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MR Brain wo+w contrast HISTORY: History of melanoma and prostate malignancy with brain metastasis. TECHNIQUE: Multiplanar, multisequence MRI of the brain was performed without and after intravenous contrast. COMPARISON: MRI of 11/20/2021 FINDINGS: INTRACRANIAL FINDINGS: There is interval mild enlargement of the cortical based T1 hyper signal and T2 low signal nodule in the left frontal lobe measuring 9 mm previously 6 mm in favor of metastasis (likely from melanoma) with mild worsening of edema. There is a new tiny punctate T1 hyper signal intensity and enhancement in the cortex of the right frontal lobe (series 1700 image 178) most consistent with a new tiny metastasis. There is a stable 11 mm T1 hyper signal and T2 low signal nodule in subcortical region of the right parietal lobe in favor of a metastasis with a stable edema. There is a persistent hematoma in the right cerebellar hemisphere measuring 45 mm previously 43 mm but with more prominent peripheral nodular T1 hyper signal intensity concerning for interval enlargement of the metastatic component. There is interval evolution of postsurgical changes status post left parietotemporal craniotomy. There is interval resolution of the left frontal pneumocephalus. The brain parenchyma appears normal without evidence for acute ischemia. The ventricles are normal in size. There is no abnormal extra-axial collection. The flow voids at the skull base are normal. The cerebellar tonsils are normal in position. EXTRACRANIAL FINDINGS: The orbital contents are unremarkable. There is opacification of the sphenoidal air cells. IMPRESSION: Interval enlargement of the nodular metastasis of left frontal lobe. A new tiny punctate metastasis in the right frontal lobe. A stable right parietal metastasis. A stable hematoma in the right cerebellum but with more peripheral nodular T1 hyper signal intensity concerning for interval enlargement of the hemorrhagic metastasis from melanoma. Minimal effacement of the fourth ventricle is unchanged without hydrocephalus at this time.
FINDINGS: INTRACRANIAL FINDINGS: There is interval mild enlargement of the cortical based T1 hyper signal and T2 low signal nodule in the left frontal lobe measuring 9 mm previously 6 mm in favor of metastasis (likely from melanoma) with mild worsening of edema. There is a new tiny punctate T1 hyper signal intensity and enhancement in the cortex of the right frontal lobe (series 1700 image 178) most consistent with a new tiny metastasis. There is a stable 11 mm T1 hyper signal and T2 low signal nodule in subcortical region of the right parietal lobe in favor of a metastasis with a stable edema. There is a persistent hematoma in the right cerebellar hemisphere measuring 45 mm previously 43 mm but with more prominent peripheral nodular T1 hyper signal intensity concerning for interval enlargement of the metastatic component. There is interval evolution of postsurgical changes status post left parietotemporal craniotomy. There is interval resolution of the left frontal pneumocephalus. The brain parenchyma appears normal without evidence for acute ischemia. The ventricles are normal in size. There is no abnormal extra-axial collection. The flow voids at the skull base are normal. The cerebellar tonsils are normal in position. EXTRACRANIAL FINDINGS: The orbital contents are unremarkable. There is opacification of the sphenoidal air cells.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Interval decrease in volume of partially loculated, small left pleural effusion, however with new scattered locules of gas. Diffuse pleural thickening on the left, incompletely evaluated on this noncontrast examination. Small left pneumothorax Associated left lower lobe subsegmental atelectasis. Interval increase in size and number of multifocal bilateral groundglass and rounded, partially cavitated consolidative densities with areas of interlobular septal thickening, new from prior. Prominent Trace biapical paraseptal emphysema. HEART / VESSELS: Normal cardiac size. No pericardial effusion. Normal thoracic aortic caliber. Mildly enlarged main pulmonary artery up to 3.3 cm.. MEDIASTINUM / ESOPHAGUS: No significant abnormality. LYMPH NODES: Interval increase in size of multiple, mildly enlarged paratracheal, subcarinal, left axillary nodes (index 1.7 cm subcarinal node on series 2, image 43). CHEST WALL: No significant abnormality. UPPER ABDOMEN: Splenomegaly. Bilateral adrenal thickening without discrete nodularity. MUSCULOSKELETAL: No aggressive osseous lesion.
15,001
Clinical history:Assess for cause of dizziness and giddiness Comparison:No direct comparison available, CT neck 11/24/2021 Technique: Multiplanar multisequence pre and postcontrast MRI images of the brain and IACs were obtained. Images include dedicated heavily T2-weighted and postcontrast images through the internal auditory structures. Patient weight: 245 lbs. IV contrast: ProHance, 20 ml, per protocol. . Findings: There is no enhancing mass in either internal auditory canal, or rest of the brain. There is no restricted diffusion to suggest an acute infarct. There are no significant chronic microangiopathic changes. The ventricles are within normal limits for caliber and configuration. The intracranial vascular flow voids are present. Minor scattered paranasal mucosal thickening. Mastoid air cells are clear. The orbits are within normal limits. No suspicious calvarial lesion is noted. Impression: No retrocochlear mass or acute infarct.
Findings: There is no enhancing mass in either internal auditory canal, or rest of the brain. There is no restricted diffusion to suggest an acute infarct. There are no significant chronic microangiopathic changes. The ventricles are within normal limits for caliber and configuration. The intracranial vascular flow voids are present. Minor scattered paranasal mucosal thickening. Mastoid air cells are clear. The orbits are within normal limits. No suspicious calvarial lesion is noted.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Calcified granuloma in the left lower lobe. Small fat-containing left Bochdalek hernia. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Stable appearance of a left adrenal lesion which currently measures 1.8 x 1.4 cm on axial series 301, image 95 (previously 1.9 x 1.5 cm). Right adrenal gland is normal. KIDNEYS: Simple left renal cyst. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered colonic diverticuli without associated inflammation. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Normal caliber abdominal aorta. Mild atherosclerotic disease. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Mildly enlarged, fibroid uterus. BODY WALL: Moderate size fat/omentum containing periumbilical hernia measures 6.0 x 4.7 cm on axial series 301, image 198. MUSCULOSKELETAL: No significant abnormality.
