracic aortic endovascular stents, as well as interval surgical clips seen overlying the left lung apex. Lower neck and Mediastinum: Evaluation of the mediastinal structures is limited in such a noncontrast study. Partially visualized thyroid gland is unremarkable. No evidence of focal esophageal wall abnormalities. No evidence of pneumomediastinum or mediastinal hematomas. Multiple new surgical clips within the left lower neck and superior mediastinum are noted. Lymph nodes: Multiple small mediastinal and bilateral axillary lymph nodes are similar, most likely reactive. Evaluation of the hilar lymph nodes is limited in such a noncontrast study. Heart and great arteries: The left-sided cardiac chambers are mildly dilated. The right-sided cardiac chambers appear normal in size. Small pericardial effusion, which appear similar or slightly decreased when compared to prior. Interval placement of thoracic aortic multiple overlapping endovascular stents extending from the proximal aortic arch, just beyond the origin of the right brachiocephalic artery, down to the distal descending thoracic aorta. Diffuse ectasia of the thoracic aorta is similar to prior. Persistent enlarged main pulmonary artery, which measures up to 3.5 cm. Airways: The trachea and central bronchi are patent and clear. Lungs : Multiple scattered linear opacities of subsegmental scarring/atelectasis. The lungs are otherwise clear without evidence of focal pulmonary opacities or suspicious pulmonary nodules or masses. Pleura: Interval decreased small left pleural effusion, with residual trace component. 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. No aggressive or destructive intrathoracic osseous lesions.

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: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Left upper pole nonobstructive renal calculus is noted measuring up to 3 mm (series 2, image 64). Otherwise, bilateral kidneys are normal without hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. Trace atherosclerotic calcification is seen within the left common iliac artery. No significant atherosclerotic calcification is seen within the right common or bilateral external iliac arteries. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus appears surgically absent. No definite adnexal masses or cysts. BODY WALL: Epigastric and periumbilical fat-containing hernias. Mild diffuse anasarca. MUSCULOSKELETAL: No significant abnormality.

EXAM: CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: History of aortic dissection COMPARISON: 11/30/2021 TECHNIQUE: CT Abdomen and Pelvis wo IV contrast. Scan field of view: 444 mm. DLP: 386 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately reported chest CT. ABDOMEN and PELVIS: LIVER: Normal. 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: Scattered colonic diverticula without surrounding inflammation. The appendix is normal. PERITONEUM / MESENTERY: Trace pelvic free fluid.. RETROPERITONEUM: Normal. VESSELS: Interval placement of an aortic stent graft within the true lumen of the previously visualized aortic dissection. The origin of this graft is not visualized on abdominal cross-sectional imaging. This graft terminates just distal to the renal artery origins. The graft appears normal in diameter. There is a crescent-shaped density adjacent to the graft lumen at likely represents thrombus within the false lumen. The remaining visualized vessels are unremarkable within limitations of the study. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostatomegaly. BODY WALL: Small fat-containing umbilical hernia. Left anterior abdominal wall stranding is unchanged. MUSCULOSKELETAL: No acute or aggressive osseous abnormality. Mild degenerative changes involving the lumbar spine, most advanced at the S1 L5 level.. CONCLUSION: 1. Interval placement of aortic stent graft terminating in the infrarenal aorta. Sec. Flap extends further up to the aortic bifurcation. Luminal patency cannot be evaluated in absence of intravenous contrast. Otherwise, no postsurgical complication visualized. 2. Other incidental 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: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately reported chest CT. ABDOMEN and PELVIS: LIVER: Normal. 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: Scattered colonic diverticula without surrounding inflammation. The appendix is normal. PERITONEUM / MESENTERY: Trace pelvic free fluid.. RETROPERITONEUM: Normal. VESSELS: Interval placement of an aortic stent graft within the true lumen of the previously visualized aortic dissection. The origin of this graft is not visualized on abdominal cross-sectional imaging. This graft terminates just distal to the renal artery origins. The graft appears normal in diameter. There is a crescent-shaped density adjacent to the graft lumen at likely represents thrombus within the false lumen. The remaining visualized vessels are unremarkable within limitations of the study. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostatomegaly. BODY WALL: Small fat-containing umbilical hernia. Left anterior abdominal wall stranding is unchanged. MUSCULOSKELETAL: No acute or aggressive osseous abnormality. Mild degenerative changes involving the lumbar spine, most advanced at the S1 L5 level..

Findings: A 2.4 mm calcific density is seen in the dermis layer of the right paramedian glabella. The bilateral temple and preauricular skin shows incisional scar. Forehead skin dimples are also noted. No soft tissue mass lesion is identified. The preseptal orbit is unremarkable. Chronic sinusitis with total opacification of the right maxillary sinus is again noted.

EXAM: CT Rsh Chest with contrast METRIC CLINICAL INFORMATION: History of bladder cancer undergoing restaging. COMPARISON: CT chest 9/8/2021 TECHNIQUE: CT Rsh Chest with contrast METRIC. Patient weight: 226 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 175 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 60/300/600 sec. Scan field of view: 388 mm. DLP: 3514 mGy cm. FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. Small nodules in the right major and minor fissures (series 302, images 116 and 117) are unchanged, probably intrafissural lymph nodes. Calcified right upper lobe granuloma is again seen. Mild bilateral dependent atelectasis. No new suspicious nodule or mass. No pleural effusion. HEART / VESSELS: The heart is normal in size with mild coronary artery atherosclerotic calcifications with a stent in the LAD. The thoracic aorta is normal caliber with mild atherosclerotic disease. The pulmonary artery is normal caliber central or proximal segmental pulmonary embolus. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Scattered borderline enlarged mediastinal and bilateral hilar lymph nodes are seen with interval decrease in size of the lower right paraesophageal node, right lower perihilar node and left hilar nodes.. Calcified right hilar and right paratracheal lymph nodes are again seen. Right subpectoral lymph node is decreased in size. CHEST WALL: Interval removal of right chest port with associated subcutaneous stranding/scarring. MUSCULOSKELETAL: No aggressive osseous lesions. CT abdomen pelvis will be reported separately. CONCLUSION: 1. Interval decrease in size of mediastinal and hilar nodes.. Decreased size of right subpectoral lymph node. 2. Unchanged small nodules which are probably intrapulmonary lymph nodes. No new pulmonary nodules or masses. This patient is participating in a clinical trial and a separate Tumor Metrics report will be provided and include tumor measurements as applicable for response assessment. 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: The central airways are patent. Small nodules in the right major and minor fissures (series 302, images 116 and 117) are unchanged, probably intrafissural lymph nodes. Calcified right upper lobe granuloma is again seen. Mild bilateral dependent atelectasis. No new suspicious nodule or mass. No pleural effusion. HEART / VESSELS: The heart is normal in size with mild coronary artery atherosclerotic calcifications with a stent in the LAD. The thoracic aorta is normal caliber with mild atherosclerotic disease. The pulmonary artery is normal caliber central or proximal segmental pulmonary embolus. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Scattered borderline enlarged mediastinal and bilateral hilar lymph nodes are seen with interval decrease in size of the lower right paraesophageal node, right lower perihilar node and left hilar nodes.. Calcified right hilar and right paratracheal lymph nodes are again seen. Right subpectoral lymph node is decreased in size. CHEST WALL: Interval removal of right chest port with associated subcutaneous stranding/scarring. MUSCULOSKELETAL: No aggressive osseous lesions. CT abdomen pelvis will be reported separately.

Findings: Lines and Tubes: Right-sided port tip terminates in the upper SVC, similar, after looping into the neck. Body Wall and Abdomen: No destructive osseous lesions. CT of the abdomen and pelvis will be reported separately. Lymph Nodes, Mediastinum and Neck: No axillary or mediastinal adenopathy. Lungs and Pleura: No pleural effusion. Mild bronchiectasis. Tiny middle lobe nodule image 129 series 11 is unchanged. Nodule or prominent vessel bifurcation in the right lower lobe image 123 has a similar appearance. Right lower lobe nodule in the azygoesophageal recess image 130 is unchanged. Cardiovascular: Heart size is normal. No central PTE, pericardial effusion, or dense coronary artery atherosclerotic calcifications.

EXAM: CT Rsh Body with contrast METRIC CLINICAL INFORMATION: Bladder cancer COMPARISON: 9/8/2021. TECHNIQUE: CT Rsh Body with contrast METRIC. Patient weight: 226 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 175 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 60/300/600 sec. Scan field of view: 226 mm. DLP: 3514 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis The chest portion of the exam will be reported separately. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: The kidneys enhance and excrete contrast symmetrically. Mild perinephric stranding. Subcentimeter simple appearing left renal pole renal cyst is again noted. Unchanged mild bilateral hydronephrosis. Both ureters remain mildly dilated to the level of the neobladder. LYMPH NODES: Stable appearance of the mildly prominent periportal lymph nodes. There are two mesenteric lymph nodes in the right pelvis (image 395 and 415, series 302) that appear larger than on prior exam. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: And scattered colonic diverticula. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: The bladder is again noted with similar configuration. The fluid collection adjacent to the urinary bladder has decreased in size (measures 3.2 x 3.1 cm on image 432, series 302 and previously measured 6.5 x 5.5 cm on image 229, series 501). However, the wall appears more thickened and there is mild stranding surrounding the collection. REPRODUCTIVE ORGANS: Prostate is surgically absent. BODY WALL: Interval postsurgical changes from ventral hernia repair with a small amount of fluid (for example image 396, series 302) and surrounding stranding MUSCULOSKELETAL: No aggressive osseous lesion. CONCLUSION: 1. Slight interval increase in size of small mesenteric lymph nodes adjacent to the superior margin of the neobladder. Close attention at follow-up is recommended. 2. Interval decreased size of the fluid collection adjacent to the neobladder, but with increased wall thickening and surrounding stranding. This likely represents evolution of a postoperative collection which may have changed morphology due to recent ventral hernia repair. Continued close follow-up is recommended. 3. Mild bilateral hydroureteronephrosis with dilation of the ureters to the level of the neobladder, similar to prior exam. 4. Additional findings as above. This patient is participating in a clinical trial and a separate Tumor Metrics report will be provided and include tumor measurements as applicable for response assessment.

FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis The chest portion of the exam will be reported separately. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: The kidneys enhance and excrete contrast symmetrically. Mild perinephric stranding. Subcentimeter simple appearing left renal pole renal cyst is again noted. Unchanged mild bilateral hydronephrosis. Both ureters remain mildly dilated to the level of the neobladder. LYMPH NODES: Stable appearance of the mildly prominent periportal lymph nodes. There are two mesenteric lymph nodes in the right pelvis (image 395 and 415, series 302) that appear larger than on prior exam. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: And scattered colonic diverticula. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: The bladder is again noted with similar configuration. The fluid collection adjacent to the urinary bladder has decreased in size (measures 3.2 x 3.1 cm on image 432, series 302 and previously measured 6.5 x 5.5 cm on image 229, series 501). However, the wall appears more thickened and there is mild stranding surrounding the collection. REPRODUCTIVE ORGANS: Prostate is surgically absent. BODY WALL: Interval postsurgical changes from ventral hernia repair with a small amount of fluid (for example image 396, series 302) and surrounding stranding MUSCULOSKELETAL: No aggressive osseous lesion.

FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Unchanged small liver cysts. BILIARY TRACT: Normal. GALLBLADDER: Absent. 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: Uterus is absent. Ovaries are normal in appearance for the patient's age. BODY WALL: Unchanged mild rectus diastases. MUSCULOSKELETAL: No significant abnormality.

CTA Coronary Artery CLINICAL INFORMATION: 40-year-old female with history of chest pain, abnormal stress test, and peripheral T-cell lymphoma status post whole body radiation. TECHNIQUE: Precontrast axial images through the heart were acquired for calcium score evaluation. Postcontrast images were helically acquired in retrospective ECG gating to the heart with dual source 256 detectors Siemens CT scanner (Somatom FORCE). Images reviewed in multiple phases of the cardiac cycle. Source images, multiplanar reformatted images, MIP and volume rendered images were also reviewed. Patient was given 0.4 mg of sublingual nitroglycerin coronary arterial vasodilatation. Patient weight: 230 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 5 ml per sec. Scan delay: Bolus Tracked. Scan field of view: 170 mm. Heart Rate: 64 bpm. DLP: 925 mGy cm. COMPARISON: PET/CT 3/23/2015 FINDINGS: CALCIUM SCORE: Using a modified Agatston scoring method, the coronary artery calcification score is 0. CORONARY ARTERIES: * Dominance: Right dominant coronary arterial circulation, with both PDA and posterolateral branches are seen arising from the distal RCA. * LM: Normal origin at the left coronary cusp. No significant calcified or noncalcified atheromatous plaque or significant luminal stenosis. Trifurcates into LAD, LCx and ramus intermedius artery. * LAD: It has normal course and caliber, without significant atherosclerotic plaque or stenosis. It gives origin into patent obtuse marginal and septal arteries. * LCx: It has normal course and caliber, without significant atherosclerotic plaque or stenosis. It gives origin into normal obtuse marginal artery. * Ramus intermedius artery: It has normal course and caliber, without evidence of significant atherosclerotic plaque or stenosis. * RCA: Normal origin of the right coronary cusp. It has normal course and caliber, without significant atherosclerotic plaque or stenosis. It gives origin into patent PDA and posterolateral arteries. HEART AND GREAT VESSELS: Cardiac chambers: Cardiac chambers are normal in size. No pericardial effusion. LVEF: 69 % LVED volume: 136 ml LVES volume: 42 ml LV Stroke volume: 93 ml The visualized thoracic aorta is normal in caliber The visualized pulmonary arteries are normal in caliber, without evidence of large central pulmonary thromboembolic disease. LUNGS AND EXTRACARDIAC STRUCTURES: The scanned part of the mediastinum: Mildly patulous lower esophagus with mild thickening. The mediastinum is unremarkable. The scanned trachea and central bronchi: The imaged central airways are patent. The scanned lungs: Mild bilateral dependent atelectasis. No pleural effusion. The scanned part of the upper abdomen: Hepatic steatosis. The scanned chest wall soft tissues and skeletal structures: Unremarkable. CONCLUSION: 1. No evidence of atherosclerotic coronary artery disease, CAD-RADS 0. 2. Mildly patulous lower esophagus with mild esophageal wall thickening, which could be seen with reflux esophagitis, for clinical correlation.. 3. Hepatic steatosis. 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: CALCIUM SCORE: Using a modified Agatston scoring method, the coronary artery calcification score is 0. CORONARY ARTERIES: * Dominance: Right dominant coronary arterial circulation, with both PDA and posterolateral branches are seen arising from the distal RCA. * LM: Normal origin at the left coronary cusp. No significant calcified or noncalcified atheromatous plaque or significant luminal stenosis. Trifurcates into LAD, LCx and ramus intermedius artery. * LAD: It has normal course and caliber, without significant atherosclerotic plaque or stenosis. It gives origin into patent obtuse marginal and septal arteries. * LCx: It has normal course and caliber, without significant atherosclerotic plaque or stenosis. It gives origin into normal obtuse marginal artery. * Ramus intermedius artery: It has normal course and caliber, without evidence of significant atherosclerotic plaque or stenosis. * RCA: Normal origin of the right coronary cusp. It has normal course and caliber, without significant atherosclerotic plaque or stenosis. It gives origin into patent PDA and posterolateral arteries. HEART AND GREAT VESSELS: Cardiac chambers: Cardiac chambers are normal in size. No pericardial effusion. LVEF: 69 % LVED volume: 136 ml LVES volume: 42 ml LV Stroke volume: 93 ml The visualized thoracic aorta is normal in caliber The visualized pulmonary arteries are normal in caliber, without evidence of large central pulmonary thromboembolic disease. LUNGS AND EXTRACARDIAC STRUCTURES: The scanned part of the mediastinum: Mildly patulous lower esophagus with mild thickening. The mediastinum is unremarkable. The scanned trachea and central bronchi: The imaged central airways are patent. The scanned lungs: Mild bilateral dependent atelectasis. No pleural effusion. The scanned part of the upper abdomen: Hepatic steatosis. The scanned chest wall soft tissues and skeletal structures: Unremarkable.

FINDINGS: The left PCA territory acute infarction shows interval evolution of edema. An 1.4 cm focal hemorrhage within the left hippocampal formation is again noted. There is no interval progression of hemorrhagic transformation, new ischemic insult or mass effect. Right pterional craniotomy approach MCA aneurysm clipping and right temporal encephalomalacia are again noted.

EXAM: CT Abdomen and Pelvis wo+w contrast CLINICAL INFORMATION: Hematuria COMPARISON: CT 01/05/2022. TECHNIQUE: CT Abdomen and Pelvis wo+w contrast. Patient weight: 134 lbs. IV contrast: Omnipaque 350, 143 ml, per protocol. IV contrast injection rate: 3 ml per sec. Scan delay: 60. 300. sec. Scan field of view: 330 mm. DLP: 748 mGy cm. FINDINGS: STRUCTURED REPORT: CT Urogram LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN AND PELVIS: KIDNEYS: No enhancing renal mass. UPPER URINARY TRACTS: - Calculi: No urothelial calculi. - Urothelium: No abnormal urothelial enhancement, thickening or filling defects. URINARY BLADDER: No abnormal bladder wall thickening or enhancement. No bladder mass. LIVER: Several small simple hepatic cysts. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Normal. Nonspecific subcutaneous gluteal calcifications probable injection granulomas. MUSCULOSKELETAL: No suspicious destructive osseous lesions. Lumbar vertebrae demonstrate normal height. Tiny sclerotic foci in the sacrum probably bony islands. CONCLUSION: 1. Unremarkable CT urogram. No acute findings in abdomen and pelvis.

FINDINGS: STRUCTURED REPORT: CT Urogram LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN AND PELVIS: KIDNEYS: No enhancing renal mass. UPPER URINARY TRACTS: - Calculi: No urothelial calculi. - Urothelium: No abnormal urothelial enhancement, thickening or filling defects. URINARY BLADDER: No abnormal bladder wall thickening or enhancement. No bladder mass. LIVER: Several small simple hepatic cysts. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Normal. Nonspecific subcutaneous gluteal calcifications probable injection granulomas. MUSCULOSKELETAL: No suspicious destructive osseous lesions. Lumbar vertebrae demonstrate normal height. Tiny sclerotic foci in the sacrum probably bony islands.

Findings: Mediastinal lymph nodes are smaller compared to the previous . Right hilar node to evaluate on this noncontrast exam but is still approximately 12 mm in short axis. Right paratracheal node on series 2 image 87 is 11 mm in short axis. No additional enlarged intrathoracic lymph nodes. Moderate-advanced destructive centrilobular emphysema. Moderate paraseptal emphysema. Coronally oriented right apical scarring around image 40 series 2 is similar. Subpleural scarring in the right upper lobe and middle lobe is increased in conspicuity. Stellate nodular opacity in the right upper lobe has increased in size and density measuring 6 x 8 mm (average 7 mm) on series 2 image 94 and this was 4 x 7 mm on the previous exam on series 2 image 97. Linear opacities in the right lower lobe superior segment are new, suggestive of scarring or subsegmental atelectasis. Contiguous with this is a new nodular opacity in the superior segment measuring approximately 12 x 8 mm (average 10 mm) image 118 series 2. Linear opacities in the right lower lobe anterior segment around image 180 are mildly decreased in conspicuity. Small groundglass density left lower lobe opacity image 205 has a stellate appearance on both axial and coronal images (series 601 image 123). Retained secretions are seen in both main stem bronchi. Coronary artery calcification: The visual score of calcification is 5. (Based on a publication by Kirsch et al (Detection of Coronary calcium During Standard Chest Computed Tomography Correlates With Multi-Detector Computed Tomography Coronary Artery Calcium score, Int J Cardiovasc Imaging (2012) 28:1249-1256), visual score >7 is associated with an Agatston score > 400 and independently validated increased incidence of cardiovascular mortality). The visualized liver, spleen, adrenals, and bowel are unremarkable. Bones: No destructive osseous lesions.

EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Lymph node surveillance COMPARISON: CT 06/30/2021. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 185 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 78 sec Scan field of view: 433 mm. DLP: 1100.68 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: Postsurgical changes in the medial segment of left hepatic lobe. Resolving small post surgical seroma adjacent to surgical staples. Small stable simple hepatic cysts. Liver is otherwise unremarkable. No suspicious enhancing solid lesions. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Stable simple left renal cyst.. LYMPH NODES: Unchanged left perirectal lymph node measuring about 1.7 x 1.0 cm (series 2/image 266). Additional tiny nodule more superiorly on the left, measuring about 1.1 x 1.1 cm (series 2/image 264), unchanged. STOMACH / SMALL BOWEL: Stomach and duodenum partially seen. No abnormal dilatation small bowel loops. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Surgically absent uterus. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: Stable osseous structures. CONCLUSION: 1. Stable small left perirectal lymph nodes. No new enlarged suspicious abdominal or pelvic lymph nodes. 2. Resolving small post surgical seroma in the medial segment of left hepatic lobe. Small simple hepatic cysts.

FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Postsurgical changes in the medial segment of left hepatic lobe. Resolving small post surgical seroma adjacent to surgical staples. Small stable simple hepatic cysts. Liver is otherwise unremarkable. No suspicious enhancing solid lesions. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Stable simple left renal cyst.. LYMPH NODES: Unchanged left perirectal lymph node measuring about 1.7 x 1.0 cm (series 2/image 266). Additional tiny nodule more superiorly on the left, measuring about 1.1 x 1.1 cm (series 2/image 264), unchanged. STOMACH / SMALL BOWEL: Stomach and duodenum partially seen. No abnormal dilatation small bowel loops. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Surgically absent uterus. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: Stable osseous structures.

FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: There is a new lobular right lower lobe nodule partially imaged on image 1 series 2. No other focal lung lesions within the lung bases. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Pacer wires are unchanged. No new abnormality. ABDOMEN and PELVIS: LIVER: Hepatic steatosis is unchanged. Tiny hypodensities in the liver parenchyma appear unchanged in size and number. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral renal cysts are unchanged. Otherwise normal. LYMPH NODES: Prominent nodes involve the periaortic, right common iliac, bilateral external iliac, bilateral obturator, and left common femoral regions, unchanged in size and number. No new adenopathy. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Ileocecal anastomosis and rectosigmoid anastomosis has normal appearance. No new abnormalities. PERITONEUM / MESENTERY: No free fluid. No omental or peritoneal nodules. RETROPERITONEUM: Normal. VESSELS: Borderline size fusiform infrarenal abdominal aortic aneurysm is unchanged. Arterial wall calcifications and mild narrowing of the SMA origin are unchanged URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Calcifications are noted along the surface of the corpora appear unchanged. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Chronic healed right posterior rib fracture. Bilateral sacroiliac fusion, bilateral pars defects at L5, and lumbar degenerative change is similar to prior study. No aggressive osseous lesions are noted.

CT angiograms of the neck and head.. Clinical Information: Left-sided weakness. New jerking of left arm. Comparison: CT angiograms on 6/22/2016 Technique: During the injection of Omnipaque 350, 125 ml, per protocol, 0.67 mm mm axial scans were obtained from the aortic arch to the vertex. Sagittal, axial and coronal MIP angiograms were generated. 3-D color surface rendered angiograms were constructed on an independent workstation. DLP: 5673.10 mGy cm. Findings: CTA neck: There are calcified plaques but otherwise expected appearance of the top of the aortic arch and the brachiocephalic arteries. There are calcified plaques at the right carotid bifurcation extending into the bulb with approximately 50% stenosis. There is calcified plaques in the left proximal ECA but the bifurcation and ICA have no significant stenosis. The cervical ICAs are tortuous but otherwise normal. Both vertebral arteries are sizable with approximately 50% stenosis at the origins but no other apparent defect. Compared to the outside CTA on 6/22/2016 there is slight progression of the stenosis at the right carotid bifurcation. There is degenerative disc disease at C3-C6 with circumferential osteophytes. There is severe facet arthropathy at C2-C6 on the right and lesser on the left. No lytic or sclerotic lesion is seen. CTA head: There are dense calcifications in the cavernous ICAs but no significant stenosis is seen. The supraclinoid ICAs and the proximal ACAs, MCA's or PCAs are unremarkable. There is dolichoectasia of the basilar artery but otherwise normal appearance. ---------------- Conclusion: Calcified plaques at the right carotid bifurcation with approximately 50%. Sight stenosis at the vertebral origins, approximately 50%. Extensive diffuse atherosclerotic calcifications but no other significant stenosis.

Findings: CTA neck: There are calcified plaques but otherwise expected appearance of the top of the aortic arch and the brachiocephalic arteries. There are calcified plaques at the right carotid bifurcation extending into the bulb with approximately 50% stenosis. There is calcified plaques in the left proximal ECA but the bifurcation and ICA have no significant stenosis. The cervical ICAs are tortuous but otherwise normal. Both vertebral arteries are sizable with approximately 50% stenosis at the origins but no other apparent defect. Compared to the outside CTA on 6/22/2016 there is slight progression of the stenosis at the right carotid bifurcation. There is degenerative disc disease at C3-C6 with circumferential osteophytes. There is severe facet arthropathy at C2-C6 on the right and lesser on the left. No lytic or sclerotic lesion is seen. CTA head: There are dense calcifications in the cavernous ICAs but no significant stenosis is seen. The supraclinoid ICAs and the proximal ACAs, MCA's or PCAs are unremarkable. There is dolichoectasia of the basilar artery but otherwise normal appearance. ----------------

Findings: Image detail is degraded by motion. There are hypodensities in the posterior parietal cortices and subcortical white matter, right more prominent on the right. There may be cortical laminar necrosis on the left. Compared to the prior CT scan on 1/20/2022 the hypodensities are unchanged. The remainder of the cerebral hemispheres are essentially negative. There is minor atrophy and the ventricles are relatively small with normal appearance. The posterior fossa contents are unremarkable. There is mucosal thickening in ethmoid cells. No osseous defect is seen. ----------------

CT angiograms of the neck and head.. Clinical Information: Left-sided weakness. New jerking of left arm. Comparison: CT angiograms on 6/22/2016 Technique: During the injection of Omnipaque 350, 125 ml, per protocol, 0.67 mm mm axial scans were obtained from the aortic arch to the vertex. Sagittal, axial and coronal MIP angiograms were generated. 3-D color surface rendered angiograms were constructed on an independent workstation. DLP: 5673.10 mGy cm. Findings: CTA neck: There are calcified plaques but otherwise expected appearance of the top of the aortic arch and the brachiocephalic arteries. There are calcified plaques at the right carotid bifurcation extending into the bulb with approximately 50% stenosis. There is calcified plaques in the left proximal ECA but the bifurcation and ICA have no significant stenosis. The cervical ICAs are tortuous but otherwise normal. Both vertebral arteries are sizable with approximately 50% stenosis at the origins but no other apparent defect. Compared to the outside CTA on 6/22/2016 there is slight progression of the stenosis at the right carotid bifurcation. There is degenerative disc disease at C3-C6 with circumferential osteophytes. There is severe facet arthropathy at C2-C6 on the right and lesser on the left. No lytic or sclerotic lesion is seen. CTA head: There are dense calcifications in the cavernous ICAs but no significant stenosis is seen. The supraclinoid ICAs and the proximal ACAs, MCA's or PCAs are unremarkable. There is dolichoectasia of the basilar artery but otherwise normal appearance. ---------------- Conclusion: Calcified plaques at the right carotid bifurcation with approximately 50%. Sight stenosis at the vertebral origins, approximately 50%. Extensive diffuse atherosclerotic calcifications but no other significant stenosis.

Findings: CTA neck: There are calcified plaques but otherwise expected appearance of the top of the aortic arch and the brachiocephalic arteries. There are calcified plaques at the right carotid bifurcation extending into the bulb with approximately 50% stenosis. There is calcified plaques in the left proximal ECA but the bifurcation and ICA have no significant stenosis. The cervical ICAs are tortuous but otherwise normal. Both vertebral arteries are sizable with approximately 50% stenosis at the origins but no other apparent defect. Compared to the outside CTA on 6/22/2016 there is slight progression of the stenosis at the right carotid bifurcation. There is degenerative disc disease at C3-C6 with circumferential osteophytes. There is severe facet arthropathy at C2-C6 on the right and lesser on the left. No lytic or sclerotic lesion is seen. CTA head: There are dense calcifications in the cavernous ICAs but no significant stenosis is seen. The supraclinoid ICAs and the proximal ACAs, MCA's or PCAs are unremarkable. There is dolichoectasia of the basilar artery but otherwise normal appearance. ----------------

FINDINGS: There is an intra-arterial thrombus lodging at the left MCA bifurcation measuring 5.5 mm in length resulting abrupt cut-off of the distal M1 segment of the left MCA. Tenuous left anterior M2 branches are reconstituted from the ipsilateral anterior temporal artery. The left posterior M2 is not visualized. Minimal leptomeningeal collateral is visualized to reconstitute the left anterior/posterior M3-M4 branches. The right MCA, bilateral ACA, PCA and vertebrobasilar system are normally patent. The CCA, ICA and vertebral arteries are patent. Bilateral carotid bulbs show mild calcified atherosclerotic disease with mural thickening.

EXAM: CT Abdomen and Pelvis w contrast, CT Chest with contrast CLINICAL INFORMATION: 55-year-old male with septic shock. COMPARISON: Radiographs 1/5/2022. TECHNIQUE: CT Abdomen and Pelvis w contrast, CT Chest with contrast. Patient weight: 192 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 60 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 80 sec. Scan field of view: 392 mm. DLP: 819.90 mGy cm. (accession CT220002463), Patient weight: 192 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 60 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 80 sec. Scan field of view: 392 mm. (accession CT220002831) FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Multifocal airspace consolidation most prominent right lower lobe with surrounding groundglass opacities. HEART / VESSELS: Cardiomegaly. Right IJ approach and the left subclavian approach central venous catheters with the tips terminating in the SVC. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Numerous enlarged mediastinal nodes likely reactive. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Steatosis. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube terminates within the gastric antrum. Enteric feeding tube terminates in the third portion of the duodenum. Multiple dilated loops of small bowel filled with fluid and with air-fluid levels and a transition point within the distal ileum (series 2 image 237). The ileal loops distal to the position point are collapsed and shows air in the lumen. COLON / APPENDIX: The colon is decompressed and shows air in the lumen within the colon and rectum as well. Normal appendix. PERITONEUM / MESENTERY: Small amount of pelvic fluid. RETROPERITONEUM: Normal. VESSELS: Mild calcific atherosclerosis of the abdominal aorta and its branch vessels. URINARY BLADDER: Foley balloon within a decompressed bladder. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Tiny fat-containing umbilical hernia. Body wall subcutaneous edema. MUSCULOSKELETAL: No acute malalignment. Mild multilevel discogenic degenerative changes within the lumbar spine. CONCLUSION: 1. Small bowel obstruction with a transition point within the right flank involving the distal ileum with air in the collapsed small bowel distal to the transition point and in the colon. No evidence of pneumatosis. These findings are concerning for partial small bowel obstruction versus adynamic ileus. Correlate clinically. 2. Multifocal areas of consolidative and patchy groundglass opacities in bilateral lung, right more than left likely represent pneumonia. 3. Cardiomegaly and other incidental findings as 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 CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Multifocal airspace consolidation most prominent right lower lobe with surrounding groundglass opacities. HEART / VESSELS: Cardiomegaly. Right IJ approach and the left subclavian approach central venous catheters with the tips terminating in the SVC. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Numerous enlarged mediastinal nodes likely reactive. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Steatosis. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube terminates within the gastric antrum. Enteric feeding tube terminates in the third portion of the duodenum. Multiple dilated loops of small bowel filled with fluid and with air-fluid levels and a transition point within the distal ileum (series 2 image 237). The ileal loops distal to the position point are collapsed and shows air in the lumen. COLON / APPENDIX: The colon is decompressed and shows air in the lumen within the colon and rectum as well. Normal appendix. PERITONEUM / MESENTERY: Small amount of pelvic fluid. RETROPERITONEUM: Normal. VESSELS: Mild calcific atherosclerosis of the abdominal aorta and its branch vessels. URINARY BLADDER: Foley balloon within a decompressed bladder. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Tiny fat-containing umbilical hernia. Body wall subcutaneous edema. MUSCULOSKELETAL: No acute malalignment. Mild multilevel discogenic degenerative changes within the lumbar spine.

FINDINGS: There is an intra-arterial thrombus lodging at the left MCA bifurcation measuring 5.5 mm in length resulting abrupt cut-off of the distal M1 segment of the left MCA. Tenuous left anterior M2 branches are reconstituted from the ipsilateral anterior temporal artery. The left posterior M2 is not visualized. Minimal leptomeningeal collateral is visualized to reconstitute the left anterior/posterior M3-M4 branches. The right MCA, bilateral ACA, PCA and vertebrobasilar system are normally patent. The CCA, ICA and vertebral arteries are patent. Bilateral carotid bulbs show mild calcified atherosclerotic disease with mural thickening.

RADIOLOGIC EXAM: CT Head wo contrast, CT Cervical Spine wo contrast CLINICAL INFORMATION: mvc COMPARISON: None. TECHNIQUE: CT of the head without intravenous contrast. Following CT of the neck, reformatted images were produced to optimize visualization of the osseous structures of the cervical spine. Scan field of view: 223 mm. DLP: 1463.90 mGy cm. (accession CT220002464), Scan field of view: 216 mm. DLP: 363.90 mGy cm. (accession CT220002465) FINDINGS: HEAD: 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. The head is tilted towards the right and upwards. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. SOFT TISSUES: Normal. C-SPINE: ATLANTODENTAL INTERVAL: Normal (

FINDINGS: HEAD: 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. The head is tilted towards the right and upwards. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. SOFT TISSUES: Normal. C-SPINE: ATLANTODENTAL INTERVAL: Normal (

FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Arterial enhancing lesion in the posterior right lobe on series 4 image 71 measuring 5.1 x 4.4 cm, previously 4.1 x 4.1 cm. A left lobe lesion on image 73 measures 3.2 x 3.1 cm, previously 2.9 x 2.7 cm. A central lesion however on image 65 appears significantly less prominent compared to the prior studies. BILIARY TRACT: Normal. GALLBLADDER: Gallstones again noted. PANCREAS: Pancreatic atrophy cyst in the pancreatic tail series 9 image 89 and uncinate process cystic foci similar. SPLEEN: Normal. ADRENALS: Right adrenal nodule is unchanged as is left adrenal nodular thickening. KIDNEYS: Multiple bilateral hypoattenuating renal foci and cysts with areas of scarring, similar to prior. Hypoenhancing area in the left upper pole on series 9 image 101 is similar to slightly less prominent than previous. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Heterogeneous enlarged prostate with multiple calcifications. BODY WALL: Tiny umbilical hernia. MUSCULOSKELETAL: Multiple lucent lesions in the pelvis are similar. There is an area of vague sclerosis in the right iliac bone which is also similar in appearance. Prior spinal fusion. No definite new lesions are identified. Degenerative changes in the spine.

RADIOLOGIC EXAM: CT Head wo contrast, CT Cervical Spine wo contrast CLINICAL INFORMATION: mvc COMPARISON: None. TECHNIQUE: CT of the head without intravenous contrast. Following CT of the neck, reformatted images were produced to optimize visualization of the osseous structures of the cervical spine. Scan field of view: 223 mm. DLP: 1463.90 mGy cm. (accession CT220002464), Scan field of view: 216 mm. DLP: 363.90 mGy cm. (accession CT220002465) FINDINGS: HEAD: 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. The head is tilted towards the right and upwards. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. SOFT TISSUES: Normal. C-SPINE: ATLANTODENTAL INTERVAL: Normal (

FINDINGS: HEAD: 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. The head is tilted towards the right and upwards. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. SOFT TISSUES: Normal. C-SPINE: ATLANTODENTAL INTERVAL: Normal (

FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Small subcentimeter low-attenuation lesion in the right lobe of the thyroid and a tiny focus of calcification in the right lobe of the thyroid not significantly changed in comparison with 1/25/2021. CHEST: LUNGS / AIRWAYS / PLEURA: Left upper lobectomy changes are again seen. Mild biapical centrilobular and paraseptal emphysematous changes. No suspicious pulmonary nodules. HEART / VESSELS: Borderline heart size. Mild coronary artery calcifications. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Please note that the concurrently obtained CT scan of the Abdomen will be dictated separately. MUSCULOSKELETAL: Cervical thoracic and lower thoracic spinal fusion hardware. Old healed sternal fracture. T5 vertebral body is sclerotic changes are stable.

EXAM: CT Angio Abdomen and or Pelvis w Runoff CLINICAL INFORMATION: 80-year-old male with chronic aortic dissection and left internal iliac artery aneurysm with clinical concern for embolic event to the right lower extremity. COMPARISON: None available. TECHNIQUE: CT Angio Abdomen and or Pelvis w Runoff. Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 185 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 4 ml per sec. Scan delay: BOLUS TRACK sec. Scan field of view: 400 mm. DLP: 2837.01 mGy cm. FINDINGS: STRUCTURED REPORT: CTA Aorta Runoff VASCULATURE: DISTAL DESCENDING THORACIC AORTA: Chronic appearing aortic dissection. ABDOMINAL AORTA: Chronic aortic dissection with circumferential atherosclerotic calcification. No aneurysm. CELIAC AXIS: Likely arises from true lumen without significant stenosis. SMA: Likely arises from the true lumen without significant stenosis. RIGHT RENAL: Likely arises from the true lumen with mild ostial stenosis. There is an accessory right renal artery which supplies the lower pole. 65 LEFT RENAL: Likely arises from the false lumen with moderate ostial stenosis. There is an accessory left renal artery which supplies the lower pole. IMA: Patent. RIGHT ILIAC ARTERIES: No significant abnormality. RIGHT FEMORAL \T\ POPLITEAL ARTERIES: Femoral arteries demonstrate mild circumferential atherosclerotic calcification. The right popliteal artery appears occluded at the level of the knee. RIGHT TIBIAL AND PERONEAL ARTERIES: Appear occluded with circumferential atherosclerotic calcification. RIGHT FOOT ARTERIES: Poorly evaluated due to contrast bolus timing. LEFT ILIAC ARTERIES: Partially thrombosed aneurysm of the left internal iliac artery measuring approximately 2.2 cm in greatest diameter. Otherwise, left sided iliac arteries appear unremarkable. LEFT FEMORAL \T\ POPLITEAL ARTERIES: Femoral and popliteal arteries appear patent. LEFT TIBIAL AND PERONEAL ARTERIES: Patent proximally. Evaluation of the distal calf arteries is limited due to contrast bolus timing and circumferential atherosclerotic calcification. LEFT FOOT ARTERIES: Poorly evaluated due to contrast bolus timing. ------------------------------------------------------------- LOWER CHEST: LUNG BASES / PLEURA: Mild dependent atelectasis. No pleural effusion. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Mild multivessel coronary calcifications. Normal heart size. Leads of cardiac pacer are in place. ABDOMEN and PELVIS: LIVER: Calcified hepatic dome lesion, possibly a granuloma. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Multiple left-sided renal cysts and tiny nonobstructive calculi. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Redundant sigmoid colon. Scattered diverticula without evidence of diverticulitis.. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Mild circumferential wall thickening, possibly due to underdistention versus cystitis. REPRODUCTIVE ORGANS: Prostatomegaly. BODY WALL: Small intramuscular fluid collection superolateral to the right femoral head measures 5.5 x 3.2 cm (image 3-23, series 304). MUSCULOSKELETAL: Moderate to severe multilevel discogenic degenerative change, particularly of the lower lumbar spine where there is posterior fusion of L3-L5. No aggressive appearing osseous lesion is identified. CONCLUSION: 1. Bilateral peripheral artery disease with possible occlusion of the right popliteal artery and right calf arteries. Proper evaluation of the popliteal artery and distal calf/foot arteries is limited by contrast bolus timing. 2. Chronic aortic dissection and partially thrombosed left internal iliac aneurysm measuring up to 2.2 cm in diameter. 3. Small intramuscular fluid collection superolateral to the right femoral head, possible hematoma versus abscess. 4. Additional CT scan findings as described. 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: CTA Aorta Runoff VASCULATURE: DISTAL DESCENDING THORACIC AORTA: Chronic appearing aortic dissection. ABDOMINAL AORTA: Chronic aortic dissection with circumferential atherosclerotic calcification. No aneurysm. CELIAC AXIS: Likely arises from true lumen without significant stenosis. SMA: Likely arises from the true lumen without significant stenosis. RIGHT RENAL: Likely arises from the true lumen with mild ostial stenosis. There is an accessory right renal artery which supplies the lower pole. 65 LEFT RENAL: Likely arises from the false lumen with moderate ostial stenosis. There is an accessory left renal artery which supplies the lower pole. IMA: Patent. RIGHT ILIAC ARTERIES: No significant abnormality. RIGHT FEMORAL \T\ POPLITEAL ARTERIES: Femoral arteries demonstrate mild circumferential atherosclerotic calcification. The right popliteal artery appears occluded at the level of the knee. RIGHT TIBIAL AND PERONEAL ARTERIES: Appear occluded with circumferential atherosclerotic calcification. RIGHT FOOT ARTERIES: Poorly evaluated due to contrast bolus timing. LEFT ILIAC ARTERIES: Partially thrombosed aneurysm of the left internal iliac artery measuring approximately 2.2 cm in greatest diameter. Otherwise, left sided iliac arteries appear unremarkable. LEFT FEMORAL \T\ POPLITEAL ARTERIES: Femoral and popliteal arteries appear patent. LEFT TIBIAL AND PERONEAL ARTERIES: Patent proximally. Evaluation of the distal calf arteries is limited due to contrast bolus timing and circumferential atherosclerotic calcification. LEFT FOOT ARTERIES: Poorly evaluated due to contrast bolus timing. ------------------------------------------------------------- LOWER CHEST: LUNG BASES / PLEURA: Mild dependent atelectasis. No pleural effusion. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Mild multivessel coronary calcifications. Normal heart size. Leads of cardiac pacer are in place. ABDOMEN and PELVIS: LIVER: Calcified hepatic dome lesion, possibly a granuloma. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Multiple left-sided renal cysts and tiny nonobstructive calculi. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Redundant sigmoid colon. Scattered diverticula without evidence of diverticulitis.. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Mild circumferential wall thickening, possibly due to underdistention versus cystitis. REPRODUCTIVE ORGANS: Prostatomegaly. BODY WALL: Small intramuscular fluid collection superolateral to the right femoral head measures 5.5 x 3.2 cm (image 3-23, series 304). MUSCULOSKELETAL: Moderate to severe multilevel discogenic degenerative change, particularly of the lower lumbar spine where there is posterior fusion of L3-L5. No aggressive appearing osseous lesion is identified.

FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Dependent atelectasis. Bilateral lower lobe calcified granulomata. DISTAL ESOPHAGUS: Unremarkable. HEART / VESSELS: The visualized heart is normal in size. ABDOMEN and PELVIS: LIVER: No suspicious lesion. BILIARY TRACT: Normal. GALLBLADDER: The gallbladder is distended. PANCREAS: There is fluid and stranding adjacent to the pancreatic tail tracking down the left paracolic. SPLEEN: Scattered granulomata. ADRENALS: Normal. KIDNEYS: No hydronephrosis or suspicious mass. LYMPH NODES: Multiple prominent retroperitoneal lymph nodes. STOMACH / SMALL BOWEL: The stomach appears unremarkable. The loops of small bowel are normal in caliber. COLON / APPENDIX: No evidence of acute colonic pathology. The appendix appears unremarkable. PERITONEUM / MESENTERY: There is scattered free fluid in the abdomen. RETROPERITONEUM: Normal. VESSELS: Circumaortic left renal vein. URINARY BLADDER: Unremarkable. REPRODUCTIVE ORGANS: Unremarkable. BODY WALL: No significant abnormality. MUSCULOSKELETAL: There are degenerative changes of the spine.

EXAM: CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: Transplant hydronephrosis. COMPARISON: 12/18/2013. TECHNIQUE: CT Abdomen and Pelvis wo IV contrast. Scan field of view: 436.90 mm. DLP: 975.80 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: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: Mostly collapsed but otherwise normal. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral native kidneys are atrophic. There is mild right native hydronephrosis, similar in appearance compared to 2013. Sensitivity for the evaluation of renal parenchymal lesions is limited by noncontrast technique. Pelvic transplant kidney is noted. Double-J ureteral stent is in appropriate position. There is mild transplant hydronephrosis. No peritransplant fluid collection is visualized. 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: Intrauterine device is in place. No adnexal lesions. BODY WALL: Simple fluid collection is seen within the subcutaneous fat within the right lower quadrant which measures 3.2 x 1.9 x 4.7 cm (series 201, image 190; series 204, image 119). MUSCULOSKELETAL: No aggressive osseous lesions. CONCLUSION: 1. Right pelvic transplant kidney with double-J ureteral stent in appropriate position. There is mild transplant hydronephrosis. 2. Simple fluid collection within the subcutaneous fat overlying the right lower quadrant, likely postoperative seroma. 3. Incidental findings as above.

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 for technique. BILIARY TRACT: Normal. GALLBLADDER: Mostly collapsed but otherwise normal. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral native kidneys are atrophic. There is mild right native hydronephrosis, similar in appearance compared to 2013. Sensitivity for the evaluation of renal parenchymal lesions is limited by noncontrast technique. Pelvic transplant kidney is noted. Double-J ureteral stent is in appropriate position. There is mild transplant hydronephrosis. No peritransplant fluid collection is visualized. 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: Intrauterine device is in place. No adnexal lesions. BODY WALL: Simple fluid collection is seen within the subcutaneous fat within the right lower quadrant which measures 3.2 x 1.9 x 4.7 cm (series 201, image 190; series 204, image 119). MUSCULOSKELETAL: No aggressive 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: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Electric lead is in the right ventricle. Heart size is normal. ABDOMEN and PELVIS: LIVER: Small cyst in the right hepatic lobe is unchanged. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Left kidney is normal. Right kidney is absent. LYMPH NODES: Unchanged enlarged distal right paraesophageal lymph node measuring 2.0 x 1.5 cm. There are borderline enlarged upper retroperitoneal and central mesenteric lymph nodes. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The transverse colon is in the upper abdomen adjacent to the abdominal wall, immediately inferior to the heart. PERITONEUM / MESENTERY: Small volume of free fluid in the pelvis. RETROPERITONEUM: There is bilateral mild retroperitoneal edema. VESSELS: Moderate aortoiliac calcified atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.

EXAM: CT Neck Soft Tissue w contrast CLINICAL INFORMATION: Male patient 72 years with history of parotid cancer, Z85.818 Personal history of malignant neoplasm of other sites of lip, oral cavity, and pharynx, Z92.3 Personal history of irradiation Spec Inst: staging exam - ho surgery and XRT with multiple skin cancers TECHNIQUE: 1.25 mm thick serial axial images were obtained through the neck after the intravenous administration of contrast. Sagittal and coronal reformatted views were also obtained. Technique: Patient weight: 246 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 2 ml per sec. Scan delay: 45 sec. Scan field of view: 270 mm. DLP: 956.42 mGy cm. COMPARISON: 6/10/2021 FINDINGS: There are multiple surgical clips within the right neck. The right parotid gland has been resected. The nasopharynx appears unremarkable the oropharynx and oral cavity appear within normal limits. No mass lesion is identified within the hypopharynx or larynx. Thyroid gland is small in size without focal lesion. There is no lesion involving left parotid gland. There is no lesion involving others submandibular gland. There is no lymphadenopathy using CT size criteria. There are mild atherosclerotic calcifications involving both carotid bifurcations. There is no destructive osseous lesion. There is multilevel mild degenerative disc disease. Lungs are clear. There is a small mucous retention cyst within the left maxillary sinus. Remaining paranasal sinuses are clear. Mastoid air cells are clear. No acute abnormality is identified within the visualized brain or orbits. CONCLUSION: 01. Right parotidectomy and right internal jugular chain lymph node dissection postsurgical changes. No evidence of enhancing mass within the surgical bed. 02. No evidence of lymphadenopathy.

FINDINGS: There are multiple surgical clips within the right neck. The right parotid gland has been resected. The nasopharynx appears unremarkable the oropharynx and oral cavity appear within normal limits. No mass lesion is identified within the hypopharynx or larynx. Thyroid gland is small in size without focal lesion. There is no lesion involving left parotid gland. There is no lesion involving others submandibular gland. There is no lymphadenopathy using CT size criteria. There are mild atherosclerotic calcifications involving both carotid bifurcations. There is no destructive osseous lesion. There is multilevel mild degenerative disc disease. Lungs are clear. There is a small mucous retention cyst within the left maxillary sinus. Remaining paranasal sinuses are clear. Mastoid air cells are clear. No acute abnormality is identified within the visualized brain or orbits.

FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. Limitations: None. Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: A 12 x 8 mm right middle lobe nodule adjacent to the major fissure (image 131, series 2), previously measured 13 x 10 mm. A 3 mm left upper lobe nodule (image 72) and 4 mm right lower lobe nodule (image 117) are new from prior. Additional tiny scattered nodules in both lungs, unchanged for example a 2 mm right upper lobe subpleural nodule (image 35). Additional scattered centrilobular nodules shows waxing and waning since the prior exam, likely infectious/inflammatory in etiology. Redemonstrated bibasilar subsegmental atelectasis/scarring with small left pleural effusion/thickening. Mild diffuse bronchial wall thickening is again noted. There is interval development of scarring/atelectasis in the right lower lobe (image 184). The trachea and main bronchi are patent. Thoracic inlet, heart, and mediastinum: No new or enlarging thoracic lymphadenopathy. Small hiatal hernia. The thoracic aorta and main pulmonary arteries are normal in caliber. The overall heart size normal. No pericardial effusion. Severe scattered coronary calcification. Bones and soft tissues: No aggressive bone lesion. Left posterior rib remote fractures, similar to prior. Chest wall soft tissues are unremarkable. Upper abdomen: Unremarkable.

Radiologic Exam: CT Head wo No Charge, CT Angio Neck, CT Angio Head Code Stroke Clinical Information:COVID Confirmed Other- Spec Inst: CODE STROKE: Acute Symptoms Comparison: None. TECHNIQUE: CT Head wo No Charge, CT Angio Neck, CT Angio Head Code Stroke. 3-D CT MIP and volume rendered angiographic images were generated in post processing. During the injection of Omnipaque 350, 125 ml, per protocol, 0.67 mm axial scans were obtained from the aortic arch to the vertex. MIP angiograms were constructed from the data set. 3-D color surface rendered angiograms were constructed on an independent workstation. DLP: 1416.20 mGy cm. (DLP: 2727 mGy cm. (Accession CT220002470) DLP: 2727 mGy cm. (Accession CT220002471)Accession FINDINGS: CT OF THE HEAD WITH AND WITHOUT CONTRAST: Inferior left frontal new parenchymal hematoma. Suspected other small foci of parenchymal hemorrhage within the anterior left temporal lobe. No abnormal intracranial enhancing mass. CT ANGIOGRAM OF THE HEAD AND NECK: AORTIC ARCH AND PROXIMAL GREAT VESSELS: Evaluation of the major vessels due to photon starvation artifacts. No apparent abnormality with severe conclusion. RIGHT CAROTID: Normal. LEFT CAROTID: Normal. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Normal. RIGHT VERTEBRAL ARTERY: Normal. LEFT VERTEBRAL ARTERY: Evaluation of the V1 segment is limited due to image artifacts. Otherwise no signs of vertebral artery occlusion. BASILAR ARTERY: Normal. CT head without contrast CT head without contrast Clinical Information: COVID confirmed. CODE STROKE. CHI. Comparison: CT head on 1/5/2022 Technique: Axial helical images of the head were obtained. Coronal and sagittal reformatted images were obtained from the axial data set. During the injection of Omnipaque 350, 125 ml, per protocol, 0.67 mm axial scans were obtained from the aortic arch to the vertex. MIP angiograms were constructed from the data set. 3-D color surface rendered angiograms were constructed on an independent workstation. DLP: 1416.20 mGy cm. (DLP: 2727 mGy cm. (Accession CT220002470) DLP: 2727 mGy cm. (Accession CT220002471)Accession Findings: CT head: There is a small (1 x 1.1 cm cortical hematoma in the left frontal lobe with slight surrounding edema having the appearance of hemorrhagic contusion. This is a new finding compared to prior scan on 1/2/2022. The parenchyma is otherwise unremarkable with no visible infarct or extracerebral collection. There is preservation of gray-white margins with slight blurring. No hypodensity seen in the white matter. The ventricles are small with normal appearance. The posterior fossa contents are unremarkable. There is minor mucosal thickening in the left maxillary and sphenoid sinuses. The remainder the paranasal sinuses are clear. No defect is seen in the calvarium and skull base. CT of the neck: The top aortic arch is faintly opacified with expected appearance. The brachiocephalic arteries are obscured. The common carotid arteries and bifurcations appear normal. The cervical ICAs also appear normal. The right vertebral artery is sizable and the left is small, arising directly from the arch. Both vertebrals have expected appearance with antegrade flow. CTA Head: The precavernous ICAs, carotid siphons, supraclinoid ICAs and the proximal ACAs, MCA's and PCAs appear normal. The basilar artery is supplied by the right vertebral artery and the small left vertebral artery ends as the PICA. No aneurysm AVM or intrinsic vascular lesion is seen. ---------------- Conclusion: 1. Small left frontal hemorrhagic contusion near the pterion. 2. Essentially negative CT angiograms of the neck and head. Code stroke team paged at the time of dictation. 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 head: There is a small (1 x 1.1 cm cortical hematoma in the left frontal lobe with slight surrounding edema having the appearance of hemorrhagic contusion. This is a new finding compared to prior scan on 1/2/2022. The parenchyma is otherwise unremarkable with no visible infarct or extracerebral collection. There is preservation of gray-white margins with slight blurring. No hypodensity seen in the white matter. The ventricles are small with normal appearance. The posterior fossa contents are unremarkable. There is minor mucosal thickening in the left maxillary and sphenoid sinuses. The remainder the paranasal sinuses are clear. No defect is seen in the calvarium and skull base. CT of the neck: The top aortic arch is faintly opacified with expected appearance. The brachiocephalic arteries are obscured. The common carotid arteries and bifurcations appear normal. The cervical ICAs also appear normal. The right vertebral artery is sizable and the left is small, arising directly from the arch. Both vertebrals have expected appearance with antegrade flow. CTA Head: The precavernous ICAs, carotid siphons, supraclinoid ICAs and the proximal ACAs, MCA's and PCAs appear normal. The basilar artery is supplied by the right vertebral artery and the small left vertebral artery ends as the PICA. No aneurysm AVM or intrinsic vascular lesion is seen. ----------------

Findings: Lines and Tubes: None. Body Wall and Abdomen: Advanced disc degenerative disease at C6-C7. No destructive osseous lesions. Included portions of the upper abdomen have an unremarkable appearance. Lymph Nodes, Mediastinum and Neck: No axillary adenopathy. A few shotty bronchial lymph nodes are present bilaterally. No mediastinal adenopathy. Lungs and Pleura: No pleural effusion. There are a few scattered tiny nodules. Cluster of tiny nodules in the right lower lobe is present around image 76. Cardiovascular: No central PTE. Heart size is overall within normal limits with mildly enlarged right ventricle and right ventricular hypertrophy. The main pulmonary artery has a normal caliber. At least moderate coronary artery atherosclerotic calcifications. No pericardial effusion.

Radiologic Exam: CT Head wo No Charge, CT Angio Neck, CT Angio Head Code Stroke Clinical Information:COVID Confirmed Other- Spec Inst: CODE STROKE: Acute Symptoms Comparison: None. TECHNIQUE: CT Head wo No Charge, CT Angio Neck, CT Angio Head Code Stroke. 3-D CT MIP and volume rendered angiographic images were generated in post processing. During the injection of Omnipaque 350, 125 ml, per protocol, 0.67 mm axial scans were obtained from the aortic arch to the vertex. MIP angiograms were constructed from the data set. 3-D color surface rendered angiograms were constructed on an independent workstation. DLP: 1416.20 mGy cm. (DLP: 2727 mGy cm. (Accession CT220002470) DLP: 2727 mGy cm. (Accession CT220002471)Accession FINDINGS: CT OF THE HEAD WITH AND WITHOUT CONTRAST: Inferior left frontal new parenchymal hematoma. Suspected other small foci of parenchymal hemorrhage within the anterior left temporal lobe. No abnormal intracranial enhancing mass. CT ANGIOGRAM OF THE HEAD AND NECK: AORTIC ARCH AND PROXIMAL GREAT VESSELS: Evaluation of the major vessels due to photon starvation artifacts. No apparent abnormality with severe conclusion. RIGHT CAROTID: Normal. LEFT CAROTID: Normal. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Normal. RIGHT VERTEBRAL ARTERY: Normal. LEFT VERTEBRAL ARTERY: Evaluation of the V1 segment is limited due to image artifacts. Otherwise no signs of vertebral artery occlusion. BASILAR ARTERY: Normal. CT head without contrast CT head without contrast Clinical Information: COVID confirmed. CODE STROKE. CHI. Comparison: CT head on 1/5/2022 Technique: Axial helical images of the head were obtained. Coronal and sagittal reformatted images were obtained from the axial data set. During the injection of Omnipaque 350, 125 ml, per protocol, 0.67 mm axial scans were obtained from the aortic arch to the vertex. MIP angiograms were constructed from the data set. 3-D color surface rendered angiograms were constructed on an independent workstation. DLP: 1416.20 mGy cm. (DLP: 2727 mGy cm. (Accession CT220002470) DLP: 2727 mGy cm. (Accession CT220002471)Accession Findings: CT head: There is a small (1 x 1.1 cm cortical hematoma in the left frontal lobe with slight surrounding edema having the appearance of hemorrhagic contusion. This is a new finding compared to prior scan on 1/2/2022. The parenchyma is otherwise unremarkable with no visible infarct or extracerebral collection. There is preservation of gray-white margins with slight blurring. No hypodensity seen in the white matter. The ventricles are small with normal appearance. The posterior fossa contents are unremarkable. There is minor mucosal thickening in the left maxillary and sphenoid sinuses. The remainder the paranasal sinuses are clear. No defect is seen in the calvarium and skull base. CT of the neck: The top aortic arch is faintly opacified with expected appearance. The brachiocephalic arteries are obscured. The common carotid arteries and bifurcations appear normal. The cervical ICAs also appear normal. The right vertebral artery is sizable and the left is small, arising directly from the arch. Both vertebrals have expected appearance with antegrade flow. CTA Head: The precavernous ICAs, carotid siphons, supraclinoid ICAs and the proximal ACAs, MCA's and PCAs appear normal. The basilar artery is supplied by the right vertebral artery and the small left vertebral artery ends as the PICA. No aneurysm AVM or intrinsic vascular lesion is seen. ---------------- Conclusion: 1. Small left frontal hemorrhagic contusion near the pterion. 2. Essentially negative CT angiograms of the neck and head. Code stroke team paged at the time of dictation. 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 head: There is a small (1 x 1.1 cm cortical hematoma in the left frontal lobe with slight surrounding edema having the appearance of hemorrhagic contusion. This is a new finding compared to prior scan on 1/2/2022. The parenchyma is otherwise unremarkable with no visible infarct or extracerebral collection. There is preservation of gray-white margins with slight blurring. No hypodensity seen in the white matter. The ventricles are small with normal appearance. The posterior fossa contents are unremarkable. There is minor mucosal thickening in the left maxillary and sphenoid sinuses. The remainder the paranasal sinuses are clear. No defect is seen in the calvarium and skull base. CT of the neck: The top aortic arch is faintly opacified with expected appearance. The brachiocephalic arteries are obscured. The common carotid arteries and bifurcations appear normal. The cervical ICAs also appear normal. The right vertebral artery is sizable and the left is small, arising directly from the arch. Both vertebrals have expected appearance with antegrade flow. CTA Head: The precavernous ICAs, carotid siphons, supraclinoid ICAs and the proximal ACAs, MCA's and PCAs appear normal. The basilar artery is supplied by the right vertebral artery and the small left vertebral artery ends as the PICA. No aneurysm AVM or intrinsic vascular lesion is seen. ----------------

Findings: There is markedly decreased CBV and CBF in the left frontal and parietal lobes with predicted infarction. Color parametric maps show predicted infarction in the left frontal and parietal cortices, left MCA territory. ---------------