15,002
EXAM:MR Shoulder Right wo contrast CLINICAL INFORMATION:48-year-old male with right shoulder pain. There is concern for rotator cuff tear. COMPARISON:Radiographs dated 12/3/2021, right shoulder ultrasound 1/14/2022 TECHNIQUE:MR Shoulder Right wo contrast STRUCTURED REPORT: MRI SHOULDERv5/23//2019 FINDINGS: Examination is somewhat limited due to motion artifact. BONES:No fracture, marrow replacement or suspicious focal lesion. ROTATOR CUFF: Supraspinatus:Focal bursal surface fluid-filled partial-thickness tear of the anterior supraspinatus fibers at the footplate, measuring approximately 9 mm in width (image 4 series 5). Infraspinatus: Normal Subscapularis: Normal Teres minor: Normal LONG HEAD BICEPS TENDON:Normal. GLENOHUMERAL JOINT: Position:Normal. Articular cartilage:Normal. Ligaments/Capsule: Borderline thickening of the inferior glenohumeral ligament. Faint inflammatory changes within the rotator interval Labrum:Normal given limitations of non-arthrographic technique and patient motion. BURSAE: Small amount of fluid within the bursa. ACROMIAL CLAVICULAR JOINT:Mild acromioclavicular degenerative changes with small inferiorly projecting osteophytes. No os acromiale. SUBACROMIAL ENCROACHMENT:None. MUSCLES:No atrophy. CONCLUSION: 01. Small partial-thickness bursal sided tear of the distal supraspinatus tendon involving the anterior most fibers.. 02. Mild subacromial/subdeltoid bursitis. Mild to moderate AC joint degenerative osteoarthrosis. 03. Findings suggest adhesive capsulitis. 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: Examination is somewhat limited due to motion artifact. BONES:No fracture, marrow replacement or suspicious focal lesion. ROTATOR CUFF: Supraspinatus:Focal bursal surface fluid-filled partial-thickness tear of the anterior supraspinatus fibers at the footplate, measuring approximately 9 mm in width (image 4 series 5). Infraspinatus: Normal Subscapularis: Normal Teres minor: Normal LONG HEAD BICEPS TENDON:Normal. GLENOHUMERAL JOINT: Position:Normal. Articular cartilage:Normal. Ligaments/Capsule: Borderline thickening of the inferior glenohumeral ligament. Faint inflammatory changes within the rotator interval Labrum:Normal given limitations of non-arthrographic technique and patient motion. BURSAE: Small amount of fluid within the bursa. ACROMIAL CLAVICULAR JOINT:Mild acromioclavicular degenerative changes with small inferiorly projecting osteophytes. No os acromiale. SUBACROMIAL ENCROACHMENT:None. MUSCLES:No atrophy.
FINDINGS: VENTRICULAR SYSTEM: Severely effaced with leftward shift. EXTRA-AXIAL SPACES: Large heterogenous extra-axial fluid collection with mixed density. VASCULAR SYSTEM: No significant abnormality of the vascular system. BRAIN PARENCHYMA: Diffuse edema and global sulcal effacement, greater on the right with leftward subfalcine herniation measuring 3 cm. Severe effacement of the suprasellar cistern. SINUSES: Normal. SKULL AND SKULL BASE: No fracture. ORBITS: Normal.
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MRI brain with and without contrast Clinical Information: Male aged 57 years with small cell lung cancer, treatment response evaluation. Comparison: MR 11/7/2011 Technique: Multiplanar, multisequence MRI of the brain were obtained in multiple planes pre-and post administration of intravenous contrast per departmental protocol. Patient weight: 137 lbs. IV contrast: ProHance, 12 ml, per protocol. IV contrast injection rate: 1 ml per sec. Findings: No acute infarct or intracranial hemorrhage. No midline shift, hydrocephalus, mass effect, or other space-occupying lesion. No abnormal enhancing lesions identified. No abnormal parenchymal or leptomeningeal enhancement. No significant abnormality of the extracranial osseous and soft tissue structures. Conclusion: No definite evidence of brain metastasis. No acute intracranial 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: No acute infarct or intracranial hemorrhage. No midline shift, hydrocephalus, mass effect, or other space-occupying lesion. No abnormal enhancing lesions identified. No abnormal parenchymal or leptomeningeal enhancement. No significant abnormality of the extracranial osseous and soft tissue structures.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Patchy bibasilar groundglass densities, right greater than left. DISTAL ESOPHAGUS: Small hiatal hernia. HEART / VESSELS: Mildly enlarged heart size. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Unchanged atrophy of the bilateral native kidneys with scattered renovascular calcifications. Unchanged appearance of the transplant kidney with similar peritransplant stranding. No hydronephrosis or renal calculi of the transplant kidney. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No free intraperitoneal fluid or air. RETROPERITONEUM: Normal. VESSELS: Advanced eccentric calcifications of the abdominal aorta and branch vessels, likely sequelae of chronic renal disease. Small caliber IVC, likely secondary to dehydration. URINARY BLADDER: Decompressed with Foley catheter present. Intraluminal gas, likely secondary to recent catheterization. REPRODUCTIVE ORGANS: Uterus is present. No adnexal mass. BODY WALL: Unchanged appearance of the right lower quadrant postsurgical site with associated soft tissue thickening, likely scarring. No focal large fluid collection identified. Bilateral fat-containing inguinal hernias. MUSCULOSKELETAL: Mild multilevel discogenic degenerative change, most prominent at L3-L4. Chronic sclerosis of the bilateral sacroiliac joints. No aggressive osseous lesions.