Radiologic Exam: CT Head wo No Charge, CT Angio Neck, CT Angio Head Code Stroke Clinical Information:COVID Confirmed Other- Spec Inst: CODE STROKE: Acute Symptoms Comparison: None. TECHNIQUE: CT Head wo No Charge, CT Angio Neck, CT Angio Head Code Stroke. 3-D CT MIP and volume rendered angiographic images were generated in post processing. During the injection of Omnipaque 350, 125 ml, per protocol, 0.67 mm axial scans were obtained from the aortic arch to the vertex. MIP angiograms were constructed from the data set. 3-D color surface rendered angiograms were constructed on an independent workstation. DLP: 1416.20 mGy cm. (DLP: 2727 mGy cm. (Accession CT220002470) DLP: 2727 mGy cm. (Accession CT220002471)Accession FINDINGS: CT OF THE HEAD WITH AND WITHOUT CONTRAST: Inferior left frontal new parenchymal hematoma. Suspected other small foci of parenchymal hemorrhage within the anterior left temporal lobe. No abnormal intracranial enhancing mass. CT ANGIOGRAM OF THE HEAD AND NECK: AORTIC ARCH AND PROXIMAL GREAT VESSELS: Evaluation of the major vessels due to photon starvation artifacts. No apparent abnormality with severe conclusion. RIGHT CAROTID: Normal. LEFT CAROTID: Normal. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Normal. RIGHT VERTEBRAL ARTERY: Normal. LEFT VERTEBRAL ARTERY: Evaluation of the V1 segment is limited due to image artifacts. Otherwise no signs of vertebral artery occlusion. BASILAR ARTERY: Normal. CT head without contrast CT head without contrast Clinical Information: COVID confirmed. CODE STROKE. CHI. Comparison: CT head on 1/5/2022 Technique: Axial helical images of the head were obtained. Coronal and sagittal reformatted images were obtained from the axial data set. During the injection of Omnipaque 350, 125 ml, per protocol, 0.67 mm axial scans were obtained from the aortic arch to the vertex. MIP angiograms were constructed from the data set. 3-D color surface rendered angiograms were constructed on an independent workstation. DLP: 1416.20 mGy cm. (DLP: 2727 mGy cm. (Accession CT220002470) DLP: 2727 mGy cm. (Accession CT220002471)Accession Findings: CT head: There is a small (1 x 1.1 cm cortical hematoma in the left frontal lobe with slight surrounding edema having the appearance of hemorrhagic contusion. This is a new finding compared to prior scan on 1/2/2022. The parenchyma is otherwise unremarkable with no visible infarct or extracerebral collection. There is preservation of gray-white margins with slight blurring. No hypodensity seen in the white matter. The ventricles are small with normal appearance. The posterior fossa contents are unremarkable. There is minor mucosal thickening in the left maxillary and sphenoid sinuses. The remainder the paranasal sinuses are clear. No defect is seen in the calvarium and skull base. CT of the neck: The top aortic arch is faintly opacified with expected appearance. The brachiocephalic arteries are obscured. The common carotid arteries and bifurcations appear normal. The cervical ICAs also appear normal. The right vertebral artery is sizable and the left is small, arising directly from the arch. Both vertebrals have expected appearance with antegrade flow. CTA Head: The precavernous ICAs, carotid siphons, supraclinoid ICAs and the proximal ACAs, MCA's and PCAs appear normal. The basilar artery is supplied by the right vertebral artery and the small left vertebral artery ends as the PICA. No aneurysm AVM or intrinsic vascular lesion is seen. ---------------- Conclusion: 1. Small left frontal hemorrhagic contusion near the pterion. 2. Essentially negative CT angiograms of the neck and head. Code stroke team paged at the time of dictation. 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 head: There is a small (1 x 1.1 cm cortical hematoma in the left frontal lobe with slight surrounding edema having the appearance of hemorrhagic contusion. This is a new finding compared to prior scan on 1/2/2022. The parenchyma is otherwise unremarkable with no visible infarct or extracerebral collection. There is preservation of gray-white margins with slight blurring. No hypodensity seen in the white matter. The ventricles are small with normal appearance. The posterior fossa contents are unremarkable. There is minor mucosal thickening in the left maxillary and sphenoid sinuses. The remainder the paranasal sinuses are clear. No defect is seen in the calvarium and skull base. CT of the neck: The top aortic arch is faintly opacified with expected appearance. The brachiocephalic arteries are obscured. The common carotid arteries and bifurcations appear normal. The cervical ICAs also appear normal. The right vertebral artery is sizable and the left is small, arising directly from the arch. Both vertebrals have expected appearance with antegrade flow. CTA Head: The precavernous ICAs, carotid siphons, supraclinoid ICAs and the proximal ACAs, MCA's and PCAs appear normal. The basilar artery is supplied by the right vertebral artery and the small left vertebral artery ends as the PICA. No aneurysm AVM or intrinsic vascular lesion is seen. ----------------

FINDINGS: STRUCTURED REPORT: CT Urogram LOWER CHEST: LUNG BASES / PLEURA: Mild atelectasis in the lung bases. There is calcified granuloma in the right lung base. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Heart size is normal. Moderate coronary calcified atherosclerosis. ABDOMEN AND PELVIS: KIDNEYS: No enhancing renal mass. UPPER URINARY TRACTS: - Calculi: No urothelial calculi. - Urothelium: No abnormal urothelial enhancement, thickening or filling defects. URINARY BLADDER: No abnormal bladder wall thickening or enhancement. No bladder mass. LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Incidental note is made of a retroaortic left renal vein. Moderate aortoiliac calcified atherosclerosis. REPRODUCTIVE ORGANS: Uterus is absent. Ovaries are normal in appearance for the patient's age. BODY WALL: Calcifications are in the superficial subcutaneous tissues of the bilateral lower ventral abdominal wall. MUSCULOSKELETAL: No significant abnormality.

CT Perfusion 1/5/2022 10:23 AM Clinical Information: COVID Confirmed stroke rule out 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: 177 lbs. IV contrast: Omnipaque 350, 40 ml, per protocol. Saline flush: 60 ml. IV contrast injection rate: 4 ml per sec. Scan delay: no delay sec. Scan field of view: 232.60 mm. DLP: 1440 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. There is no abnormal MTT, T max, CBV and CBF to suggest significant ischemia or infarction at the territory of the major intracranial arteries. Conclusion: 1. No significant ischemia or ischemic infarction at the territory of major intracranial arteries. 2. See separate head CT report for additional findings. 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. There is no abnormal MTT, T max, CBV and CBF to suggest significant ischemia or infarction at the territory of the major intracranial arteries.

FINDINGS: There is severe motion artifact. SINOCRANIAL AND SINOORBITAL JUNCTIONS: The bones adjacent to the sinuses, including the lamina papyracea, cribriform plates and fovea ethmoidalis, are intact. NASAL SEPTUM/NASAL CAVITY: There is severe left-sided nasal septal deviation with a spur formation and mucosal contact with left inferior turbinates. FRONTAL SINUSES, DRAINAGE PATHWAYS, AND ASSOCIATED ANATOMIC VARIANTS: The frontal sinuses are well developed and aerated. The frontal recesses are free of mucosal disease. ETHMOID SINUSES: The ethmoid air cells are free of mucosal disease. SPHENOID SINUSES, DRAINAGE PATHWAYS, AND ASSOCIATED VARIANTS: The sphenoid sinuses and sphenoethmoidal recesses are free of mucosal disease. The intersinus septum inserts at left carotid canal. The carotid canals are covered by bone. Pneumatization of the right anterior ethmoidal canal is seen. MAXILLARY SINUSES, DRAINAGE PATHWAYS, AND ASSOCIATED VARIANTS: Maxillary sinuses are patent. MASTOID AIR CELLS: The mastoid air cells are well developed and aerated. OTHER: Limited evaluation of the brain parenchyma is unremarkable.

CT Thoracic Spine wo contrast 1/5/2022 7:15 PM Clinical information: vertebra plana of T10 with spinal stenosis Comparison: CT thoracic spine 12/29/2021 Technique: Unenhanced axial CT of the thoracic spine coronal and sagittal reformats. Scan field of view: 216 mm. DLP: 1090 mGy cm. Findings: Redemonstration of changes of renal osteodystrophy and vertebra plana of T10 with minimal retropulsion and spinal canal narrowing, not significantly changed compared to prior thoracic spine CT from 12/29/2021. Mild kyphosis centered at T10. Partially visualized multiple blastic changes at L2. Remaining thoracic vertebrae show no acute fracture. There is interval mild worsening of bilateral pleural effusion compared to prior thoracic spine CT. Impression: No significant change of T10 vertebra plana with persistent retropulsion and mild to moderate spinal canal stenosis. Mild kyphotic deformity centered at T10. Mild worsening of bilateral pleural effusion compared to prior CT thoracic spine

Findings: Redemonstration of changes of renal osteodystrophy and vertebra plana of T10 with minimal retropulsion and spinal canal narrowing, not significantly changed compared to prior thoracic spine CT from 12/29/2021. Mild kyphosis centered at T10. Partially visualized multiple blastic changes at L2. Remaining thoracic vertebrae show no acute fracture. There is interval mild worsening of bilateral pleural effusion compared to prior thoracic spine CT.

FINDINGS: STRUCTURED REPORT: CTA Aorta Runoff VASCULATURE: Scattered aortic and pelvic branch arterial wall calcifications are present. DISTAL DESCENDING THORACIC AORTA: No significant abnormality. ABDOMINAL AORTA: No significant abnormality. CELIAC AXIS: No significant abnormality. Replaced left hepatic artery from the left gastric artery. SMA: No significant abnormality. RIGHT RENAL: No significant abnormality. LEFT RENAL: No significant abnormality. IMA: Patent. RIGHT ILIAC ARTERIES: No significant abnormality. RIGHT FEMORAL \T\ POPLITEAL ARTERIES: No significant abnormality. RIGHT TIBIAL AND PERONEAL ARTERIES: No significant abnormality. RIGHT FOOT ARTERIES: No significant abnormality. Normal three-vessel runoff. LEFT ILIAC ARTERIES: No significant abnormality. LEFT FEMORAL \T\ POPLITEAL ARTERIES: No significant abnormality. LEFT TIBIAL AND PERONEAL ARTERIES: No significant abnormality. LEFT FOOT ARTERIES: No significant abnormality. Normal three-vessel runoff. Hyperemia of the branch vessels. ------------------------------------------------------------- LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Small pericardial effusion. Otherwise normal. ABDOMEN and PELVIS: LIVER: Hepatomegaly, unchanged. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Mild splenomegaly, unchanged without focal lesion. ADRENALS: Mild left adrenal gland thickening without focal nodule. Normal right adrenal gland. KIDNEYS: Normal. LYMPH NODES: Prominent gastrohepatic ligament nodes and periportal nodes are unchanged. No new adenopathy. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Normal appendix. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Small uterine fibroid. Otherwise unremarkable. BODY WALL: Small rectus muscle diastases at the umbilical origin. Mild abdominal subcutaneous edema. MUSCULOSKELETAL: Edema and superficial stranding of the left lower extremity extends from below the knee to the foot. There is mild edema of the right foot. No drainable collection or gas in the subcutaneous tissues.

CT Coronary Calcium Scoring CT CORONARY ARTERY CALCIFICATION SCORING CLINICAL INFORMATION: 56-year-old male, presenting for screening CT scan for coronary artery calcification scoring. PALPITATIONS, R00.2 Palpitations COMPARISON: Chest radiograph 12/14/2021 TECHNIQUE: Noncontrast helical examination of the heart was performed for calcium score evaluation. TeraRecon calcium score software was used for calculation. Scan field of view: 250 mm. DLP: 53 mGy cm. FINDINGS: Using a modified Agatston scoring method, the coronary artery calcification score is 95 (LM = 0, LCx = 0, LAD = 2, RCA = 93), which corresponds to the 76th percentile for the patient's age, gender and ethnicity, using the online available MESA calcium score calculator . Cardiac chambers are normal in size. No pericardial effusion. The the visualized mediastinal great arteries are normal in caliber. There is a small sliding hiatal hernia with associated visualized mildly patulous mid and lower esophagus. No visualized pathologically enlarged intrathoracic lymph nodes. The visualized central airways are patent. Partial expiratory exam with multiple groundglass opacities, likely represent atelectasis. Small right middle lobe and left lower lobe cysts, possibly pneumatoceles. No pleural effusions could be identified. There is partially visualized right hepatic lobe hypoattenuating lesion (series 301, image 58). The limited visualization of the upper abdomen and chest wall soft tissues and skeletal structures are otherwise unremarkable, apart from mild degenerative bony changes. CONCLUSION: 1. The coronary artery calcification score is 95, consistent with a moderate risk of cardiovascular disease. 2. There is a small sliding hiatal hernia with associated visualized mildly patulous mid and lower esophagus which could be seen with gastroesophageal reflux disease or esophageal dysmotility, for clinical correlation and further evaluation if clinically warranted. 3. Partially visualized right hepatic lobe hypoattenuating lesion is incompletely evaluated on this noncontrast partially upper abdominal exam. Recommend further evaluation with a dedicated abdominal ultrasound/CT. SCORING CATEGORIES ARE AS FOLLOWS: A score of 0 indicates: No identifiable atherosclerotic plaque and very low cardiovascular disease (CVD) risk. A score of 1-10 indicates: Minimal plaque burden and low CVD risk. A score of 11-100 indicates: Mild plaque burden and moderate CVD risk. A score of 101-400 indicates: Moderate plaque burden and high CVD risk. A score of over 400 indicates: Extensive plaque burden and very high CVD risk. 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: Using a modified Agatston scoring method, the coronary artery calcification score is 95 (LM = 0, LCx = 0, LAD = 2, RCA = 93), which corresponds to the 76th percentile for the patient's age, gender and ethnicity, using the online available MESA calcium score calculator . Cardiac chambers are normal in size. No pericardial effusion. The the visualized mediastinal great arteries are normal in caliber. There is a small sliding hiatal hernia with associated visualized mildly patulous mid and lower esophagus. No visualized pathologically enlarged intrathoracic lymph nodes. The visualized central airways are patent. Partial expiratory exam with multiple groundglass opacities, likely represent atelectasis. Small right middle lobe and left lower lobe cysts, possibly pneumatoceles. No pleural effusions could be identified. There is partially visualized right hepatic lobe hypoattenuating lesion (series 301, image 58). The limited visualization of the upper abdomen and chest wall soft tissues and skeletal structures are otherwise unremarkable, apart from mild degenerative bony changes.

Findings: Sinuses and drainage pathways: Frontal sinus: Clear on both sides. Frontoethmoidal recess: Patent. Maxillary sinus: Clear. Ostiomeatal complex: Patent. Ethmoid sinus: Clear. Sphenoid sinus: Clear. Sphenoethmoidal recess: Patent. Nasal cavity: No polyp or mass. No significant variation of the nasal septum and turbinates. Olfactory fossa: Keros type 2. No bony dehiscence. Orbits: Normal Anterior cranial fossa: Unremarkable. Dentition: Unremarkable. Mandible and temporomandibular joint: Unremarkable.

EXAM: CT Chest wo contrast CLINICAL INFORMATION: 71-year-old female follow-up lymphoma COMPARISON: December 16, 2021 TECHNIQUE: CT Chest wo contrast. Scan field of view: 350 mm. DLP: 424 mGy cm. FINDINGS: The large confluent nodal mass in the left anterior mediastinum in image 25, series 3 measures approximately 34 x 33 mm, it was 49 x 45 mm before in image 35, series 601. Other more well-defined nodes in the mediastinum also have decreased in size including bilateral cardiophrenic angle confluent adenopathy. The right pleural effusion has completely resolved while the left effusion has significantly decreased in size without pneumothorax. Several tiny nodular clusters are present in the dependent both upper lobes right lower lobe, middle lobe and lingula. There is no focal lytic or sclerotic bone lesion. Heavily calcified bilateral prepectoral breast implants appear intact. CONCLUSION: 1. Interval improvement in intrathoracic lymphomatous mediastinal adenopathy. 2. Right pleural effusion has completely resolved while left has significantly decreased. 3. Several tiny nodular clusters in both lungs are nonspecific and could be due to bronchiolitis versus lymphomatous involvement of the lung parenchyma.

FINDINGS: The large confluent nodal mass in the left anterior mediastinum in image 25, series 3 measures approximately 34 x 33 mm, it was 49 x 45 mm before in image 35, series 601. Other more well-defined nodes in the mediastinum also have decreased in size including bilateral cardiophrenic angle confluent adenopathy. The right pleural effusion has completely resolved while the left effusion has significantly decreased in size without pneumothorax. Several tiny nodular clusters are present in the dependent both upper lobes right lower lobe, middle lobe and lingula. There is no focal lytic or sclerotic bone lesion. Heavily calcified bilateral prepectoral breast implants appear intact.

FINDINGS: Head: Distal internal carotid artery (ICA) : Patent. Petrous carotid artery : Patent. Cavernous carotid artery : Patent. Supraclinoid ICA : Patent. Normal visualization of ophthalmic arteries. Circle of Willis: No evidence of aneurysm. Middle cerebral artery (MCA) : Normal. Anterior cerebral artery (ACA) : Normal.. Posterior cerebral artery (PCA) : Normal. Basilar artery (BA): Normal. Dural venous sinuses and cortical veins: Unremarkable. Neck: Aortic arch: Normal great vessel origin anatomy. No great vessel origin stenosis. CCA: Normal. ICA: Normal. Vertebral artery: Normal.

EXAM: CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: Lymphoma COMPARISON: PET/CT 11/15/2021. TECHNIQUE: CT Abdomen and Pelvis wo IV contrast. Scan field of view: 350 mm. Oral contrast Omnipaque: 16.9 oz. DLP: 424 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Chest CT reported separately. ABDOMEN and PELVIS: LIVER: Normal unenhanced appearance of liver.. BILIARY TRACT: Normal. GALLBLADDER: Contracted gallbladder PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: Confluent left para-aortic mass with corresponding FDG uptake represents known lymphoma. Additional small para-aortic nodules are also visualized, similar in appearance to recent CT. Small calcified mesenteric nodules in the right lower quadrant.. STOMACH / SMALL BOWEL: Persistent marked irregular gastric wall thickening consistent with known lymphomatous involvement. Contrast has progressed to the distal small bowel loops. No abnormal dilatation of small bowel loops. COLON / APPENDIX: Small to moderate colonic stool burden. No abnormal colonic distention PERITONEUM / MESENTERY: No ascites or pneumoperitoneum. There is mild omental nodularity and stranding in the left upper quadrant and midline abdomen RETROPERITONEUM: Normal. VESSELS: Bilobed saccular aneurysmal dilatation of suprarenal aorta, measuring about 3.5 x 3.1 cm (series 3/image 175). Inferiorly a saccular aneurysm on the left lateral aspect of the aorta measures about 1.6 x 1.4 cm (series 3/image 192). Moderate aortic calcifications. URINARY BLADDER: Partially distended REPRODUCTIVE ORGANS: Uterus is not enlarged in size. There is a 4.1 cm sized left ovarian dermoid cyst in the left anterior hemipelvis. No pelvic fluid collection. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Generalized bony demineralization. Lumbar vertebrae demonstrate normal height and multilevel degenerative changes. No acute osseous findings. CONCLUSION: 1. Marked diffuse gastric wall thickening along with left para-aortic adenopathy consistent with known lymphoma. 2. Diffuse omental nodularity/stranding in the central abdomen left upper quadrant, most suggestive of lymphoma. 3. Other incidental/chronic findings as described above including bilobed saccular aneurysm of suprarenal aorta. Left ovarian dermoid cyst. Chest CT is reported separately.

FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Chest CT reported separately. ABDOMEN and PELVIS: LIVER: Normal unenhanced appearance of liver.. BILIARY TRACT: Normal. GALLBLADDER: Contracted gallbladder PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: Confluent left para-aortic mass with corresponding FDG uptake represents known lymphoma. Additional small para-aortic nodules are also visualized, similar in appearance to recent CT. Small calcified mesenteric nodules in the right lower quadrant.. STOMACH / SMALL BOWEL: Persistent marked irregular gastric wall thickening consistent with known lymphomatous involvement. Contrast has progressed to the distal small bowel loops. No abnormal dilatation of small bowel loops. COLON / APPENDIX: Small to moderate colonic stool burden. No abnormal colonic distention PERITONEUM / MESENTERY: No ascites or pneumoperitoneum. There is mild omental nodularity and stranding in the left upper quadrant and midline abdomen RETROPERITONEUM: Normal. VESSELS: Bilobed saccular aneurysmal dilatation of suprarenal aorta, measuring about 3.5 x 3.1 cm (series 3/image 175). Inferiorly a saccular aneurysm on the left lateral aspect of the aorta measures about 1.6 x 1.4 cm (series 3/image 192). Moderate aortic calcifications. URINARY BLADDER: Partially distended REPRODUCTIVE ORGANS: Uterus is not enlarged in size. There is a 4.1 cm sized left ovarian dermoid cyst in the left anterior hemipelvis. No pelvic fluid collection. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Generalized bony demineralization. Lumbar vertebrae demonstrate normal height and multilevel degenerative changes. No acute osseous findings.

FINDINGS: Head: Distal internal carotid artery (ICA) : Patent. Petrous carotid artery : Patent. Cavernous carotid artery : Patent. Supraclinoid ICA : Patent. Normal visualization of ophthalmic arteries. Circle of Willis: No evidence of aneurysm. Middle cerebral artery (MCA) : Normal. Anterior cerebral artery (ACA) : Normal.. Posterior cerebral artery (PCA) : Normal. Basilar artery (BA): Normal. Dural venous sinuses and cortical veins: Unremarkable. Neck: Aortic arch: Normal great vessel origin anatomy. No great vessel origin stenosis. CCA: Normal. ICA: Normal. Vertebral artery: Normal.

CT angiogram of the head with contrast CT angiogram of the neck with contrast Indication: R arm sensation changes Comparison: Concurrent noncontrast CT of the head. No prior exams for comparison Technique: After the administration of IV contrast bolus, thin slice axial images were obtained from the thoracic inlet to the vertex. Delayed contrast enhanced axial images were then performed from the base of the skull to the vertex. 3-D CT MIP and Volume rendered angiographic images were generated in postprocessing from the axial data set. Patient weight: 180 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: 244 mm. DLP: 3218 mGy cm. Findings: CT angiogram of the head: There is no flow-limiting stenosis involving the intracranial segments of the internal carotid, basilar artery, arteries of the circle of Willis and proximal branches of anterior, middle and posterior cerebral arteries. The left A1 segment is hypoplastic. There is no evidence of aneurysm or AVM. CT angiogram of the neck: Venous contamination mildly limits evaluation. Normal three-vessel aortic arch. The bilateral common carotid, internal carotid, and vertebral arteries are patent with no flow-limiting stenosis, occlusion, or evidence of dissection. Nonangiographic findings: The visualized upper lungs are clear. A few tiny subcentimeter thyroid nodules are incidentally noted. Thyroid gland is otherwise unremarkable. Soft tissues of the neck appear normal. No pathologic cervical adenopathy. Impression: No flow limiting stenosis or occlusion of the major craniocervical arteries. Unremarkable CTA of the head and neck.

Findings: CT angiogram of the head: There is no flow-limiting stenosis involving the intracranial segments of the internal carotid, basilar artery, arteries of the circle of Willis and proximal branches of anterior, middle and posterior cerebral arteries. The left A1 segment is hypoplastic. There is no evidence of aneurysm or AVM. CT angiogram of the neck: Venous contamination mildly limits evaluation. Normal three-vessel aortic arch. The bilateral common carotid, internal carotid, and vertebral arteries are patent with no flow-limiting stenosis, occlusion, or evidence of dissection. Nonangiographic findings: The visualized upper lungs are clear. A few tiny subcentimeter thyroid nodules are incidentally noted. Thyroid gland is otherwise unremarkable. Soft tissues of the neck appear normal. No pathologic cervical adenopathy.

FINDINGS: Scouts: No additional findings. A - Vascular structures: Cardiovascular: Postsurgical changes from prior d-TGA repair with dilated and trabeculated right atrium and ventricle with mild bowing of the interventricular septum. Borderline dilated left ventricle. Postsurgical changes from prior membranous VSD repair are redemonstrated with no definite residual defect. Redemonstration of small interatrial communication between the left atrium and right atrial appendage (series 2 image 110). All four pulmonary veins drain into the left atrium. SVC and IVC seen draining into the right atrium. Unchanged appearance of partially calcified right ventricle to main pulmonary artery conduit with unchanged mild narrowing at the site of anastomosis. Distal main pulmonary artery and its branches are widely patent. Mild dilation of the mid ascending aorta is unchanged. No acute aortic abnormality. Common origin of the right brachycephalic and left common carotid arteries, normal variant. Occluded left BTT shunt again seen. Clockwise rotation of the aortic root again seen with left circumflex artery arising posteriorly from the left aortic sinus. Right coronary sinus gives rise to left anterior descending artery which runs between the native pulmonic root and the RV to PA conduit. Right coronary arteries courses along the anterior wall of the right ventricle. Coronary artery atherosclerotic calcification: None detected. Aortic measurements are as follows: Aortic root: level of the sinuses: 38 x 38 x 36 mm. Mid-ascending thoracic aorta: 37 x 35 mm. Aortic arch: 28 x 24 mm. Proximal descending thoracic aorta: 20 x 18 mm. Mid descending thoracic aorta: 18 x 16 mm. Distal descending thoracic aorta: 19 x 17 mm. B - Nonvascular structures: Lines and tubes: None. Lungs and pleura: No pulmonary consolidation. No central endobronchial masses. No pleural effusion. No pneumothorax. Esophagus, Mediastinum and neck: Mild fluid distention in the distal esophagus. No abnormality in the mediastinum. The thyroid gland is partially visualized. Surgical staples in the visualized right neck. Lymph Nodes: None enlarged. Abdomen: Please refer to same day CT abdomen report for detailed findings below the diaphragm. Musculoskeletal/Body Wall: No soft tissue masses. No aggressive appearing skeletal lesions. Postsurgical changes from prior remote sternotomy with intact wires. Bilateral gynecomastia.

CT angiogram of the head with contrast CT angiogram of the neck with contrast Indication: R arm sensation changes Comparison: Concurrent noncontrast CT of the head. No prior exams for comparison Technique: After the administration of IV contrast bolus, thin slice axial images were obtained from the thoracic inlet to the vertex. Delayed contrast enhanced axial images were then performed from the base of the skull to the vertex. 3-D CT MIP and Volume rendered angiographic images were generated in postprocessing from the axial data set. Patient weight: 180 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: 244 mm. DLP: 3218 mGy cm. Findings: CT angiogram of the head: There is no flow-limiting stenosis involving the intracranial segments of the internal carotid, basilar artery, arteries of the circle of Willis and proximal branches of anterior, middle and posterior cerebral arteries. The left A1 segment is hypoplastic. There is no evidence of aneurysm or AVM. CT angiogram of the neck: Venous contamination mildly limits evaluation. Normal three-vessel aortic arch. The bilateral common carotid, internal carotid, and vertebral arteries are patent with no flow-limiting stenosis, occlusion, or evidence of dissection. Nonangiographic findings: The visualized upper lungs are clear. A few tiny subcentimeter thyroid nodules are incidentally noted. Thyroid gland is otherwise unremarkable. Soft tissues of the neck appear normal. No pathologic cervical adenopathy. Impression: No flow limiting stenosis or occlusion of the major craniocervical arteries. Unremarkable CTA of the head and neck.

Findings: CT angiogram of the head: There is no flow-limiting stenosis involving the intracranial segments of the internal carotid, basilar artery, arteries of the circle of Willis and proximal branches of anterior, middle and posterior cerebral arteries. The left A1 segment is hypoplastic. There is no evidence of aneurysm or AVM. CT angiogram of the neck: Venous contamination mildly limits evaluation. Normal three-vessel aortic arch. The bilateral common carotid, internal carotid, and vertebral arteries are patent with no flow-limiting stenosis, occlusion, or evidence of dissection. Nonangiographic findings: The visualized upper lungs are clear. A few tiny subcentimeter thyroid nodules are incidentally noted. Thyroid gland is otherwise unremarkable. Soft tissues of the neck appear normal. No pathologic cervical adenopathy.

FINDINGS: STRUCTURED REPORT: CTA Abdomen Pelvis VASCULATURE: DISTAL DESCENDING THORACIC AORTA: No significant abnormality. ABDOMINAL AORTA: Minimal noncalcified atherosclerotic disease of the infrarenal abdominal aorta, which is normal in caliber. CELIAC AXIS: No significant abnormality. SMA: No significant abnormality. RIGHT RENAL: Patent main and accessory right renal arteries. LEFT RENAL: No significant abnormality. IMA: No significant abnormality. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. ------------------------------------------------------------- ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. 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. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.

CT Head wo contrast CLINICAL INFORMATION: R arm sensation changes COMPARISON: None TECHNIQUE: CT Head wo contrastScan field of view: 237 mm. DLP: 1219 mGy cm. STRUCTURED REPORT: CT Head FINDINGS: BRAIN PARENCHYMA: No hemorrhage, intracranial mass, large territory infarct, or edema. Gray-white matter differentiation maintained. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. No aggressive osseous lesion. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. CONCLUSION: No acute intracranial process.

FINDINGS: BRAIN PARENCHYMA: No hemorrhage, intracranial mass, large territory infarct, or edema. Gray-white matter differentiation maintained. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. No aggressive osseous lesion. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal.

FINDINGS: SINOCRANIAL AND SINOORBITAL JUNCTIONS: The bones adjacent to the sinuses, including the lamina papyracea, cribriform plates and fovea ethmoidalis, are intact. There is Keros anatomy type II bilaterally. NASAL SEPTUM/NASAL CAVITY: There is moderate right-sided deviation involving the anterior portion of the nasal septum. FRONTAL SINUSES, DRAINAGE PATHWAYS, AND ASSOCIATED ANATOMIC VARIANTS: Mucosal thickening in the frontal sinuses is suggestive for sinusitis. Frontal recesses are occluded. ETHMOID SINUSES: Near complete opacification of the ethmoidal air cells is suggestive for sinusitis. SPHENOID SINUSES, DRAINAGE PATHWAYS, AND ASSOCIATED VARIANTS: Mucosal thickening of the sphenoidal air cells is suggestive for sinusitis. The intersinus septum inserts at left carotid canal. Dehiscence of bilateral carotid canals is seen. There is a persistent focus of hyperdensity within the left the sphenoidal sinus in favor of antrolith versus sequela of allergic fungal infection. Mild hyperdensity within the right sphenoidal air cell may represent inspissated secretion however superimposed allergic fungal infection cannot be excluded. MAXILLARY SINUSES, DRAINAGE PATHWAYS, AND ASSOCIATED VARIANTS: Mucosal thickening in the maxillary sinuses is suggestive for sinusitis. The OMCs are occluded. MASTOID AIR CELLS: The mastoid air cells are well developed and aerated. OTHER: Limited evaluation of the brain parenchyma is unremarkable.

CT perfusion Indication: Stroke. Comparison: Technique: A CT perfusion study was acquired during single pass of 40 cc contrast bolus. Axial images were generated through the cerebrum only at 16 axial locations and time-attenuation curves generated from this dataset were utilized to calculate cerebral blood flow, mean transit time, Tmax, and cerebral blood volume. Regions of >70% CBF reduction are labeled as red. Regions of Tmax prolongation greater than 6 sec are labeled green. Please note that infarcted regions with very low attenuation may not be labeled red despite decreased CBF to avoid color- labeling remote infarcts. Normalized CBF on delayed perfusion scans does not exclude completed infarction. IV contrast: Omnipaque 350, 40 ml, per protocol. DLP: 1965 mGy cm. Findings: The perfusion scan is essentially negative with no increased CBV or CBF. There is 7 mm of Tmax greater than 4 seconds, likely artifactual. --------------- Conclusion: Normal CT perfusion scan of the brain.

Findings: The perfusion scan is essentially negative with no increased CBV or CBF. There is 7 mm of Tmax greater than 4 seconds, likely artifactual. ---------------

FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. Tip of the left-sided port catheter is in the mid SVC. Tip of the right IJ line is at the SVC atrial junction. The hila are difficult to evaluate without contrast. No enlarged intrathoracic lymph nodes are identified. Minimal calcific atherosclerosis is seen in the aorta and coronary arteries. The main pulmonary artery is again noted to be dilated at 34 mm. There is some increased pericardial thickening particularly in the anterior pericardium. Within the limits of a noncontrast exam, the heart size and the mediastinum are otherwise normal. No pleural effusion. The previously seen RML nodule was measured is not identified on the current exam. A groundglass nodule is seen in the inferior RUL on series 4 image 58 but appears to be secretions in the bronchus. A tiny RUL subpleural nodule on image 32 is unchanged. No additional nodules or masses are identified. Bilateral bronchial wall thickening is present increased over the prior exams particularly in the left lower lobe. Small amount secretions is seen layering in the trachea. Enlarged spleen with the small area of peripheral linear calcification is redemonstrated. Limited noncontrast images of the upper abdomen are otherwise unremarkable. Anterior wedging at T5 is unchanged from the previous exam. No acute or destructive osseous lesion is identified.

RADIOLOGIC EXAM: CT Head wo contrast CLINICAL INFORMATION: new seizure activity COMPARISON: None. TECHNIQUE: CT of the head without intravenous contrast. Scan field of view: 249 mm. DLP: 1252.70 mGy cm. 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. Mega cisterna magna incidentally noted. ORBITS: Normal. SINUSES: Normal. SOFT TISSUES: Normal. CONCLUSION: No acute intracranial process. 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. Mega cisterna magna incidentally noted. ORBITS: Normal. SINUSES: Normal. SOFT TISSUES: Normal.

Findings: There are interval postsurgical changes from removal of previous L4-5 posterior fixation hardware with placement of new L5-S1 hardware. Prior left L4-5 laminectomy changes are noted. The hardware is intact. Bilateral S1 screws extend beyond the cortex with the left-sided screw appearing to extend beyond the posterior aspect of the left common iliac vein, indenting or extending into the vein. The L4-5 disc space there is unchanged in position with a new L5-S1 disc spacer in place which is seen in an oblique orientation along the left side of the disc space. There is no acute lumbar spine fracture There is an intrathecal catheter in place along the posterior margin of the spinal canal entering at the L1 level. There is grade 1 anterolisthesis of L5 over S1, slightly improved alignment compared to previously. There is mild retrolisthesis of L3 over L4 with a disc bulge causing mild spinal canal narrowing with moderate bilateral foraminal narrowing. There are mild degenerative changes along the SI joint. There is osseous remodeling of the spinal canal at the S2 level, possibly Tarlov cysts. There are partially visualized cystic structures within the visualized liver, possible hepatic cysts. ----------------

EXAM: CT Angio Chest wo+w contrast CLINICAL INFORMATION: Follow Up Aortic Injury. 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: 177 lbs. IV contrast: Omnipaque 350, 60 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracking Scan field of view: 393.50 mm. KVP: 120 DLP: 421.40 mGy cm. FINDINGS: STRUCTURED REPORT: CTA Chest VASCULATURE: As follows. CORONARY ARTERIES: There are no atherosclerotic calcifications of the native coronary arteries. PULMONARY ARTERIES: No central pulmonary embolus. ASCENDING THORACIC AORTA: No significant abnormality. AORTIC ARCH: No significant abnormality. ARCH VESSELS: No significant abnormality. DESCENDING THORACIC AORTA: No significant abnormality. UPPER ABDOMINAL AORTA: No significant abnormality. Limited by streak artifact. ------------------------------------------------------------- LOWER NECK: An endotracheal tube terminates in the lower thoracic trachea 1.5 cm above the carina. CHEST: LUNGS / AIRWAYS / PLEURA: A left-sided pleural effusion has increased and is now moderate to large in size. No definitive hemothorax allowing for limitations of streak artifact. The right pleural space is clear. No pneumothorax. Left upper lobe consolidation has improved. New scattered patchy consolidative airspace opacities most pronounced in the right upper lobe and right lung base. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Stable retrosternal hematoma. LYMPH NODES: None enlarged. CHEST WALL: Edema / hematoma within the anterior chest wall. UPPER ABDOMEN: High density material within the stomach limits evaluation resulting in streak artifact. A left perinephric hematoma is partially visualized. Limited evaluation of the spleen. MUSCULOSKELETAL: Similar appearance of a non-displaced upper oblique sternal fracture. CONCLUSION: 1. No evidence of thoracic aortic injury. A left perinephric/subcaspular hematoma is incompletely evaluated on today's examination. 2. Increased moderate to large left pleural effusion without definitive hemothorax. 3. New patchy consolidative airspace opacities most pronounced in the right upper lobe which is possibly inflammatory versus infectious in nature. Improving left upper lobe consolidation. 4. Endotracheal tube terminates in the lower thoracic trachea approximately 1.5 cm above the carina. This can be retracted 2 to 3 cm for optimal positioning. 5. Sternal fracture with stable retrosternal hematoma.

FINDINGS: STRUCTURED REPORT: CTA Chest VASCULATURE: As follows. CORONARY ARTERIES: There are no atherosclerotic calcifications of the native coronary arteries. PULMONARY ARTERIES: No central pulmonary embolus. ASCENDING THORACIC AORTA: No significant abnormality. AORTIC ARCH: No significant abnormality. ARCH VESSELS: No significant abnormality. DESCENDING THORACIC AORTA: No significant abnormality. UPPER ABDOMINAL AORTA: No significant abnormality. Limited by streak artifact. ------------------------------------------------------------- LOWER NECK: An endotracheal tube terminates in the lower thoracic trachea 1.5 cm above the carina. CHEST: LUNGS / AIRWAYS / PLEURA: A left-sided pleural effusion has increased and is now moderate to large in size. No definitive hemothorax allowing for limitations of streak artifact. The right pleural space is clear. No pneumothorax. Left upper lobe consolidation has improved. New scattered patchy consolidative airspace opacities most pronounced in the right upper lobe and right lung base. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Stable retrosternal hematoma. LYMPH NODES: None enlarged. CHEST WALL: Edema / hematoma within the anterior chest wall. UPPER ABDOMEN: High density material within the stomach limits evaluation resulting in streak artifact. A left perinephric hematoma is partially visualized. Limited evaluation of the spleen. MUSCULOSKELETAL: Similar appearance of a non-displaced upper oblique sternal fracture.

FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Moderately suboptimal quality with incomplete evaluation of segmental and subsegmental pulmonary arteries. LOWER NECK: Foci of gas within the proximal right internal jugular vein, likely iatrogenic. CHEST: PULMONARY ARTERIES: Positive for pulmonary embolus. - Pulmonary Embolus Distribution: Nonobstructing an obstructing segmental pulmonary emboli at the left lower lobe involving most of the branches distally. - Pulmonary Artery Diameter: Slightly enlarged reaching 3.3 cm. - Ascending Aortic Diameter: Normal. - RV:LV Ratio: Normal. - Interventricular Septum: Normal. - Contrast reflux into IVC: There is contrast into the inferior vena cava extending into the intrahepatic veins. LUNGS / AIRWAYS / PLEURA: Small right and trace left layering pleural effusions with associated passive atelectasis. Moderate upper lobe-predominant mixed paraseptal and centrilobular emphysema. No pneumothorax. HEART / OTHER VESSELS: Mild cardiomegaly. Small pericardial effusion. Normal thoracic aortic caliber. Mildly enlarged main pulmonary artery trunk up to 3.3 cm. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Moderately enlarged paratracheal, subcarinal, and periaortic nodes up to 1.6 cm (series 908, images 42, 47, 51). CHEST WALL: Diffuse anasarca. UPPER ABDOMEN: Mild hepatomegaly without cirrhotic morphology. MUSCULOSKELETAL: Multilevel upper cervicothoracic spine degenerative changes. No aggressive osseous lesion.

EXAM: CT Abdomen wo+w contrast CLINICAL INFORMATION: History of HCC status post TACE and ablation. COMPARISON: 10/27/2021. TECHNIQUE: CT Abdomen wo+w contrast. Patient weight: 160 lbs. IV contrast: Omnipaque 350, 143 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: bt/80 sec. Scan field of view: 340 mm. DLP: 1224.18 mGy cm. FINDINGS: STRUCTURED REPORT: CT HCC Follow-up IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. No steatosis. TREATED LIVER LESIONS: - Lesion Number: 1 - Description: Post TACE changes redemonstrated. - Location: Segment(s) 7 - Size: 4.5 x 4.2 cm (series 13, image 62), previously 4.9 x 4.3 cm - Enhancement: No lesional enhancement - Additional features: - Arterial phase hyperenhancement: Not present. - Washout: Not present. - Enhancement similar to pretreatment: Not present. - Vascular invasion: No - LI-RADS: LR-TR Nonviable - Lesion Number: 2 - Description: Percutaneous ablation defect within the inferior right hepatic lobe. - Location: Segment(s) 7 - Size: 5.4 x 3.5 cm (series 11, image 85) - Enhancement: No lesional enhancement - Additional features: - Arterial phase hyperenhancement: Not present. - Washout: Not present. - Enhancement similar to pretreatment: Not present. - Vascular invasion: No - LI-RADS: LR-TR Nonviable UNTREATED OR NEW LIVER LESION(S): No new arterial hyperenhancement or regions of delayed washout are visualized. LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent. Replaced right hepatic arises from the SMA. Accessory left hepatic artery arising from the left gastric. - Portal venous system: Patent intra- and extra-hepatic portal venous system. TIPS is patent. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: None. - Other varices or collaterals: Perigastric collaterals. Few mesenteric venous collaterals. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: Cholelithiasis. No wall thickening or pericholecystic fluid. LYMPH NODES: Borderline enlarged periportal lymph nodes. SPLEEN: Splenomegaly. PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Numerous bilateral renal cysts. Otherwise, bilateral kidneys are normal without hydronephrosis. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: Significant atherosclerotic disease of the abdominal aorta which is normal in caliber. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous lesions. CONCLUSION: 1. Post treatment change within the right hepatic lobe consistent with prior TACE and ablations. No suspicious enhancement to suggest residual malignancy (LR-TR nonviable). No new suspicious hepatic lesions. 2. Hepatic cirrhosis with sequelae of portal hypertension with patent TIPS. 3. Chronic and incidental findings as above.