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MR Brain wo+w contrast 1/20/2022 4:53 PM CLINICAL INFORMATION: invasive fungal sinusitis and stroke COMPARISON: Multiple priors, most recently a CT head from 1/16/2022 and MR facial bones 1/15/2022. TECHNIQUE: Multiplanar, multisequence MR images of the brain were obtained before and after the administration of intravenous contrast. Patient weight: 300 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 1 ml per sec. FINDINGS: Again seen are multiple areas of restricted diffusion including the left optic nerve extending to near the optic chiasm, the left anterior thalamus and left MCA-ACA watershed region, this latter finding appears more extensive than the prior examination. There are also increasing foci of restricted diffusion in the left posterior parietal lobe and relatively unchanged appearance of restricted diffusion in the left occipital lobe. There is a new focus of restricted diffusion in the left temporal lobe. These areas are associated with increased signal on T2/FLAIR, especially in the posterior left frontal lobe. There is no intracranial hemorrhage. The ventricles are normal in size for age and there is no midline shift. On postcontrast images there is mild enhancement seen in the left posterior frontal cortex such as on series 801 images 18 and 19. There is slight increased T2 signal within the left orbit intraconal fat, especially surrounding the optic nerve. Again noted are postsurgical changes of debridement and paranasal sinuses. There is worsening T2 hyperintense fluid with mucosal thickening in the right greater than left maxillary sinuses and sphenoid sinus. Again seen is thinning of the right posterior lateral sphenoid wall near the transiting internal carotid artery. There is no intracranial extension of the enhancement from the paranasal sinuses. CONCLUSION: 1. Evolving left-sided watershed infarcts as above with worsening of infarcts in the left frontal and parietal regions in addition to a new punctate infarct in the left temporal lobe. 2. Relatively unchanged restricted diffusion in the left optic nerve with associated reactive/inflammatory change of the left orbit intraconal fat. 3. Extensive postsurgical changes of debridement involving the paranasal sinuses with worsening mucosal thickening and fluid seen. 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: Again seen are multiple areas of restricted diffusion including the left optic nerve extending to near the optic chiasm, the left anterior thalamus and left MCA-ACA watershed region, this latter finding appears more extensive than the prior examination. There are also increasing foci of restricted diffusion in the left posterior parietal lobe and relatively unchanged appearance of restricted diffusion in the left occipital lobe. There is a new focus of restricted diffusion in the left temporal lobe. These areas are associated with increased signal on T2/FLAIR, especially in the posterior left frontal lobe. There is no intracranial hemorrhage. The ventricles are normal in size for age and there is no midline shift. On postcontrast images there is mild enhancement seen in the left posterior frontal cortex such as on series 801 images 18 and 19. There is slight increased T2 signal within the left orbit intraconal fat, especially surrounding the optic nerve. Again noted are postsurgical changes of debridement and paranasal sinuses. There is worsening T2 hyperintense fluid with mucosal thickening in the right greater than left maxillary sinuses and sphenoid sinus. Again seen is thinning of the right posterior lateral sphenoid wall near the transiting internal carotid artery. There is no intracranial extension of the enhancement from the paranasal sinuses.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Interval decrease in size of trace right greater than left pleural effusions with associated partial bilateral lower lobe atelectatic collapse. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Normal cardiac size. No pericardial effusion. Normal thoracic aorta and main pulmonary artery caliber. Trace multivessel coronary artery atherosclerotic calcifications. Aortic valve calcifications. ABDOMEN and PELVIS: LIVER: Focal fat adjacent to the falciform ligament. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Stable 3.1 cm right adrenal mass (series 201, image 84). Nodular left adrenal thickening, unchanged. KIDNEYS: Stable scattered bilateral subcentimeter hypoattenuating lesions, technically indeterminate. Coarse calcification in the right posterior interpolar region, unchanged. No focal enhancing mass. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The colon is nondilated. Left lower quadrant percutaneous drainage catheter closely approximates the sigmoid colon Normal appendix. PERITONEUM / MESENTERY: Interval increase in size of subhepatic peripherally enhancing fluid collection, now measuring 3.0 x 1.6 cm (series 201, image 129), previously 2.7 x 1.2 cm (series 2, image 139). Interval decrease in size of deep pelvic peripherally enhancing fluid collection with associated inflammatory stranding, now measuring 6.2 x 2.7 cm (series 201, image 227), previously 7.2 x 3.7 cm (series 2, image 244). Left lower quadrant percutaneous drainage catheter closely approximates the sigmoid colon with distal tip coiled within the deep pelvic collection. Interval removal of right pelvic percutaneous drainage catheter. RETROPERITONEUM: Normal. VESSELS: Mild aortoiliac and branch vessel atherosclerotic calcifications without aneurysmal dilatation. The vertebral and portal venous systems are patent. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is surgically absent. No adnexal lesion. BODY WALL: Persistent subcentimeter gas-containing collections adjacent to the left lower quadrant percutaneous drainage catheter, similar to prior. Small fat-containing periumbilical hernia. Bilateral flank subcutaneous fat stranding/edema, unchanged. MUSCULOSKELETAL: The imaged bilateral upper extremities demonstrate no acute fracture or dislocation. No aggressive osseous lesion.
15,005
EXAM: MR Facial Bones wo+w contrast 1/20/2022 1:24 PM CLINICAL INFORMATION: Ho maxillary sinonasal tumor. Per chart review, history of left masticator space giant cell tumor status post combined approach and subsequent resection in April 2016, complicated by recurrence status post left partial maxillectomy on 6/19/2019. Presents for surveillance imaging. COMPARISON: MR right facial bones dated 1/28/2021, 5/21/2020, 10/24/2019. TECHNIQUE: Multiple T1 and T2-weighted MR sequence images of the face were obtained in the sagittal axial and coronal planes pre- and post administration of intravenous contrast per departmental protocol. Patient weight: 155 lbs. IV contrast: ProHance, 8 ml, per protocol. FINDINGS: Stable postsurgical changes from prior left partial maxillectomy, including resection of the medial and lateral maxillary walls, turbinectomy, ethmoidectomy, and partial resection of the alveolar ridge. No new or focal masslike enhancement. Exuberant left pterygoid exostosis, unchanged. Trace mucosal thickening within the residual bilateral maxillary and ethmoid sinus cavities as well as frontal and left sphenoid sinuses, unchanged. The paranasal sinuses and mastoid air cells are otherwise clear. Both orbits are unremarkable. Multiple tiny STIR hyperintense foci in the bilateral basal ganglia, likely dilated perivascular spaces. Otherwise no brain parenchymal signal abnormality. The ventricular system is normal in caliber and configuration. The basal cisterns are clear. The visualized proximal cerebrovascular flow voids appear normal. _________________________ CONCLUSION: 1. No acute intracranial process. 2. Stable left partial maxillectomy postsurgical changes. No new or focal masslike enhancement to suggest residual/recurrent disease. 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: Stable postsurgical changes from prior left partial maxillectomy, including resection of the medial and lateral maxillary walls, turbinectomy, ethmoidectomy, and partial resection of the alveolar ridge. No new or focal masslike enhancement. Exuberant left pterygoid exostosis, unchanged. Trace mucosal thickening within the residual bilateral maxillary and ethmoid sinus cavities as well as frontal and left sphenoid sinuses, unchanged. The paranasal sinuses and mastoid air cells are otherwise clear. Both orbits are unremarkable. Multiple tiny STIR hyperintense foci in the bilateral basal ganglia, likely dilated perivascular spaces. Otherwise no brain parenchymal signal abnormality. The ventricular system is normal in caliber and configuration. The basal cisterns are clear. The visualized proximal cerebrovascular flow voids appear 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: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Normal appendix. PERITONEUM / MESENTERY: Small amount of free fluid within the pelvis. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Bilateral ovarian cysts. Hemorrhagic corpus luteum on the right. Myomatous uterus with degenerated myoma measuring approximately 3.3 cm transversely by 3.4 cm anteroposteriorly. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Mild retrolisthesis of L5 on S1. No aggressive osseous lesions identified.