FINDINGS: STRUCTURED REPORT: CT HCC Follow-up IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. No steatosis. TREATED LIVER LESIONS: - Lesion Number: 1 - Description: Post TACE changes redemonstrated. - Location: Segment(s) 7 - Size: 4.5 x 4.2 cm (series 13, image 62), previously 4.9 x 4.3 cm - Enhancement: No lesional enhancement - Additional features: - Arterial phase hyperenhancement: Not present. - Washout: Not present. - Enhancement similar to pretreatment: Not present. - Vascular invasion: No - LI-RADS: LR-TR Nonviable - Lesion Number: 2 - Description: Percutaneous ablation defect within the inferior right hepatic lobe. - Location: Segment(s) 7 - Size: 5.4 x 3.5 cm (series 11, image 85) - Enhancement: No lesional enhancement - Additional features: - Arterial phase hyperenhancement: Not present. - Washout: Not present. - Enhancement similar to pretreatment: Not present. - Vascular invasion: No - LI-RADS: LR-TR Nonviable UNTREATED OR NEW LIVER LESION(S): No new arterial hyperenhancement or regions of delayed washout are visualized. LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent. Replaced right hepatic arises from the SMA. Accessory left hepatic artery arising from the left gastric. - Portal venous system: Patent intra- and extra-hepatic portal venous system. TIPS is patent. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: None. - Other varices or collaterals: Perigastric collaterals. Few mesenteric venous collaterals. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: Cholelithiasis. No wall thickening or pericholecystic fluid. LYMPH NODES: Borderline enlarged periportal lymph nodes. SPLEEN: Splenomegaly. PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Numerous bilateral renal cysts. Otherwise, bilateral kidneys are normal without hydronephrosis. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: Significant atherosclerotic disease of the abdominal aorta which is normal in caliber. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous lesions.

FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Chest CT is requested separately. ABDOMEN and PELVIS: LIVER: Stable subcentimeter hypodensity in the medial segment of left lobe, too small to characterize, probably simple cyst. Liver is otherwise unremarkable. BILIARY TRACT: Normal. GALLBLADDER: Stable gallbladder polyp measuring about 1.6 cm. No cholelithiasis. No abnormal gallbladder wall thickening. PANCREAS: Confluent soft tissue mass in the anterior aspect of the pancreatic tail and extending along the greater gastric curvature, appears to have decreased in size and measures about 4.0 x 4.0 cm (series 3/image 97), previously about 5.4 x 4.2 cm. SPLEEN: Stable appearance of spleen. Stable focal tumor extension into the mid splenic parenchyma. ADRENALS: Normal. KIDNEYS: Left kidney is partially displaced inferiorly by the enlarged left subcarinal mass. Both kidneys otherwise demonstrate symmetric enhancement. There is stable small simple right lower pole renal cyst. No radiopaque calculus, hydronephrosis or hydroureter. Nonspecific bilateral perinephric stranding without any discrete fluid collection. LYMPH NODES: Several stable subcentimeter periportal/gastrohepatic lymph nodes. STOMACH / SMALL BOWEL: Stomach is partially distended. There are several dilated congested centimeters of intravenous physis along the greater gastric curvature. There is no abnormal dilatation of small bowel loops. COLON / APPENDIX: Uncomplicated colonic diverticulosis. PERITONEUM / MESENTERY: Stable trace pelvic free fluid. No pneumoperitoneum. RETROPERITONEUM: Retroperitoneal nodular masses as seen before, the dominant left suprarenal mass measuring about 12 x 10 cm on series 3/image 207, previously about 11.5 x 10.5 cm. Additional multiple nodular masses in the anterior left perinephric space, adjacent to the lower splenic parenchyma and nodular mass extending into the left lung base as seen before. No new/enlarging retroperitoneal nodules. VESSELS: Aorta is nonaneurysmal. Several gastrohepatic and submucosal venous varices are seen. Main portal, splenic and spin mesenteric veins and hepatic veins are patent. URINARY BLADDER: Partially distended REPRODUCTIVE ORGANS: Prostate gland is not seen BODY WALL: There is small fat and fluid containing right inguinal hernia MUSCULOSKELETAL: Multilevel degenerative changes in the lumbar spine. Lumbar vertebrae demonstrate normal height. No destructive osseous lesions.

EXAM: CT Chest High Resolution wo contrast CLINICAL INFORMATION: 64-year-old female, with history of COPD, evaluation for interstitial lung disease. COMPARISON: Lung cancer screening CT dated 2/20/2017. TECHNIQUE: CT Chest High Resolution wo contrast. Scan field of view: 302 mm. DLP: 122 mGy cm. High-resolution CT imaging of the chest was performed per protocol with inspiratory and expiratory technique in supine position. FINDINGS: LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. Moderate predominantly centrilobular emphysema. Mild bronchial wall thickening and bilateral lower lobe bronchiectasis again seen with some of the peripheral bronchi with mucous plugging. A 3 mm right lung base nodule on axial image 180; series 3, was previously 3 mm. No suspicious pulmonary nodule. No peripheral reticulations or honeycombing is identified. Prominent focal pleural fat/lipoma in the left. Limited expiratory mages. Cannot evaluate for tracheobronchomalacia are at trapping. HEART / VESSELS: Right ventricle appears dilated. Pulmonary arteries normal in caliber. Normal caliber thoracic aorta. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: A few scattered nonenlarged mediastinal lymph nodes, appear similar to prior study. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Small volume excreted contrast from recent abdomen CT in the left renal pelvis. MUSCULOSKELETAL: No destructive osseous lesion. CONCLUSION: 1. No evidence of interstitial lung disease. 2. Moderate predominantly centrilobular emphysema with mild diffuse bronchial wall thickening and lower lobe bronchiectasis with some of the bronchi containing mucous plugging/secretions. 3. 3 mm right lung base nodule, overall unchanged from 2017 and represents a benign nodule. 4. Incidental findings as above.

FINDINGS: LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. Moderate predominantly centrilobular emphysema. Mild bronchial wall thickening and bilateral lower lobe bronchiectasis again seen with some of the peripheral bronchi with mucous plugging. A 3 mm right lung base nodule on axial image 180; series 3, was previously 3 mm. No suspicious pulmonary nodule. No peripheral reticulations or honeycombing is identified. Prominent focal pleural fat/lipoma in the left. Limited expiratory mages. Cannot evaluate for tracheobronchomalacia are at trapping. HEART / VESSELS: Right ventricle appears dilated. Pulmonary arteries normal in caliber. Normal caliber thoracic aorta. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: A few scattered nonenlarged mediastinal lymph nodes, appear similar to prior study. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Small volume excreted contrast from recent abdomen CT in the left renal pelvis. MUSCULOSKELETAL: No destructive osseous lesion.

FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Interval postsurgical changes of left hemithyroidectomy. Unremarkable appearance of the right lobe of the thyroid. CHEST: LUNGS / AIRWAYS / PLEURA: Redemonstration of a heterogenous soft tissue mass in the left lower lobe, currently measuring about 11.0 x 9.6 cm (series 3; image 143), previously about 10.5 x 9.9 cm at a comparable level.. Tiny subcentimeter nodules along the bilateral fissures and a tiny nodule in the left upper lobe (series 3; image 63) are not significantly changed. HEART / VESSELS: The left lower lobe mass abuts the left heart border posteriorly. A right chest port terminates near the cavoatrial junction. Trace pericardial effusion. MEDIASTINUM / ESOPHAGUS: Left lower lobe mass appears to be adjacent to the esophagus although there is a fat plane separating the 2. LYMPH NODES: A prominent subcarinal lymph node measures up to 1.3 cm in short axis, not significantly changed. An atypical high right paratracheal lymph node measures up to 0.8 cm in short axis, also not significantly changed. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Please note that the concurrently obtained CT scan of the Abdomen will be dictated separately. MUSCULOSKELETAL: Faint nonspecific tiny sclerotic changes in the left third rib laterally are stable.

EXAM: CT Chest with contrast CLINICAL INFORMATION: 64-year-old male with head and neck malignancy. COMPARISON: MR thoracic spine dated 9/16/2021, FDG PET/CT dated 9/8/2021. CT chest with contrast dated 4/25/2019.. TECHNIQUE: CT Chest with contrast. Patient weight: 269 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 2 ml per sec. Scan delay: 100 sec. Scan field of view: 480 mm. DLP: 1549 mGy cm. FINDINGS: LOWER NECK: No significant soft tissue abnormality. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. A few noncalcified pulmonary nodules in the right middle lobe, superior segment right lower lobe, unchanged from April 2019. A few mixed attenuation opacities in the lung bases, likely infectious/inflammatory. No pleural effusion. HEART / VESSELS: Normal sized cardiac chambers. No central PE. Left-sided portacatheter terminates in the right atrium. Prominent pericardial sinuses. MEDIASTINUM / ESOPHAGUS: Trace hiatal hernia. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Will be reported separately. MUSCULOSKELETAL: Extensive mixed lytic and sclerotic osseous metastasis involving multiple thoracic vertebral bodies, sternum, clavicles, multiple ribs, bilateral humeri. Redemonstrated pathologic fractures in the medial left clavicle, right humeral head, healing pathologic fractures in the anterolateral right sixth rib and left eighth rib. CONCLUSION: 1. Extensive mixed lytic and osteoblastic osseous metastasis with redemonstrated healing pathologic fractures in the medial end of left clavicle, left eighth rib. A new healing pathologic fracture in the right eighth rib. 2. A few noncalcified pulmonary nodules, overall unchanged. 3. Mixed attenuation opacities in the lower lobes likely infectious/inflammatory. Attention at follow-up studies is recommended.

FINDINGS: LOWER NECK: No significant soft tissue abnormality. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. A few noncalcified pulmonary nodules in the right middle lobe, superior segment right lower lobe, unchanged from April 2019. A few mixed attenuation opacities in the lung bases, likely infectious/inflammatory. No pleural effusion. HEART / VESSELS: Normal sized cardiac chambers. No central PE. Left-sided portacatheter terminates in the right atrium. Prominent pericardial sinuses. MEDIASTINUM / ESOPHAGUS: Trace hiatal hernia. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Will be reported separately. MUSCULOSKELETAL: Extensive mixed lytic and sclerotic osseous metastasis involving multiple thoracic vertebral bodies, sternum, clavicles, multiple ribs, bilateral humeri. Redemonstrated pathologic fractures in the medial left clavicle, right humeral head, healing pathologic fractures in the anterolateral right sixth rib and left eighth rib.

FINDINGS: The study is mildly degraded by metallic streak artifact from posterior spinal fixation hardware. STRUCTURED REPORT: CTA Abdomen Pelvis VASCULATURE: DISTAL DESCENDING THORACIC AORTA: No significant abnormality. ABDOMINAL AORTA: No significant abnormality. CELIAC AXIS: No significant abnormality. SMA: No significant abnormality. RIGHT RENAL: No significant abnormality. LEFT RENAL: No significant abnormality. IMA: No significant abnormality. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. ------------------------------------------------------------- LOWER CHEST: LUNG BASES / PLEURA: Left greater than right bibasilar partial atelectatic collapse with associated mucous plugging in the lower lobe bronchi. No pleural effusion or pneumothorax. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Extensive hypoattenuating laceration injuries involving the posterior right hepatic lobe as well as caudate lobe extending to the IVC, overall unchanged. Multiple irregular foci of arterial enhancement within the area of right hepatic lobe laceration without corresponding expansion on venous phase to suggest active extravasation (series 7, images 66, 75, 77, 80). BILIARY TRACT: Normal. GALLBLADDER: Partially collapsed. Prior cholelithiasis is not well-visualized on today's study. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Interval increase in bilateral adrenal thickening. Interval decrease in left greater than right periadrenal stranding. No focus of active extravasation. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The colon is normal. Normal appendix. PERITONEUM / MESENTERY: Mild central mesenteric haziness, unchanged. RETROPERITONEUM: Interval decrease in soft tissue thickening along the left anterior and posterior perirenal fascia. Interval decrease in mild bilateral retroperitoneal fat stranding, unchanged. OTHER VESSELS: Mild lower abdominal aorta atherosclerotic plaque without aneurysmal dilatation. Dilated left parametrial veins, unchanged. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Fibroid uterus. The right ovary is surgically absent. The left adnexa demonstrates no suspicious lesion. BODY WALL: Small fat-containing periumbilical hernia. Right groin, left hip, and bilateral gluteal soft tissue stranding, unchanged. MUSCULOSKELETAL: T11 vertebral body burst fracture with moderate height loss and fracture line extending into the posterior elements, overall unchanged. Mild retropulsion of the T11 inferior endplate fracture fragment, unchanged. Posterior spinal fixation postsurgical changes spanning T10-T12, unchanged. No evidence of hardware complication. Right L1-L4 transverse process fractures, unchanged. No aggressive osseous lesion.

EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: History of head and neck squamous cell carcinoma COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 269 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 2 ml per sec. Scan delay: 100 sec. Scan field of view: 480 mm. DLP: 1549 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately reported chest CT ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Diffuse fatty atrophy. SPLEEN: Borderline splenomegaly. ADRENALS: There is a left adrenal nodule that measures 1.7 x 1.3 cm (series 3 image 209). Its density measures approximately 63 HU. The right adrenal gland is unremarkable. KIDNEYS: There are scattered bilateral small hypodense lesions, too small to accurately characterize but likely simple renal cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered colonic diverticula without surrounding inflammation. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerosis involving the descending aorta and branching vessels. URINARY BLADDER: Mildly underdistended. Otherwise, unremarkable. REPRODUCTIVE ORGANS: Prostatomegaly and prosthetic calcifications noted. BODY WALL: Tiny fat-containing umbilical hernia. Small bilateral fat-containing inguinal hernias. MUSCULOSKELETAL: Multiple scattered sclerotic osseous metastatic lesions in the pelvic bones and lumbar vertebrae without any significant osseous destructive changes or associated soft tissue components. Also seen is moderate to severe degenerative changes multiple levels in the lumbar spine. Mild degenerative retrolisthesis of L2 on L3. CONCLUSION: 1. A 1.7 cm left adrenal metastasis. 2. Scattered sclerotic osseous metastatic disease in the lumbar spine and pelvic bones. 2. No additional soft tissue metastasis in the abdomen and pelvis. Other incidental/chronic findings as described above. Chest CT is reported separately. 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 Pelvis LOWER CHEST: Please see separately reported chest CT ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Diffuse fatty atrophy. SPLEEN: Borderline splenomegaly. ADRENALS: There is a left adrenal nodule that measures 1.7 x 1.3 cm (series 3 image 209). Its density measures approximately 63 HU. The right adrenal gland is unremarkable. KIDNEYS: There are scattered bilateral small hypodense lesions, too small to accurately characterize but likely simple renal cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered colonic diverticula without surrounding inflammation. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerosis involving the descending aorta and branching vessels. URINARY BLADDER: Mildly underdistended. Otherwise, unremarkable. REPRODUCTIVE ORGANS: Prostatomegaly and prosthetic calcifications noted. BODY WALL: Tiny fat-containing umbilical hernia. Small bilateral fat-containing inguinal hernias. MUSCULOSKELETAL: Multiple scattered sclerotic osseous metastatic lesions in the pelvic bones and lumbar vertebrae without any significant osseous destructive changes or associated soft tissue components. Also seen is moderate to severe degenerative changes multiple levels in the lumbar spine. Mild degenerative retrolisthesis of L2 on L3.

FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Trace right basilar atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Contracted around gas-containing choleliths. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral renal cysts LYMPH NODES: Enlarged right pelvic sidewall lymph nodes. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Moderate colonic fecal burden with large fecal ball in the rectal vault. There is mild circumferential rectal wall thickening and presacral edema. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerosis. URINARY BLADDER: Suprapubic catheter tip is in the prostatic urethra. Chronic circumferential bladder wall thickening. Small bladder wall diverticula are present. REPRODUCTIVE ORGANS: Round fluid collection in the right side of the prostate gland measures 3.4 x 3.5 x 3.6 cm (AP, TV, CC). Penile prosthesis. BODY WALL: Decubitus ulcers over the sacrum and right greater tuberosity with exposure of the bone. There are sclerotic changes, erosions, and periosteal reaction of the distal sacrum. Although wound is larger, bony changes have minimally progressed. A small amount of fluid and gas tracking from the ulcer overlying the right greater tuberosity extends into the deeper soft tissues. The right greater tuberosity demonstrates periosteal reaction and shallow erosions, new from prior. Anasarca. MUSCULOSKELETAL: Small right hip joint effusion with marked synovial thickening. There is trace periosteal reaction along the femoral neck, which is also seen on the contralateral hip. No definite erosions. Scattered sclerotic lesions are unchanged.

CLINICAL HISTORY: NPH, G91.2 (Idiopathic) normal pressure hydrocephalus Spec Inst: stealth 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: 798.53 mGy cm. COMPARISON: 12/15/2020 FINDINGS: Right frontal approach VP shunt catheter again terminates in the right lateral ventricle. There is stable moderate ventriculomegaly. There is also stable hypoattenuation along the catheter tract within the right frontal lobe representing gliosis. 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 small hypodensities within the bilateral thalami and right basal ganglia. Right frontal burr hole is again noted. There is diffuse increased sclerosis of the calvarium. The visualized paranasal sinuses and mastoid air cells are clear. The orbits are unremarkable. CONCLUSION: 01. Stable shunted ventricles. Stable moderate ventriculomegaly. No extra-axial collection. 02. Diffuse sclerosis of the calvarium possibly on metabolic basis. No focal osseous lesion is identified. 03. Stable age related changes and bilateral small remote deep gray matter lacunar infarctions.

FINDINGS: Right frontal approach VP shunt catheter again terminates in the right lateral ventricle. There is stable moderate ventriculomegaly. There is also stable hypoattenuation along the catheter tract within the right frontal lobe representing gliosis. 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 small hypodensities within the bilateral thalami and right basal ganglia. Right frontal burr hole is again noted. There is diffuse increased sclerosis of the calvarium. The visualized paranasal sinuses and mastoid air cells are clear. The orbits are unremarkable.

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: Trace left pleural effusion HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No significant abnormality.

EXAM: CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: Hydronephrosis COMPARISON: CT 11/17/2021. TECHNIQUE: CT Abdomen and Pelvis wo IV contrast. Scan field of view: 294 mm. DLP: 272 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: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: Somewhat limited abdominal soft tissue evaluation due to paucity of abdominal fat absence of intravenous contrast. LIVER: Normal. Diffuse periportal hypoattenuation likely corresponds to previously seen biliary thickening. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Interval placement of left ureteral stent with decompression of left renal collecting system. Both kidneys otherwise demonstrate normal appearance without hydronephrosis or perinephric collection. 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. CONCLUSION: 1. Limited soft tissue evaluation in absence of intravenous contrast. Interval placement of left ureteral stent with decompression of left renal collecting system. No hydronephrosis or perinephric collection.

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: Somewhat limited abdominal soft tissue evaluation due to paucity of abdominal fat absence of intravenous contrast. LIVER: Normal. Diffuse periportal hypoattenuation likely corresponds to previously seen biliary thickening. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Interval placement of left ureteral stent with decompression of left renal collecting system. Both kidneys otherwise demonstrate normal appearance without hydronephrosis or perinephric collection. 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.

FINDINGS: STRUCTURED REPORT: CT Urogram LOWER CHEST: LUNG BASES / PLEURA: Mild right lung base atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN AND PELVIS: KIDNEYS: No enhancing renal mass. Small exophytic simple cyst in the interpolar region of the left kidney. UPPER URINARY TRACTS: - Calculi: No urothelial calculi. - Urothelium: No abnormal urothelial enhancement, thickening or filling defects. URINARY BLADDER: No abnormal bladder wall thickening or enhancement. No bladder mass. LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis without evidence of diverticulitis. Otherwise, the colon, including the appendix, is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic calcification of the abdominal aorta which is normal in caliber. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing periumbilical hernia. MUSCULOSKELETAL: No aggressive osseous lesions.

CT scan of the cervical spine. Clinical: Sensory changes right arm Technical: CT C-spine protocol DLP: 908 mGy cm. Findings: No C-spine fracture or subluxation is seen. There is contrast from prior studies. There is incomplete fusion of the posterior arch of C1 and there is a closed suture in the anterior arch midline. The paraspinal soft tissues are unremarkable. --------------- Conclusion: No C-spine fracture or subluxation.