15,006
MRI brain with and without contrast Clinical Information: Male aged 46 years with asymmetry in hearing, L>R, Comparison: None. Technique: Multiplanar, multisequence MRI of the brain were obtained in multiple planes pre-and post administration of intravenous contrast per departmental protocol. Patient weight: 180 lbs. IV contrast: Meglumine Dotarem, 9 ml, per protocol. IV contrast injection rate: 1 ml per sec. Findings: No abnormal enhancement. No space occupying lesions seen at the cerebellopontine angle. No mastoid air cell effusion. No fluid in the middle ear cavities. The otic capsules appear normal. Cranial nerve VIII and CN VII are intact in the IAC bilaterally. No vascular abnormalities in the petrous portions. No acute infarct or intracranial hemorrhage. No midline shift, hydrocephalus, mass effect, or other space-occupying lesion. No abnormal parenchymal or leptomeningeal enhancement. No significant abnormality of the extracranial osseous and soft tissue structures. Conclusion: No acute intracranial process. Bilateral IACs, 7th and 8th cranial nerves as well as inner ear structures are within normal limits 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: No abnormal enhancement. No space occupying lesions seen at the cerebellopontine angle. No mastoid air cell effusion. No fluid in the middle ear cavities. The otic capsules appear normal. Cranial nerve VIII and CN VII are intact in the IAC bilaterally. No vascular abnormalities in the petrous portions. No acute infarct or intracranial hemorrhage. No midline shift, hydrocephalus, mass effect, or other space-occupying lesion. No abnormal parenchymal or leptomeningeal enhancement. No significant abnormality of the extracranial osseous and soft tissue structures.
FINDINGS: STRUCTURED REPORT: CT Chest PE and Abdomen Pelvis OVERALL DIAGNOSTIC QUALITY: Mildly suboptimal quality with incomplete evaluation of subsegmental pulmonary arteries. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus within the limits of this examination. LUNGS / AIRWAYS / PLEURA: Normal. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Left calyceal diverticulum with punctate internal calcifications and retained excreted contrast similar to CT dated 7/6/2004. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered diverticuli without inflammation. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: Again partially calcified splenic artery aneurysm measuring 1.3 cm (series 303, image 89). URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is absent. No adnexal abnormalities. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: Multilevel degenerative changes of the spine with anterior wedging of L2
15,007
Clinical history:Follow up intracranial metastasis Comparison: MRI 10/20/2021, 7/20/2021 Technique: Multiplanar multisequence noncontrast MRI images of the brain were obtained. After uneventful administration of intravenous contrast, postcontrast images were obtained. Patient weight: 126 lbs. IV contrast: ProHance, 12 ml, per protocol. IV contrast injection rate: 0.50 ml per sec. Findings: There has been trace decrease in the size of the 1.9 x 1.5 x 0.9 cm heterogeneously enhancing lesion in the left temporal lobe, previously 1.9 x 1.6 x 1.3 cm. Also mild decreased surrounding T2/FLAIR hyperintensity involving the left temporal lobe. A few foci of GRE related to the lesion. There is no new lesion. Redemonstration of confluent T2/FLAIR hyperintensity involving the bilateral corona radiata, likely representing treatment changes. Ventricular caliber and configuration are stable. There is no midline shift. Minor scattered paranasal mucosal thickening. Small amount of fluid in the left mastoid air cells. The orbits are within normal limits. No suspicious calvarial lesion is noted. Impression: Trace decrease in the size of the 1.9 cm heterogeneously enhancing lesion in the left temporal lobe. Also mild decreased surrounding T2/FLAIR hyperintensity. Findings are favored to be related to treatment effects.
Findings: There has been trace decrease in the size of the 1.9 x 1.5 x 0.9 cm heterogeneously enhancing lesion in the left temporal lobe, previously 1.9 x 1.6 x 1.3 cm. Also mild decreased surrounding T2/FLAIR hyperintensity involving the left temporal lobe. A few foci of GRE related to the lesion. There is no new lesion. Redemonstration of confluent T2/FLAIR hyperintensity involving the bilateral corona radiata, likely representing treatment changes. Ventricular caliber and configuration are stable. There is no midline shift. Minor scattered paranasal mucosal thickening. Small amount of fluid in the left mastoid air cells. The orbits are within normal limits. No suspicious calvarial lesion is noted.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Subsegmental atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Multivessel coronary artery atherosclerotic calcifications. ABDOMEN and PELVIS: LIVER: Scattered subcentimeter hypoattenuating lesions, indeterminate but statistically cysts. Focal fat adjacent to the falciform. BILIARY TRACT: Normal. GALLBLADDER: No acute abnormality PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Borderline hiatal hernia. Nondilated and otherwise within normal limits COLON / APPENDIX: Colonic diverticula with inflamed diverticulum at the level of the distal sigmoid colon. No extraluminal air or organized pericolonic fluid collection. PERITONEUM / MESENTERY: Inflammatory mesenteric stranding along the sigmoid colon. Trace pelvic free fluid. No free intraperitoneal air. RETROPERITONEUM: Normal. VESSELS: Mild aortoiliac atherosclerotic calcifications. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is surgically absent. No adnexal lesion. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: Multilevel mild lumbar spine degenerative changes. Mild bilateral sacroiliac and hip joint degenerative osteoarthrosis.
15,008
Clinical history:Memory loss, assess previously seen lesions Comparison:MRI performed on one 6/20/2020, 9/7/2012 Technique: Multiplanar multisequence noncontrast MRI images of the brain were obtained. After uneventful administration of intravenous contrast, postcontrast images were obtained. Patient weight: 185 lbs. IV contrast: ProHance, 18 ml, per protocol. IV contrast injection rate: 0.50 ml per sec. Findings: There is no enhancing intracranial mass or abnormal enhancement. There is no restricted diffusion to suggest an acute infarct. There is no evidence of acute hemorrhage on the susceptibility weighted images. There has been no significant change in multiple subcortical T2/FLAIR hyperintensities involving the bilateral cerebral hemispheres. The ventricles are stable in caliber and configuration. The intracranial vascular flow voids are present. Minor scattered paranasal mucosal thickening. Mastoid air cells are clear. The orbits are within normal limits. No suspicious calvarial lesion is noted. Impression: 1. No abnormal intracranial enhancement, or acute intracranial abnormality. 2. No significant change in multiple subcortical T2/FLAIR hyperintensities involving the bilateral cerebral hemispheres. These are more than expected for patient's age and could represent underlying vasculopathy, less likely sequela of prior demyelination.
Findings: There is no enhancing intracranial mass or abnormal enhancement. There is no restricted diffusion to suggest an acute infarct. There is no evidence of acute hemorrhage on the susceptibility weighted images. There has been no significant change in multiple subcortical T2/FLAIR hyperintensities involving the bilateral cerebral hemispheres. The ventricles are stable in caliber and configuration. The intracranial vascular flow voids are present. Minor scattered paranasal mucosal thickening. Mastoid air cells are clear. The orbits are within normal limits. No suspicious calvarial lesion is noted.