Findings: No C-spine fracture or subluxation is seen. There is contrast from prior studies. There is incomplete fusion of the posterior arch of C1 and there is a closed suture in the anterior arch midline. The paraspinal soft tissues are unremarkable. ---------------

Findings: Surgical clips are seen at the level the right thyroid lobe. No enlarged intrathoracic nodes are present. Small hiatal hernia is noted. Mild calcific atherosclerosis is seen in the aorta and coronary arteries. Small pericardial effusion is noted. The heart size and mediastinum are otherwise normal. Tiny nodule along the right major fissure on series 3 image 45 is unchanged and consistent with benign intrapulmonary lymph node. Similar nodule in the left major fissure also on image 59 is unchanged. The tiny right apical nodule on image 33 is unchanged back to the 2019 exam consistent with benign nodule. The lungs are otherwise normal without suspicious nodules or masses. No pleural effusion. No focal destructive osseous lesions identified. The gallbladder has been surgically removed. Limited images the upper abdomen are otherwise unremarkable.

CT Head wo contrast 1/6/2022 4:19 AM Clinical Information: Sp skull base repair Spec Inst: stealth protocol Comparison: Sinus CT 12/9/2021 Technique: Unenhanced axial brain CT with coronal and sagittal reconstructions. Scan field of view: 223 mm. DLP: 1711 mGy cm. Findings: There are postsurgical changes in the nasal ethmoid/sphenoid region from skull base encephalocele repair with packing material and secretions. There is a moderate fluid level in the left maxillary sinus with hyperdensity, likely intermixed hemorrhage. Intracranially, there is no acute hemorrhage, evidence of acute infarction or hydrocephalus. There is no pneumocephalus. The mastoid air cells are clear. Impression: 1. Interval postsurgical changes from central skull base encephalocele repair. No acute intracranial abnormality.

Findings: There are postsurgical changes in the nasal ethmoid/sphenoid region from skull base encephalocele repair with packing material and secretions. There is a moderate fluid level in the left maxillary sinus with hyperdensity, likely intermixed hemorrhage. Intracranially, there is no acute hemorrhage, evidence of acute infarction or hydrocephalus. There is no pneumocephalus. The mastoid air cells are clear.

FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Tiny low attenuation lesion in the left lobe of the thyroid. CHEST: LUNGS / AIRWAYS / PLEURA: Hazy peripheral groundlass opacities are nonspecific, but may represent infectious or inflammatory changes. A couple of peripheral subcentimeter noncalcified nodules in the right lung (for example, Series 9; images 100 and 105). HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Please note that the concurrently obtained CT scan of the Abdomen will be dictated separately. MUSCULOSKELETAL: No significant abnormality.

CT head with and without contrast Indication: evd w cf ventriculitis Spec Inst: stealth. Comparison: Multiple prior CT head examinations, most recently from 1/4/2022. Technique: Multiple contiguous axial images of the brain were obtained from base to the vertex pre- and post the administration of intravenous contrast. Patient weight: 180 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 2 ml per sec. Scan delay: 300 sec Scan field of view: 231 mm. DLP: 3147 mGy cm. . Findings: There is no evidence of acute intra- or extra-axial hemorrhage, mass effect, or other space-occupying lesion. Gray-white differentiation appears maintained. No evidence of acute territorial infarction. Stable positioning of bifrontal ventriculostomy catheters with tips terminating in the anterior horns of the lateral ventricles. The ventricles are grossly stable in size and configuration, with mild prominence of the right lateral ventricle and decompressed slitlike left lateral ventricle. There are no layering debris seen within the ventricles. Features of Chiari malformation status post decompression surgery again noted. Unchanged large upper cervical cord syringomyelia eccentric to the right. Post administration of contrast material, there is no abnormal ependymal enhancement within the ventricles. Mild dural thickening and enhancement along the falx is nonspecific. No abnormal meningeal enhancement. There is persistent mucosal thickening and partial opacification of the left greater than right maxillary sinuses. The mastoid air cells are clear. Impression: Overall stable exam, with no evidence of acute intracranial process. Specifically no convincing CT evidence of ventriculitis. Stable shunted ventricular system.

Findings: There is no evidence of acute intra- or extra-axial hemorrhage, mass effect, or other space-occupying lesion. Gray-white differentiation appears maintained. No evidence of acute territorial infarction. Stable positioning of bifrontal ventriculostomy catheters with tips terminating in the anterior horns of the lateral ventricles. The ventricles are grossly stable in size and configuration, with mild prominence of the right lateral ventricle and decompressed slitlike left lateral ventricle. There are no layering debris seen within the ventricles. Features of Chiari malformation status post decompression surgery again noted. Unchanged large upper cervical cord syringomyelia eccentric to the right. Post administration of contrast material, there is no abnormal ependymal enhancement within the ventricles. Mild dural thickening and enhancement along the falx is nonspecific. No abnormal meningeal enhancement. There is persistent mucosal thickening and partial opacification of the left greater than right maxillary sinuses. The mastoid air cells are clear.

FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: See separate chest CT report. ABDOMEN and PELVIS: LIVER: Focal mass in the inferior aspect of the right hepatic lobe is larger. Focal lesion in segment VIII is also larger and has bilobed lobular appearance . Both lesions have wedge shaped associated hyperemia. No new hepatic lesions. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Tiny right renal cyst. Otherwise normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Normal appendix. PERITONEUM / MESENTERY: A peritoneal nodule inferior to the tip of the liver on image 269 series 9 is grossly unchanged. Small pelvic ascites. RETROPERITONEUM: Normal. VESSELS: Replaced right hepatic artery originates from the SMA. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is absent. Cystic lesion lies adjacent to the rectosigmoid colon, possibly right ovarian, measuring 2.8 x 2.5 cm (image 365 series 9). BODY WALL: Rectus muscle diastases near the umbilicus contains nonobstructed small bowel loop. MUSCULOSKELETAL: No significant abnormality. No osseous metastasis.

CT Head wo contrast 1/5/2022 5:46 PM Clinical information: monitor edema, mildly sedated Comparison: CT head 1/2/2022 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: 213 mm. DLP: 1032 mGy cm. Findings: Redemonstration of evolving right frontal parenchymal hematoma with surrounding vasogenic edema and leftward midline shift by 10 mm, overall unchanged. No new hemorrhage. Stable minimal layering of hemorrhage in the left occipital horn. Impression: Evolving right frontal parenchymal hematoma with vasogenic edema, mass effect and 10 mm leftward midline shift. No new hemorrhage or worsening edema. Stable small hemorrhage layering in the left occipital horn.

Findings: Redemonstration of evolving right frontal parenchymal hematoma with surrounding vasogenic edema and leftward midline shift by 10 mm, overall unchanged. No new hemorrhage. Stable minimal layering of hemorrhage in the left occipital horn.

FINDINGS: Minimal scarring is seen posteriorly in both upper lobes. No significant subpleural reticulation is identified. Mild bilateral bronchiectasis is noted. No honeycombing. A few scattered calcified granuloma are seen with an area of focal calcified plaque in the right lung on series 2 image 131. The lungs are otherwise normal without suspicious nodules or masses. No pleural effusion. - Bilateral air trapping is seen in both upper and lower lobes. Tracheobronchomalacia is seen with collapse of the right mainstem bronchus on series 4 image 68. - No enlarged intrathoracic lymph nodes are identified. Small hiatal hernia is seen with dilatation of the esophagus. Mild calcific atherosclerosis is seen in the aorta and coronary arteries with some calcification aortic valve leaflets noted. The main pulmonary artery is enlarged at 35 mm. The heart is the upper limits of normal. Within the limits of a noncontrast exam, the mediastinum is otherwise normal. - Low-attenuation lesion is seen posteriorly in the lateral left hepatic lobe measuring approximately 2 cm. This is difficult to fully characterize but suggests a small hemangioma or small cyst. An IVC filter is partially visualized. Limited noncontrast images the upper abdomen are otherwise unremarkable. - No focal destructive osseous lesions. -

RADIOLOGIC EXAM: CT Maxillofacial wo contrast, CT Head wo contrast CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT of the head and maxillofacial region without intravenous contrast. Scan field of view: 200 mm. DLP: 345 mGy cm. (accession CT220002497), Scan field of view: 250 mm. DLP: 1096 mGy cm. (accession CT220002496) FINDINGS: BRAIN PARENCHYMA: No hemorrhage, acute infarct, or cerebral edema. No midline shift or mass effect. Advanced white matter microangiopathic changes and generalized cerebral atrophy. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Ex vacuo ventriculomegaly. ORBITS: Pseudophakia bilaterally. SKULL AND SKULL BASE: No fracture. FACIAL BONES: Normal. MANDIBLE: Normal. SINONASAL CAVITIES: Minimal ethmoid air cells and right maxillary sinus mucosal thickening SOFT TISSUES: Right frontal scalp small hematoma. CONCLUSION: No acute intracranial process or maxillofacial fractures. Small right frontal/periorbital scalp hematoma. No orbital 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: BRAIN PARENCHYMA: No hemorrhage, acute infarct, or cerebral edema. No midline shift or mass effect. Advanced white matter microangiopathic changes and generalized cerebral atrophy. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Ex vacuo ventriculomegaly. ORBITS: Pseudophakia bilaterally. SKULL AND SKULL BASE: No fracture. FACIAL BONES: Normal. MANDIBLE: Normal. SINONASAL CAVITIES: Minimal ethmoid air cells and right maxillary sinus mucosal thickening SOFT TISSUES: Right frontal scalp small hematoma.

FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Pelvis Renal Transplant VASCULATURE: LOWER ABDOMINAL AORTA: Severe calcified atherosclerotic disease. RIGHT COMMON / INTERNAL ILIAC ARTERIES: Severe calcified atherosclerotic disease. RIGHT EXTERNAL ILIAC ARTERY: Mild calcified atherosclerotic disease. LEFT COMMON / INTERNAL ILIAC ARTERIES: Severe calcified atherosclerotic disease. LEFT EXTERNAL ILIAC ARTERY: Mild calcified atherosclerotic disease. LOWER ABDOMEN: BOWEL: No abnormality. PERITONEUM: Trace pelvic fluid. OTHER: No other abnormality. PELVIS: LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Decompressed. REPRODUCTIVE ORGANS: Mild prostatomegaly. BODY WALL: Minute umbilical hernia. MUSCULOSKELETAL: Degenerative changes in the spine. Lucent areas in the pelvis are nonspecific but could relate to renal disease.

RADIOLOGIC EXAM: CT Maxillofacial wo contrast, CT Head wo contrast CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT of the head and maxillofacial region without intravenous contrast. Scan field of view: 200 mm. DLP: 345 mGy cm. (accession CT220002497), Scan field of view: 250 mm. DLP: 1096 mGy cm. (accession CT220002496) FINDINGS: BRAIN PARENCHYMA: No hemorrhage, acute infarct, or cerebral edema. No midline shift or mass effect. Advanced white matter microangiopathic changes and generalized cerebral atrophy. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Ex vacuo ventriculomegaly. ORBITS: Pseudophakia bilaterally. SKULL AND SKULL BASE: No fracture. FACIAL BONES: Normal. MANDIBLE: Normal. SINONASAL CAVITIES: Minimal ethmoid air cells and right maxillary sinus mucosal thickening SOFT TISSUES: Right frontal scalp small hematoma. CONCLUSION: No acute intracranial process or maxillofacial fractures. Small right frontal/periorbital scalp hematoma. No orbital 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: BRAIN PARENCHYMA: No hemorrhage, acute infarct, or cerebral edema. No midline shift or mass effect. Advanced white matter microangiopathic changes and generalized cerebral atrophy. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Ex vacuo ventriculomegaly. ORBITS: Pseudophakia bilaterally. SKULL AND SKULL BASE: No fracture. FACIAL BONES: Normal. MANDIBLE: Normal. SINONASAL CAVITIES: Minimal ethmoid air cells and right maxillary sinus mucosal thickening SOFT TISSUES: Right frontal scalp small hematoma.

FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Please see same-day CT neck for neck findings. CHEST: LUNGS / AIRWAYS / PLEURA: Overall similar appearance of calcified and noncalcified pulmonary nodules. There are new scattered bilateral areas of focal groundglass opacity in the right upper lobe on series 3 image 45 and in the left upper lobe on series 3 image 41. There is no pleural effusion or pneumothorax. Central airways are patent with mild bronchial wall thickening. There is narrowing of the transverse diameter of the thoracic trachea. Stable appearance of moderate to severe apical predominant centrilobular emphysema. HEART / VESSELS: Heart size is normal. No pericardial effusion. Stable appearance of moderate atherosclerotic calcifications of the thoracic aorta and coronary artery calcifications. MEDIASTINUM / ESOPHAGUS: Prominent mediastinal lymph nodes. See below. LYMPH NODES: Mild increase in prominence of lymph nodes throughout the mediastinum and bilateral hila, largest measuring 1.2 cm in short axis diameter on series 3 image 40 in the left paratracheal distribution, previously 1.0 cm. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality. Stable focal degenerative changes of the upper thoracic spine at T2-3.

EXAM: CT Abdomen wo+w contrast CLINICAL INFORMATION: Cirrhosis COMPARISON: None. TECHNIQUE: CT Abdomen wo+w contrast. Patient weight: 190 lbs. IV contrast: Omnipaque 350, 143 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 2.20 ml per sec. Scan delay: BOLUS TRACK, 105 SEC., 180 SEC. sec. Scan field of view: 440 mm. GFR: 60 DLP: 2015.30 mGy cm. FINDINGS: STRUCTURED REPORT: CT HCC Screening IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. Mild steatosis. LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: Small (

FINDINGS: STRUCTURED REPORT: CT HCC Screening IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. Mild steatosis. LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: Small (

FINDINGS: SOFT TISSUES: Dental hardware streak artifact limits evaluation of oral cavity. Within these limits, no enhancing masslike lesion is seen. Postsurgical appearance consistent with patient's known for mouth resection, bilateral lymph node dissection, partial mandibulectomy and anterior mandibular implants. Mild soft tissue swelling of the overlying soft tissue. LYMPH NODES: There are new bilateral supraclavicular lymph nodes which are oval-shaped with preserved fatty hilum in favor of reactive changes. Enlarged right paratracheal lymph node measuring 1.0 cm in short axis (series 3, image 371). Prominent lymph nodes throughout the bilateral cervical chains that do not meet imaging size criteria for pathologic adenopathy. AERODIGESTIVE STRUCTURES: New asymmetric thickening of the right posterior hypopharynx (series 3, image 260) with inward protrusion into the lumen of the pharynx. PAROTID GLANDS: Normal. SUBMANDIBULAR GLANDS: Submandibular glands have been removed. Soft tissue stranding and fluid collection is noted in the submandibular region which is likely postsurgical changes and seroma. The largest left submandibular fluid collection measures 62 x 12 mm on the left side and 24 x 6 mm on right side. THYROID GLAND: Normal. VASCULAR STRUCTURES: Saccular aneurysmal dilatation of the M1 bifurcation on the right measures 5 mm (series 3, image 72 and can also be seen on series 4, image 139). Atherosclerotic calcifications of the carotid siphons. Atherosclerosis of carotid bifurcations is seen without significant narrowing. OSSEOUS STRUCTURES: Moderate multilevel degenerative changes of the spine with bulky bridging anterior osteophyte formation is prominent in the lower cervical spine and mild anterolisthesis of C5 on C6 and C7 on T1. Multilevel facet and focal hypertrophy. No aggressive osseous lesions identified. ORBITS: Normal. PARANASAL SINUSES AND MASTOID AIR CELLS: Mucosal thickening in the ethmoid air cells and sphenoid and maxillary sinuses. PARTIALLY VISUALIZED INTRACRANIAL STRUCTURES: No significant abnormalities. The previously seen right frontal operculum encephalomalacia is not well-visualized. LUNG APICES: Limited evaluation due to motion. The right upper lung 4 mm nodule (series 3, image 390) is unchanged. The previously seen 6 mm right upper lobe nodule is less definitively seen, likely due to motion artifact (series 3, image 20). Emphysematous changes of the lung apices. Anterior-posterior elongation the tracheal diameter consistent with chronic obstructive pulmonary disease.

EXAM: CT Angio Upper Ext Right wo+w contrast CLINICAL INFORMATION: COMPARISON: None. TECHNIQUE: CT Angio Upper Ext Right 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, 115 ml, per protocol. IV contrast injection rate: 4 ml per sec. Scan delay: Bolus Track Scan field of view: 250 mm. DLP: 865 mGy cm. FINDINGS: STRUCTURED REPORT: CTA Upper Extremity FINDINGS: VASCULATURE: RIGHT SUBCLAVIAN ARTERY: No significant abnormality. RIGHT AXILLARY ARTERY: No significant abnormality. RIGHT BRACHIAL ARTERY: No significant abnormality. RIGHT RADIAL ARTERY: No significant abnormality. RIGHT ULNAR ARTERY: No significant abnormality. RIGHT HAND ARTERIES: No significant abnormality. MUSCULOSKELETAL: Comminuted right proximal humerus fracture extending to the humeral neck and tuberosities with surrounding soft tissue edema and unorganized hematoma.. CONCLUSION: 1. Major arterial vasculature of the right upper extremity is widely patent without acute abnormality. 2. Comminuted right proximal humerus fracture with surrounding hematoma and soft tissue edema.

FINDINGS: STRUCTURED REPORT: CTA Upper Extremity FINDINGS: VASCULATURE: RIGHT SUBCLAVIAN ARTERY: No significant abnormality. RIGHT AXILLARY ARTERY: No significant abnormality. RIGHT BRACHIAL ARTERY: No significant abnormality. RIGHT RADIAL ARTERY: No significant abnormality. RIGHT ULNAR ARTERY: No significant abnormality. RIGHT HAND ARTERIES: No significant abnormality. MUSCULOSKELETAL: Comminuted right proximal humerus fracture extending to the humeral neck and tuberosities with surrounding soft tissue edema and unorganized hematoma..

Findings: CT head: BRAIN PARENCHYMA: No hemorrhage, intracranial mass, large territory infarct, or edema. Gray-white matter differentiation maintained. Mild calcification of the carotid artery siphons bilaterally. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No acute fracture. No aggressive osseous lesion. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Visualized paranasal sinuses are clear. Redemonstrated under pneumatization of the bilateral mastoid air cells with trace right mastoid effusion. There is calcified atherosclerotic disease of the cavernous carotid arteries.

EXAM: CT Chest High Resolution wo contrast CLINICAL INFORMATION: 67-year-old male status post endobronchial valve placement, for follow-up. COMPARISON: CT chest without contrast dated 11/30/2021. TECHNIQUE: CT Chest High Resolution wo contrast. Scan field of view: 360 mm. DLP: 185.36 mGy cm. High-resolution CT imaging of the chest was performed per protocol with inspiratory technique in supine position. FINDINGS: LOWER NECK: No significant abnormality in the soft tissues. CHEST: LUNGS / AIRWAYS / PLEURA: Trachea is patent with small volume tracheal secretions. Redemonstrated endobronchial valves in the left upper lobes, total four in number with near complete atelectasis of the left upper lobe. Interval resolution of the previous left-sided pneumothorax. Advanced predominantly centrilobular emphysema in the reminder of the upper lobes. A few noncalcified pulmonary nodules in both lungs, some of which appear as intraparenchymal lymph nodes, overall unchanged. No suspicious nodule. No pleural effusion. HEART / VESSELS: Normal sized cardiac chambers. Coronary artery calcifications. Normal caliber pulmonary artery. Atherosclerotic calcifications through the arch and descending thoracic aorta. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. LYMPH NODES: A few scattered nonenlarged mediastinal lymph nodes. CHEST WALL: No significant abnormality. UPPER ABDOMEN: No significant abnormality. MUSCULOSKELETAL: No destructive osseous lesion. CONCLUSION: 1. Interval resolution of the left pneumothorax. Persistent near complete collapse of the left upper lobe, following endobronchial valves placement. 2. Advanced predominantly centrilobular emphysema, with overall unchanged multiple noncalcified pulmonary nodules, some of which represent intraparenchymal lymph nodes. Other incidental findings as above.

FINDINGS: LOWER NECK: No significant abnormality in the soft tissues. CHEST: LUNGS / AIRWAYS / PLEURA: Trachea is patent with small volume tracheal secretions. Redemonstrated endobronchial valves in the left upper lobes, total four in number with near complete atelectasis of the left upper lobe. Interval resolution of the previous left-sided pneumothorax. Advanced predominantly centrilobular emphysema in the reminder of the upper lobes. A few noncalcified pulmonary nodules in both lungs, some of which appear as intraparenchymal lymph nodes, overall unchanged. No suspicious nodule. No pleural effusion. HEART / VESSELS: Normal sized cardiac chambers. Coronary artery calcifications. Normal caliber pulmonary artery. Atherosclerotic calcifications through the arch and descending thoracic aorta. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. LYMPH NODES: A few scattered nonenlarged mediastinal lymph nodes. CHEST WALL: No significant abnormality. UPPER ABDOMEN: No significant abnormality. MUSCULOSKELETAL: No destructive osseous lesion.

FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Mildly suboptimal quality with incomplete evaluation of subsegmental pulmonary arteries due to motion artifacts. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Positive for pulmonary embolus. - Pulmonary Embolus Distribution: Pulmonary emboli seen within the right lower lobe segmental and subsegmental vessels. - Pulmonary Artery Diameter: Borderline enlarged at 3 cm. - Ascending Aortic Diameter: Normal. - RV:LV Ratio: Normal. - Interventricular Septum: Normal. - Contrast reflux into IVC: No significant abnormality. LUNGS / AIRWAYS / PLEURA: Evaluation of pulmonary parenchyma slightly compromised by respiratory motion artifacts. Patchy peripheral opacities bilaterally, more prominent in the upper lobes. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Small to moderate hiatal hernia. LYMPH NODES: Mildly prominent mediastinal lymph nodes are likely reactive. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No significant abnormality.

EXAM: CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: Right upper quadrant pain, history of HCC COMPARISON: 12/23/21 TECHNIQUE: CT Abdomen and Pelvis wo IV contrast. Scan field of view: 363 mm. DLP: 567 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: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Cirrhotic. Ill-defined hypoattenuating lesion in the posterior right hepatic lobe such as on image 67, series 2 appears similar to prior. No perihepatic fluid. BILIARY TRACT: Small focus of pneumobilia presumably related to prior sphincterectomy. GALLBLADDER: Prior cholecystectomy. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Stable bilateral adrenal nodules with unchanged calcifications of the left adrenal nodule. KIDNEYS: Unchanged right upper pole hyperdense cyst. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: A few noninflamed colonic diverticula. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate aortoiliac atherosclerotic calcification with stable eccentric calcified plaque in the infrarenal abdominal aorta. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No acute abnormality. Prior hysterectomy. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. No acute abdominal or pelvic abnormality. 2. Cirrhotic liver with overall unchanged appearing ill-defined hypoattenuating right hepatic lobe lesion. 3. Stable bilateral adrenal nodules and additional unchanged findings as above.

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: Cirrhotic. Ill-defined hypoattenuating lesion in the posterior right hepatic lobe such as on image 67, series 2 appears similar to prior. No perihepatic fluid. BILIARY TRACT: Small focus of pneumobilia presumably related to prior sphincterectomy. GALLBLADDER: Prior cholecystectomy. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Stable bilateral adrenal nodules with unchanged calcifications of the left adrenal nodule. KIDNEYS: Unchanged right upper pole hyperdense cyst. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: A few noninflamed colonic diverticula. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate aortoiliac atherosclerotic calcification with stable eccentric calcified plaque in the infrarenal abdominal aorta. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No acute abnormality. Prior hysterectomy. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.

FINDINGS: The right frontoparietal convexity shows 0.9 cm thickness hypodense subdural collection containing 1 cm hyperdense blood clot. Chronic subdural collections are also present over the left frontal convexity and left posterior fossa. There is advanced cerebral cortical atrophy prominently seen around the bilateral frontotemporal lobes. Size of the ventricles appears within normal limits and proportionate to diffuse cerebral volume loss. No intra-axial acute abnormality is identified.

CT Chest wo contrast CLINICAL INFORMATION: 65-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 performed without IV contrast administration. Axial, sagittal and Coronal reformatted images were reconstructed at 2.5 mm and reviewed. Scan field of view: 500 mm. Oral contrast Omnipaque: 16.9 oz. DLP: 1571.69 mGy cm. COMPARISON: Prior chest CT dated 8/28/2018. FINDINGS: Scouts: No additional findings. Lower neck and Mediastinum: Thyroid gland is unremarkable. No new focal esophageal wall abnormalities. Lymph nodes: There are calcified subcarinal and right hilar lymph nodes are again noted, likely related to healed granulomatous lung disease. No evidence of new pathologically enlarged intrathoracic lymph nodes. Heart and great arteries: The right-sided cardiac chambers are mildly dilated, similar to prior. The ascending thoracic aortic aneurysm is slightly larger when compared to prior, now measuring up to 4.5 cm (series 2, image 1:15), previously measured by myself up to 4.3 cm. Persistent enlarged main pulmonary artery, measuring up to 3.7 cm, which could be seen with pulmonary arterial hypertension. Airways: Small amount of strandy secretions are noted within the lower trachea and right mainstem bronchus. The trachea and central bronchi are otherwise patent and clear. Redemonstrated mild diffuse bronchial thickening, which could be seen with bronchitis. Lungs : Multiple calcified right lower lobe granulomas are again noted. Interval new multiple noncalcified pulmonary nodules, for example: a right upper lobe pulmonary nodule measures up to 4 mm (on series 2, image 80), and another right upper lobe nodule measures up to 7 mm (series 2, image 64), as well as an new left lower lobe pulmonary nodule measures up to 5 mm (on series 2, image 17). Pleura: No pleural effusion or pneumothorax. Upper abdomen: The CT of the abdomen and pelvis will be reported separately. Bones and soft tissues: Mild bilateral symmetrical gynecomastia, worse when compared to prior. Calcifications within the left subscapularis muscle are again noted. The chest wall soft tissues are otherwise unremarkable. Lucent lesions noted within the T1-T5 vertebral bodies are similar to prior. No new aggressive or destructive intrathoracic osseous lesions. CONCLUSION: 1. Interval new multiple noncalcified pulmonary nodules, which are nonspecific to etiology, but are concerning for metastatic pulmonary nodules. Attention on follow-up scans recommended. 2. Interval mild increase in size of the ascending thoracic aortic aneurysm, now measuring up to 4.5 cm, previously measured 4.3 cm over three years ago. 3. Other findings as described.

FINDINGS: Scouts: No additional findings. Lower neck and Mediastinum: Thyroid gland is unremarkable. No new focal esophageal wall abnormalities. Lymph nodes: There are calcified subcarinal and right hilar lymph nodes are again noted, likely related to healed granulomatous lung disease. No evidence of new pathologically enlarged intrathoracic lymph nodes. Heart and great arteries: The right-sided cardiac chambers are mildly dilated, similar to prior. The ascending thoracic aortic aneurysm is slightly larger when compared to prior, now measuring up to 4.5 cm (series 2, image 1:15), previously measured by myself up to 4.3 cm. Persistent enlarged main pulmonary artery, measuring up to 3.7 cm, which could be seen with pulmonary arterial hypertension. Airways: Small amount of strandy secretions are noted within the lower trachea and right mainstem bronchus. The trachea and central bronchi are otherwise patent and clear. Redemonstrated mild diffuse bronchial thickening, which could be seen with bronchitis. Lungs : Multiple calcified right lower lobe granulomas are again noted. Interval new multiple noncalcified pulmonary nodules, for example: a right upper lobe pulmonary nodule measures up to 4 mm (on series 2, image 80), and another right upper lobe nodule measures up to 7 mm (series 2, image 64), as well as an new left lower lobe pulmonary nodule measures up to 5 mm (on series 2, image 17). Pleura: No pleural effusion or pneumothorax. Upper abdomen: The CT of the abdomen and pelvis will be reported separately. Bones and soft tissues: Mild bilateral symmetrical gynecomastia, worse when compared to prior. Calcifications within the left subscapularis muscle are again noted. The chest wall soft tissues are otherwise unremarkable. Lucent lesions noted within the T1-T5 vertebral bodies are similar to prior. No new aggressive or destructive intrathoracic osseous lesions.

Findings: No enlarged intrathoracic nodes are present. Small hiatal hernia is noted. Calcific atherosclerosis is seen in the aorta and coronary arteries. The main pulmonary artery is dilated at 40 mm similar to the previous exam. The heart size and mediastinum are otherwise normal. No pleural effusions. Predominantly peripheral and upper lobe groundglass nodularity is again seen with some involvement of the medial segment of the RML is also present on the current exam. A tiny right apical nodule on series 2 image 46 is unchanged from series 201 image 31 on the prior. Additional posterior RUL nodule on image 76 also appears unchanged. Scattered bilateral calcified granuloma are noted. Central bronchiectasis is redemonstrated. Area of linear scarring in the left upper lobe is again noted. A 4 mm LUL nodule on series 2 image 75 is unchanged from the previous exam on series 201 image 41. Mild subpleural reticulation is seen in both lung bases with a few areas of potential honeycombing such as in the LUL on series 2 image 165. No focal airspace consolidation. No focal destructive osseous lesions identified. Patient has had a previous cholecystectomy. Limited images of the upper abdomen are otherwise unremarkable.

EXAM: CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: Prostate cancer COMPARISON: CT 11/04/2021. TECHNIQUE: CT Abdomen and Pelvis wo IV contrast. Scan field of view: 500 mm. Oral contrast Omnipaque: 16.9 oz. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Chest CT is reported separately ABDOMEN and PELVIS: LIVER: Small hypoattenuating lesion in the medial segment of left hepatic lobe measuring about 2.1 cm, unchanged since prior CT (on series 2/image 217). BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Right kidney is mildly atrophic. No definite calculus, hydronephrosis or hydroureter. Nonspecific bilateral perinephric stranding without any discrete fluid collection. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Small hiatal hernia. Stomach is partially distended. No abnormal dilatation small bowel loops. Enteric contrast has progressed to the distal small bowel loops. COLON / APPENDIX: Large bowel loops are nondilated. Uncomplicated colonic diverticulosis. PERITONEUM / MESENTERY: No ascites or pneumoperitoneum. RETROPERITONEUM: Percent diffuse edematous stranding in the presacral region. No discrete retroperitoneal fluid collection. VESSELS: Aorta is nonaneurysmal. URINARY BLADDER: Urinary bladder is surgically absent. Right lower quadrant ileal conduit is visualized. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing midline ventral abdominal wall hernia. Small fat-containing left inguinal hernia. MUSCULOSKELETAL: Stable sclerotic osseous metastasis in the pelvic bones. Lumbar vertebrae demonstrate normal height and multilevel degenerative changes. No new destructive osseous lesions. CONCLUSION: 1. Stable sclerotic osseous metastasis. 2. Stable hypoattenuating lesion in the left hepatic lobe. 3. Other stable abdominal findings as described above. Chest CT reported separately.

FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Chest CT is reported separately ABDOMEN and PELVIS: LIVER: Small hypoattenuating lesion in the medial segment of left hepatic lobe measuring about 2.1 cm, unchanged since prior CT (on series 2/image 217). BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Right kidney is mildly atrophic. No definite calculus, hydronephrosis or hydroureter. Nonspecific bilateral perinephric stranding without any discrete fluid collection. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Small hiatal hernia. Stomach is partially distended. No abnormal dilatation small bowel loops. Enteric contrast has progressed to the distal small bowel loops. COLON / APPENDIX: Large bowel loops are nondilated. Uncomplicated colonic diverticulosis. PERITONEUM / MESENTERY: No ascites or pneumoperitoneum. RETROPERITONEUM: Percent diffuse edematous stranding in the presacral region. No discrete retroperitoneal fluid collection. VESSELS: Aorta is nonaneurysmal. URINARY BLADDER: Urinary bladder is surgically absent. Right lower quadrant ileal conduit is visualized. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing midline ventral abdominal wall hernia. Small fat-containing left inguinal hernia. MUSCULOSKELETAL: Stable sclerotic osseous metastasis in the pelvic bones. Lumbar vertebrae demonstrate normal height and multilevel degenerative changes. No new destructive osseous lesions.

FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Small bilateral pleural effusions. Worsening pulmonary opacities in the right lung base with bibasilar atelectasis DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Stable cardiomegaly and unchanged calcification of the aortic valve, mitral annulus, and descending thoracic aorta. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Possible dependent sludge in the gallbladder versus vicarious excretion of contrast. No radiopaque stones, wall thickening, or pericholecystic fluid. PANCREAS: Normal. SPLEEN: Thin hypoattenuating density at the periphery of the spleen most likely represents subcapsular hematoma and is unchanged, involving about 50% of the splenic surface area. Previously seen splenic laceration measures approximately 1.5 cm. No injury to the hilum or vessels. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Enteric contrast opacifies the stomach and small bowel. No abnormality. COLON / APPENDIX: Diverticulosis without diverticulitis. The appendix is normal. PERITONEUM / MESENTERY: Unchanged dystrophic calcifications of the abdominal mesentery at the level of the umbilicus. RETROPERITONEUM: Normal. VESSELS: Diffuse calcific atherosclerosis of the abdominal aorta. Narrowing of the proximal SMA, as previously described with severe ostial stenosis. Moderate narrowing of the origin of the celiac artery and right renal artery atherosclerotic calcifications. URINARY BLADDER: Interval placement of a Foley catheter within decompressed urinary bladder REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous lesion. Degenerative changes of the thoracolumbar spine as described previously. Soft tissue stranding in the bilateral hips.

EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Colorectal staging. COMPARISON: 3/10/2021. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 150 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 78 sec. Scan field of view: 380 mm. DLP: 874.66 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis Chest findings to be dictated separately. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Mild splenomegaly. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Postsurgical changes consistent with partial colectomy with anastomosis in the right mid abdomen. No abnormal mucosal thickening or pericolonic stranding. Scattered diverticulosis without evidence of diverticulitis within the rectosigmoid colon. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Mild prostatomegaly. BODY WALL: Tiny fat-containing periumbilical hernia. MUSCULOSKELETAL: No aggressive osseous lesions. CONCLUSION: 1. Post surgical changes consistent with prior partial colectomy. No CT evidence of recurrent malignancy or abdominopelvic metastatic disease. 2. Chronic and incidental findings as above. Please see separately dictated report for dedicated chest findings.

FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis Chest findings to be dictated separately. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Mild splenomegaly. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Postsurgical changes consistent with partial colectomy with anastomosis in the right mid abdomen. No abnormal mucosal thickening or pericolonic stranding. Scattered diverticulosis without evidence of diverticulitis within the rectosigmoid colon. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Mild prostatomegaly. BODY WALL: Tiny fat-containing periumbilical hernia. MUSCULOSKELETAL: No aggressive osseous lesions.

FINDINGS: The supraclavicular region is unremarkable. Central airways are patent. The thoracic aorta is nonaneurysmal. The pulmonary arteries are normal caliber. The heart is not enlarged. There is a small pericardial effusion, similar to prior. No enlarged supraclavicular, axillary, mediastinal or hilar lymph nodes are identified. Residual thymic tissue seen within the anterior mediastinum. The esophagus is not dilated. Upper lobe predominant mixed emphysema is again noted bilaterally, similar to the prior examination. Multiple solid and subsolid lung nodules are again seen bilaterally. At the right lung apex on image 70 of series 2 and two, there is a new tiny nodular opacity in association with an airway, likely a tiny mucus plug. A new mucus plug is also seen within the right upper lobe on image 23. A 6 x 5 mm subpleural nodule within the right lung apex on image 86 is unchanged. A 6 x 5 mm part solid nodule in the middle lobe on image 219 has a 3 mm solid component which is unchanged. A 7 x 5 mm subpleural nodule within the lateral basal right lower lobe on image 240 measured 6 x 5 mm previously. A 7 mm groundglass nodule within the left upper to 38 is stable. Other lung nodules bilaterally are unchanged. No new or enlarging lung nodules. No pleural effusion or pleural thickening. No acute or aggressive osseous abnormality.

EXAM: CT Chest with contrast CLINICAL INFORMATION: 51-year-old male follow-up colon cancer COMPARISON: March 10, 2021 TECHNIQUE: CT Chest with contrast. Patient weight: 150 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 78 sec. Scan field of view: 380 mm. DLP: 874.66 mGy cm. FINDINGS: The previously noted tiny right lower lobe nodule is not identified on today's scan. Similarly the left lower lobe nodule along the major fissure is decreased in size and is barely seen in image 121, series 2. No new nodule or mass is seen. Bilateral apical pleural and parenchymal scarring. Tiny subcentimeter size nodes in the mediastinum are stable. No pleural or pericardial effusion is seen and visualized bones are unremarkable. CONCLUSION: Previously noted right lower lobe nodule has resolved while the left lower lobe nodule near the fissure is barely visible without new intrathoracic disease.

FINDINGS: The previously noted tiny right lower lobe nodule is not identified on today's scan. Similarly the left lower lobe nodule along the major fissure is decreased in size and is barely seen in image 121, series 2. No new nodule or mass is seen. Bilateral apical pleural and parenchymal scarring. Tiny subcentimeter size nodes in the mediastinum are stable. No pleural or pericardial effusion is seen and visualized bones are unremarkable.

FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Pelvis LOWER ABDOMEN: BOWEL: Colonic diverticulosis. The visualized bowel is otherwise unremarkable for technique. PERITONEUM: Small volume ascites. OTHER: No other abnormality. PELVIS: KIDNEY: Visualized portion of the right pelvic transplant kidney is unremarkable. No hydronephrosis or peritransplant collection. VESSELS: Moderate to advanced calcific atherosclerosis. LYMPH NODES: None pathologically enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Diffuse anasarca. Small umbilical hernia containing fat and ascitic fluid. Left groin hematoma measures 4.6 x 1.8 cm (image 149 series 3) MUSCULOSKELETAL: Partially visualized gluteal skin thickening and underlying stranding (image 160 series 3). No deep ulcer or underlying abscess identified. No aggressive osseous destruction of the pelvic bones. Severe degenerative changes of the visualized lumbar spine.

EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Right lower quadrant pain COMPARISON: 10/27/2014 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 190 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. IV contrast injection rate: 3 ml per sec. Scan delay: 70 sec. Scan field of view: 404 mm. DLP: 890 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: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: There is a simple appearing cyst in the upper pole the right kidney, unchanged. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: There are scattered noninflamed colonic diverticula. The appendix is normal PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild aortoiliac atherosclerosis without aneurysmal dilatation URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Fibroid uterus is again noted. No adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. No acute abnormality is identified within the abdomen or pelvis. 2. Fibroid uterus and additional findings 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: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: There is a simple appearing cyst in the upper pole the right kidney, unchanged. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: There are scattered noninflamed colonic diverticula. The appendix is normal PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild aortoiliac atherosclerosis without aneurysmal dilatation URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Fibroid uterus is again noted. No adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.

FINDINGS: The ventricles appear adequately decompressed through the right frontal access shunt, which remains stable in position. No extra-axial fluid collection or hemorrhage is noted. The right frontal pericatheter edema is unchanged. No intra-axial acute findings are noted. The suboccipital craniectomy shows decreased size of pseudomeningocele.

EXAM: CT Chest with contrast CLINICAL INFORMATION: 55-year-old female follow-up colon cancer COMPARISON: No prior chest CT for comparison TECHNIQUE: CT Chest with contrast. Patient weight: 140 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 2 ml per sec. Scan delay: 97 sec. Scan field of view: 340 mm. DLP: 639 mGy cm. FINDINGS: No mediastinal, hilar or axillary adenopathy seen. Asymmetric mild enlargement of the thyroid gland without airway compression or retrosternal extension. A somewhat elongated noncalcified 4 mm nodule is present in the lateral basal segment of right lower lobe in image 94, series 3. No other discrete lung nodule or mass is seen. Linear atelectasis is present in the right middle lobe. No pleural or pericardial effusion is seen and visualized bones are unremarkable. CONCLUSION: Indeterminate 4 mm noncalcified right lower lobe lung nodule. Recommend comparison with any prior remote CT and follow-up in 3-6 months. Addendum: On further review there is a small nonocclusive subsegmental filling defect in the right lower lobe pulmonary artery branch as seen on axial images 111-115, series 3. These results were discussed with Dr. William Brown at 2:04 PM on 1/5/2022.

FINDINGS: No mediastinal, hilar or axillary adenopathy seen. Asymmetric mild enlargement of the thyroid gland without airway compression or retrosternal extension. A somewhat elongated noncalcified 4 mm nodule is present in the lateral basal segment of right lower lobe in image 94, series 3. No other discrete lung nodule or mass is seen. Linear atelectasis is present in the right middle lobe. No pleural or pericardial effusion is seen and visualized bones are unremarkable.

Findings: CT head: BRAIN PARENCHYMA: No acute intracranial hemorrhage, mass, large territory infarct, or edema. Gray-white matter differentiation maintained. Subcortical and periventricular low-attenuation lesions likely represent advanced microangiopathic changes. Diffuse cortical atrophy with associated ex vacuo dilatation of the ventricles. Atherosclerotic calcifications of the bilateral carotid artery siphons. EXTRA-AXIAL SPACES: Prominent, likely related to diffuse cortical volume loss. SKULL AND SKULL BASE: No acute fracture. No aggressive osseous lesion. VENTRICULAR SYSTEM: Ex vacuo ventriculomegaly ORBITS: Bilateral lens replacements. SINUSES: Mild mucosal thickening of the left sphenoid sinus. There are postoperative changes of the right mastoid air cells. The remainder of the visualized paranasal sinuses and mastoid air cells are clear.