FINDINGS: STRUCTURED REPORT: CT Chest PE and Abdomen Pelvis OVERALL DIAGNOSTIC QUALITY: Mildly suboptimal quality with incomplete evaluation of subsegmental pulmonary arteries. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus within the limits of this examination. LUNGS / AIRWAYS / PLEURA: Normal. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Left calyceal diverticulum with punctate internal calcifications and retained excreted contrast similar to CT dated 7/6/2004. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered diverticuli without inflammation. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: Again partially calcified splenic artery aneurysm measuring 1.3 cm (series 303, image 89). URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is absent. No adnexal abnormalities. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: Multilevel degenerative changes of the spine with anterior wedging of L2
15,009
MRI OF THE CERVICAL SPINE WITHOUT AND WITH CONTRAST CLINICAL INDICATION: Assess for demyelination disease TECHNIQUE: Multisequence MRI images of the cervical spine were acquired before and after intravenous contrast administration. Patient weight: 137 lbs. IV contrast: ProHance, 13 ml, per protocol. . COMPARISON: MRI head 10/31/2021, CT head 10/24/2021, CT neck 6/1/2021 FINDINGS: Straightening of the cervical spine lordotic curvature. The vertebral body heights are maintained. There is no suspicious bone marrow signal abnormality. There is no appreciable cord signal abnormality. No mass or abnormal fluid collection is present within the cervical spinal canal. The paravertebral soft tissues are unremarkable. There is no significant spinal canal or neuroforaminal stenosis anywhere. On the postcontrast images, there is no abnormal enhancement cervical spine. Redemonstration of artifact related to right ventricular peritoneal shunt catheter. IMPRESSION: No appreciable cord signal abnormality or abnormal enhancement in the cervical spine. No significant cervical spine degenerative changes.
FINDINGS: Straightening of the cervical spine lordotic curvature. The vertebral body heights are maintained. There is no suspicious bone marrow signal abnormality. There is no appreciable cord signal abnormality. No mass or abnormal fluid collection is present within the cervical spinal canal. The paravertebral soft tissues are unremarkable. There is no significant spinal canal or neuroforaminal stenosis anywhere. On the postcontrast images, there is no abnormal enhancement cervical spine. Redemonstration of artifact related to right ventricular peritoneal shunt catheter.
FINDINGS: Scouts: No additional findings. Mediastinum: Partially visualized thyroid gland is unremarkable. No evidence of focal esophageal wall abnormalities. Mildly patulous lower esophagus is again noted. No evidence of pathologically enlarged mediastinal, hilar or axillary lymph nodes. Heart and great vessels: Cardiac chambers are normal in size. No pericardial effusion. There are some calcifications within the IVC junction with the right atrium, similar to multiple prior chest CTs, but increased since 2017 chest CT exam, and could represent a calcified IVC thrombus. Airways: The trachea and central bronchi are patent and clear. Lungs : Linear opacity of scarring with associated traction is again noted within the left lower lobe. Bibasilar, right greater than left, predominant groundglass opacities have improved when compared to prior. No new focal pulmonary opacities or nodules. Pleural: No pleural effusion or pneumothorax. Upper abdomen: Limited noncontrast visualization of the upper abdomen is without acute abnormalities. Bones and soft tissues: The visualized chest wall soft tissues are unremarkable. Stable degenerative bony changes, including T9 vertebral body superior endplate mild compression fracture. No aggressive or destructive intrathoracic osseous lesions.
15,010
EXAM: MR Knee Left wo contrast CLINICAL INFORMATION: 53-year-old male with left knee pain. COMPARISON: Knee radiograph 1/18/2022. TECHNIQUE: MR Knee Left wo contrast STRUCTURED REPORT: MRI Knee 1/2/2020 FINDINGS: BONES:No fracture, marrow replacement, or aggressive osseous lesion. Small T1 and T2 hypointense area within the inferior lateral femoral epicondyle, likely representing a bone island. ARTICULATIONS: Effusion: Moderate suprapatellar effusion with synovial thickening and irregularity, likely reactive. Patellofemoral compartment:Cartilage thinning and full-thickness defects of the lateral articular facet of the patella. There is mild adjacent edema of the underlying patella (series 601 image 16). There is also a small sessile osteophyte. Medial compartment:Chondromalacia of the articular cartilage overlying the medial tibial plateau. Lateral compartment:Mild thinning of the lateral tibial plateau cartilage. MENISCI: Medial meniscus:There is a complex tear of the junction of the posterior horn in the root and horizontal extension of the tear through the posterior horn of the medial meniscus extending to the inferior articular surface (series 301 image 16-18). There is mild medial extrusion. In addition the superior and inferior meniscocapsular struts appear somewhat wavy particularly inferiorly suggesting at least partial tears Lateral meniscus:Intact. LIGAMENTS: Cruciate ligaments:Intact. Medial collateral ligament:The medial collateral ligament is intact. There is superficial edema adjacent to the ligament and mild intermediate intrasubstance signal reflecting acute injury. Lateral collateral ligament: Intact Posterolateral corner structures:Intact. EXTENSOR MECHANISM:The distal quadriceps and patellar tendons are intact. Enthesopathic changes at the superior and inferior patella. CONCLUSION: 1. Complex tear of the posterior horn of the medial meniscus with both radial and horizontal components. There is also suggestion of partial tear of the inferior and possibly superior meniscocapsular struts. 2. Grade 1 medial collateral ligament injury. 3. Tricompartmental degenerative osteoarthrosis greatest within the patellofemoral compartment where there is Full-thickness cartilage defect of the lateral articular facet of the patella with adjacent patellar edema. 4. Moderate suprapatellar effusion with synovial thickening and irregularity, likely reactive. 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: BONES:No fracture, marrow replacement, or aggressive osseous lesion. Small T1 and T2 hypointense area within the inferior lateral femoral epicondyle, likely representing a bone island. ARTICULATIONS: Effusion: Moderate suprapatellar effusion with synovial thickening and irregularity, likely reactive. Patellofemoral compartment:Cartilage thinning and full-thickness defects of the lateral articular facet of the patella. There is mild adjacent edema of the underlying patella (series 601 image 16). There is also a small sessile osteophyte. Medial compartment:Chondromalacia of the articular cartilage overlying the medial tibial plateau. Lateral compartment:Mild thinning of the lateral tibial plateau cartilage. MENISCI: Medial meniscus:There is a complex tear of the junction of the posterior horn in the root and horizontal extension of the tear through the posterior horn of the medial meniscus extending to the inferior articular surface (series 301 image 16-18). There is mild medial extrusion. In addition the superior and inferior meniscocapsular struts appear somewhat wavy particularly inferiorly suggesting at least partial tears Lateral meniscus:Intact. LIGAMENTS: Cruciate ligaments:Intact. Medial collateral ligament:The medial collateral ligament is intact. There is superficial edema adjacent to the ligament and mild intermediate intrasubstance signal reflecting acute injury. Lateral collateral ligament: Intact Posterolateral corner structures:Intact. EXTENSOR MECHANISM:The distal quadriceps and patellar tendons are intact. Enthesopathic changes at the superior and inferior patella.
FINDINGS: Scouts: No additional findings. Lines and tubes: None. Lungs: No evidence of interlobular septal thickening are reticulations. No bronchiectasis or honeycombing. Diffuse bronchial wall thickening bilaterally. No mosaic attenuation on expiratory phase imaging. Dependent atelectasis bilaterally. Small 3 mm noncalcified pulmonary nodules in the right lung apex (series 201 image 25) Pleura: No pleural effusion. No pneumothorax. Esophagus, Mediastinum and neck: Esophagus is normal. Mediastinum is normal. The thyroid gland is normal. Lymph Nodes: None enlarged. Cardiovascular: Mild left atrial dilation. No pericardial effusion. Minimal aortic root calcification. Coronary artery atherosclerotic calcification: None detected. Abdomen: Postsurgical changes from prior cholecystectomy. Diffuse hepatic steatosis. Nonobstructing calculus in the middle calyx of left kidney measuring 2 mm. Musculoskeletal/Body Wall: No soft tissue masses. Fat-containing right-sided Bochdalek hernia. No aggressive appearing skeletal lesions. Mild degenerative changes in spine.
15,011
MR Breast Screening wo+w contrast CLINICAL INFORMATION: FH of breast cancer, Z80.3 Family history of malignant neoplasm of breast, D24.9 Benign neoplasm of unspecified breast Spec Inst: LT risk 30%. TECHNIQUE: FSE T2 fat sat axial, pre and post contrast vibrant sequence with 3D reconstructions. A dedicated 8 channel breast imaging coil was utilized. Patient weight: 180 lbs. IV contrast: ProHance, 17 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: Multiple prior breast MRIs, most recently 1/14/2021 MRI FINDINGS: The breasts are composed of heterogeneous fibroglandular tissue. Following contrast administration, there is moderate background enhancement. RIGHT BREAST: There is no suspicious enhancing mass or nonmass enhancement. There is a focus susceptibility artifact in the upper outer breast consistent with postbiopsy clip. LEFT BREAST: There is no suspicious enhancing mass or nonmass enhancement. LYMPH NODES: There is no axillary or internal mammary adenopathy. IMPRESSION: No MRI evidence of malignancy within either breast. BI-RADS 2: Benign
FINDINGS: The breasts are composed of heterogeneous fibroglandular tissue. Following contrast administration, there is moderate background enhancement. RIGHT BREAST: There is no suspicious enhancing mass or nonmass enhancement. There is a focus susceptibility artifact in the upper outer breast consistent with postbiopsy clip. LEFT BREAST: There is no suspicious enhancing mass or nonmass enhancement. LYMPH NODES: There is no axillary or internal mammary adenopathy.
FINDINGS: HEAD: 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. 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 (
15,012
Clinical history:Follow-up multiple sclerosis Comparison:MRI head 3/8/2021 Technique: Multiplanar multisequence MR images of the brain were acquired without intravenous contrast using the MS protocol. Findings: There has no significant change in multiple periventricular, deep and subcortical distribution T2/FLAIR hyperintensities involving the supratentorial brain. None of these demonstrate restricted diffusion. There is no evidence of acute hemorrhage on the susceptibility weighted images. The ventricles are stable in caliber and configuration. The intracranial vascular flow voids are present. Minor scattered paranasal mucosal thickening. Mastoid air cells are clear. The orbits are within normal limits. No suspicious calvarial lesion is noted. Impression: No significant change in multiple T2/FLAIR hyperintense lesions involving the supratentorial brain, consistent with the history of multiple sclerosis.
Findings: There has no significant change in multiple periventricular, deep and subcortical distribution T2/FLAIR hyperintensities involving the supratentorial brain. None of these demonstrate restricted diffusion. There is no evidence of acute hemorrhage on the susceptibility weighted images. The ventricles are stable in caliber and configuration. The intracranial vascular flow voids are present. Minor scattered paranasal mucosal thickening. Mastoid air cells are clear. The orbits are within normal limits. No suspicious calvarial lesion is noted.
FINDINGS: STRUCTURED REPORT: CT Chest Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Trace biapical pleural-parenchymal scarring and bibasilar subsegmental atelectasis. No pleural effusion or pneumothorax. No suspicious pulmonary nodule. Small-volume tracheal secretions. The central tracheobronchial tree is otherwise patent. HEART / VESSELS: No significant abnormality. There is tethering of the right heart anterior wall at the retrosternal region. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: The gallbladder is surgically absent. MUSCULOSKELETAL: No significant abnormality.
15,013
MRI OF THE THORACIC SPINE WITHOUT CONTRAST CLINICAL INDICATION: Assess for cause of mid thoracic pain TECHNIQUE: Multiplanar multisequence MRI images of the thoracic spine were acquired without intravenous contrast. COMPARISON: Cervical spine radiograph performed on 10/7/2021, CT chest 9/6/2019 FINDINGS: There is exaggeration of the the kyphotic curvature of the thoracic spine. There is mild STIR hyperintensity involving the anterior endplates spanning from T4 through T10, best seen on the STIR images and on the previously performed CT chest. The vertebral body heights are maintained. The thoracic spinal cord is normal in caliber and signal. No mass or abnormal fluid collection is present within the spinal canal. There is no high-grade spinal canal or neuroforaminal stenosis at any level. IMPRESSION: Exaggeration of the the kyphotic curvature of the thoracic spine. Mild STIR hyperintensity involving the anterior endplates spanning T4-T10 possibly represent stress changes related to exaggerated kyphosis. No high-grade spinal canal or neuroforaminal stenosis at any level.
FINDINGS: There is exaggeration of the the kyphotic curvature of the thoracic spine. There is mild STIR hyperintensity involving the anterior endplates spanning from T4 through T10, best seen on the STIR images and on the previously performed CT chest. The vertebral body heights are maintained. The thoracic spinal cord is normal in caliber and signal. No mass or abnormal fluid collection is present within the spinal canal. There is no high-grade spinal canal or neuroforaminal stenosis at any level.
FINDINGS: HEAD: 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. 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 (
15,014
Clinical History: Lumbar radiculopathy more than six weeks Comparison: Lumbar spine radiograph from 7/7/2021 Technique: Multiplanar multisequence MRI images of the lumbar spine were performed without intravenous contrast. Findings: There is trace retrolisthesis of L1 over L2. Vertebral body heights are maintained. There are no suspicious osseous lesions. There is mild to moderate disc height loss at L5-S1. Conus terminates near L1-L2. T12-L1: Mild asymmetric left disc bulge, though no significant spinal canal or neural foraminal stenosis. L1-2: Mild disc bulge, though no significant spinal canal or neural foraminal stenosis. L2-3: No significant spinal canal or neural foraminal stenosis. L3-4: There is mild disc bulge and epidural lipomatosis, without significant spinal canal stenosis. Mild bilateral neural foraminal narrowing due to mild facet hypertrophy. L4-5: There is mild disc bulge and epidural lipomatosis without significant spinal canal stenosis. Mild bilateral neuroforaminal narrowing due to mild facet and ligamentum flavum hypertrophy. L5-S1: Combination of central disc protrusion, disc height loss, mild facet hypertrophy results in mild left lateral recess narrowing. Mild bilateral neuroforaminal narrowing. The paraspinal soft tissues and visualized intra-abdominal contents are unremarkable. Impression: Mild multilevel lumbar spine spine spondylosis, most pronounced at L5-S1 with a small disc protrusion resulting in mild left lateral recess narrowing. Mild bilateral neuroforaminal narrowing at this level as well. No acute findings in the lumbar spine.
Findings: There is trace retrolisthesis of L1 over L2. Vertebral body heights are maintained. There are no suspicious osseous lesions. There is mild to moderate disc height loss at L5-S1. Conus terminates near L1-L2. T12-L1: Mild asymmetric left disc bulge, though no significant spinal canal or neural foraminal stenosis. L1-2: Mild disc bulge, though no significant spinal canal or neural foraminal stenosis. L2-3: No significant spinal canal or neural foraminal stenosis. L3-4: There is mild disc bulge and epidural lipomatosis, without significant spinal canal stenosis. Mild bilateral neural foraminal narrowing due to mild facet hypertrophy. L4-5: There is mild disc bulge and epidural lipomatosis without significant spinal canal stenosis. Mild bilateral neuroforaminal narrowing due to mild facet and ligamentum flavum hypertrophy. L5-S1: Combination of central disc protrusion, disc height loss, mild facet hypertrophy results in mild left lateral recess narrowing. Mild bilateral neuroforaminal narrowing. The paraspinal soft tissues and visualized intra-abdominal contents are unremarkable.
FINDINGS: HEAD: 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. 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 (
15,015
MR 3D Neuro Requiring Indep Wkst, MR Diffusion Tract Imaging 1/20/2022 2:11 PM Clinical Information: Brain met, C79.31 Secondary malignant neoplasm of brain Spec Inst: DTI, tractography for visual pathways Technique: Diffusion tensor MRI scan was acquired with 60 diffusion sensitizing gradient orientations (b=0 and 1000) on 3T Siemens Prisma scanner. Fractional anisotropy and directionally encoded colormap were generated. DT tractography for the right optic radiation was produced using DynaSuite software, and results were exported to Stealth workstation. Findings/ Impression: Streamline diffusion tensor tractography mapping of the right optic radiation is provided for presurgical planning purpose.
Findings/
FINDINGS: STRUCTURED REPORT: CTA Chest VASCULATURE: CORONARY ARTERIES: There are mild atherosclerotic calcifications of the native coronary arteries. PULMONARY ARTERIES: No central pulmonary embolus. Normal size. ASCENDING THORACIC AORTA: Unchanged appearance of the ascending aortic interposition graft. AORTIC ARCH: Redemonstrated and unchanged type A dissection extending from the proximal aortic arch and extending to the proximal descending thoracic aorta. ARCH VESSELS: Dissection flap continues to extend to involve the origin of the brachiocephalic artery with persistent thrombosis of the false lumen. DESCENDING THORACIC AORTA: Unchanged mild ectasia of the proximal descending thoracic aorta. UPPER ABDOMINAL AORTA: No significant abnormality. ------------------------------------------------------------- LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Patchy consolidation at the left base shows parenchymal enhancement suggesting atelectasis. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Hyperdense focus within the distal esophagus possibly representing a pill. Postsurgical changes of prior aortic repair in the anterior mediastinum. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Wedge-shaped hypoenhancement within the spleen suggestive of infarction. No other significant abnormality. MUSCULOSKELETAL: Large Schmorl's nodes at T9-T10. Some questionable stranding in the paravertebral fat on the left at this level.
15,016
MR Breast Screening wo+w contrast Clinical Information: hx of breast cancer. Multiple palpable lumps, Z85.3 Personal history of malignant neoplasm of breast, N63.0 Unspecified lump in unspecified breast Technique: Three plane localizer, T1 axial, FSE T2 fat sat axial, pre and post contrast vibrant sequence with 3D reconstructions and time intensity curves. Delayed post contrast sagittals. Patient weight: 133 lbs. IV contrast: ProHance, 12 ml, per protocol. IV contrast injection rate: 2 ml per sec. Comparison: Multiple breast ultrasound dating back to 1/8/2020, breast MRI 10/30/2019 Amount of fibroglandular tissue: NA Background enhancement: NA Findings: Right breast: There are no suspicious masses or suspicious enhancement in the right reconstructed breast. Left breast: There are no suspicious masses or suspicious enhancement in the left reconstructed breast. Implants: Bilateral implants are grossly intact. Lymph nodes: No axillary lymphadenopathy on either side. No internal mammary lymphadenopathy on either side. Conclusion: Right breast: No MRI evidence of malignancy in the right reconstructed breast. Grossly intact right implant. BI-RADS 2: Benign findings Left breast: No MRI evidence of malignancy in the left reconstructed breast. Grossly intact left implant. BI-RADS 2: Benign findings Final BIRADS; BI-RADS 2: Benign findings
Findings: Right breast: There are no suspicious masses or suspicious enhancement in the right reconstructed breast. Left breast: There are no suspicious masses or suspicious enhancement in the left reconstructed breast. Implants: Bilateral implants are grossly intact. Lymph nodes: No axillary lymphadenopathy on either side. No internal mammary lymphadenopathy on either side.
FINDINGS: BONES/JOINTS: No acute fracture or malalignment. There is a healed fracture deformity of the mid ulna with long plate and screw construct. SOFT TISSUES: Large apparent skin defect/scar of the volar forearm is noted without associated rim-enhancing fluid collection. Within the volar distal forearm, at the level of the distal radius, there is a 1.7 cm rounded structure without definite enhancement. Numerous adjacent vascular clips are noted. No soft tissue gas is identified.
15,017
EXAM: MR Pelvis wo+w contrast CLINICAL INFORMATION: Colon cancer, assess treatment response, C18.9 Malignant neoplasm of colon, unspecified Spec Inst: recurrent colon cancer now sp RT completed November 2021. Re-assessment COMPARISON: MR pelvis dated 10/29/2021 TECHNIQUE: MR Pelvis wo+w contrast Patient weight: 168 lbs. IV contrast: ProHance, 8 ml, per protocol. IV contrast injection rate: 1 ml per sec. FINDINGS: STRUCTURED REPORT: MRI Pelvis PELVIS: VESSELS: Portions of the IMA again course through the heterogeneous distal sigmoid colon lesion. LYMPH NODES: Previously observed prominent mesocolic/mesorectal lymph nodes are decreased in size. BOWEL/PERIRECTAL REGION: Partially circumferential, enhancing mass involving the distal sigmoid colon measures at least 5.2 x 4.1 x 6.0 cm (AP, TV, CC) on axial postcontrast image 220, series 1101, and sagittal T2 image 29, series 201 (previously 7.1 x 7.6 x 8.1 cm). The cranial aspect of the tumor is not imaged on postcontrast sequences. Precontrast T1 and T2 images excluded the majority of the tumor. Marked adjacent desmoplastic reaction tracks anteriorly towards adjacent portions of small bowel and small bowel mesentery The rectum normal, aside from mild prominence of the perirectal fat. The left lower quadrant colostomy is partially imaged. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Partial visualization of a left lower quadrant ostomy. MUSCULOSKELETAL: No significant abnormality. Normal marrow signal on all pulse sequences. CONCLUSION: 1. Significant interval decrease in size in distal sigmoid colonic mass, which is partially imaged as above. 2. Prominent mesocolic/mesorectal lymph nodes appear decreased in size and, although indeterminate, appear reactive. Adjacent fat stranding likely due to posttreatment changes. 3. Marked desmoplastic reaction near the level of the anastomotic suture line which tracks anteriorly towards the small bowel mesentery and multiple loops of adjacent small bowel. No visible enterocolic fistula. 4. Left lower quadrant colostomy and additional 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: MRI Pelvis PELVIS: VESSELS: Portions of the IMA again course through the heterogeneous distal sigmoid colon lesion. LYMPH NODES: Previously observed prominent mesocolic/mesorectal lymph nodes are decreased in size. BOWEL/PERIRECTAL REGION: Partially circumferential, enhancing mass involving the distal sigmoid colon measures at least 5.2 x 4.1 x 6.0 cm (AP, TV, CC) on axial postcontrast image 220, series 1101, and sagittal T2 image 29, series 201 (previously 7.1 x 7.6 x 8.1 cm). The cranial aspect of the tumor is not imaged on postcontrast sequences. Precontrast T1 and T2 images excluded the majority of the tumor. Marked adjacent desmoplastic reaction tracks anteriorly towards adjacent portions of small bowel and small bowel mesentery The rectum normal, aside from mild prominence of the perirectal fat. The left lower quadrant colostomy is partially imaged. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Partial visualization of a left lower quadrant ostomy. MUSCULOSKELETAL: No significant abnormality. Normal marrow signal on all pulse sequences.
FINDINGS: BRAIN PARENCHYMA: Stable bifrontal contusive changes with largest hemorrhagic focus within the left frontal lobe. Unchanged herniation of brain through frontal craniectomy defect, partially within the frontal sinuses. EXTRA-AXIAL SPACES: Unchanged punctate right frontal pneumocephalus. No extra-axial collection. SKULL AND SKULL BASE: Bifrontal craniectomies extending into the frontal sinuses. Brain herniates through the defect. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Left maxillary sinus mucous retention cyst.
15,018
EXAM: MR Knee Right wo contrast CLINICAL INFORMATION: Right knee pain, instability COMPARISON: 12/13/2021 TECHNIQUE: MR Knee Right wo contrast STRUCTURED REPORT: MRI Knee 1/2/2020 FINDINGS: BONES:No fracture, marrow replacement, or aggressive osseous lesion. ARTICULATIONS: Effusion:None. Patellofemoral compartment: Mild chondromalacia in the lateral patellar facet. Medial compartment:No cartilage defect. Lateral compartment:No cartilage defect. MENISCI: Medial meniscus:Intact. Lateral meniscus:Intact. LIGAMENTS: Cruciate ligaments:Intact. Medial collateral ligament:Intact. Lateral collateral ligament:Intact. Posterolateral corner structures:Intact. EXTENSOR MECHANISM:The distal quadriceps and patellar tendons are intact. CONCLUSION: 01. Mild chondromalacia in the lateral patellar facet. 02. Otherwise unremarkable MRI of the right knee with no evidence of internal derangement. 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: BONES:No fracture, marrow replacement, or aggressive osseous lesion. ARTICULATIONS: Effusion:None. Patellofemoral compartment: Mild chondromalacia in the lateral patellar facet. Medial compartment:No cartilage defect. Lateral compartment:No cartilage defect. MENISCI: Medial meniscus:Intact. Lateral meniscus:Intact. LIGAMENTS: Cruciate ligaments:Intact. Medial collateral ligament:Intact. Lateral collateral ligament:Intact. Posterolateral corner structures:Intact. EXTENSOR MECHANISM:The distal quadriceps and patellar tendons are intact.
FINDINGS: Partial opacification of the left mastoid air cells without evidence of bony erosion. Near complete opacification of the left middle air. No enhancing drainable fluid collection identified. The nasopharynx is unremarkable. No significant abnormality of the visualized brain parenchyma. Chronic deformity of the left lamina papyracea. Mild mucosal thickening of the maxillary sinuses. Large old left lamina papyracea fracture with some thickening of the medial rectus muscle and fat herniation. Mucosal thickening of the maxillary sinuses bilaterally.
15,019
EXAM: MR Lumbar Spine wo contrast 1/20/2022 2:20 PM CLINICAL INFORMATION: Low back pain. COMPARISON: None available. TECHNIQUE: Multiple T1 and T2 weighted MR sequence images of the lumbar spine were obtained in the axial and sagittal plane without and with the use of intravenous contrast per departmental lumbar spine protocol. FINDINGS: Sagittal imaging demonstrates vertebral body heights and alignment to be maintained. Mildly T1 and markedly T2/STIR hyperintense signal at the L4-L5 anterior endplates, likely fatty conversion (Modic type II). Marrow signal otherwise appears maintained. Multilevel degenerative disc desiccation at L3-L5 with moderate intervertebral disc space height loss at L4-L5. The conus terminates at the pedicle level of L1. Axial images are evaluated on a level by level basis: T12-L1: Normal. L1-2: Normal. L2-3: Normal. L3-4: Minimal diffuse disc bulge without significant central canal or neural foraminal narrowing. L4-5: Moderate right subarticular disc protrusion with moderate spinal canal stenosis and complete effacement of the right lateral recess. Displacement of the cauda equina nerve roots with compression of the transiting right L5 nerve root. Hypertrophic bilateral ligamentum flavum and mild facet arthropathy, resulting in mild bilateral neuroforaminal stenosis. L5-S1: Minimal disc bulge and mild bilateral facet arthropathy. No significant spinal canal or neuroforaminal stenosis.. The visualized paraspinal structures appear otherwise within normal limits. The remaining visualized osseous and soft tissue structures demonstrate normal MR signal characteristics. _________________________ CONCLUSION: 1. Multilevel degenerative discogenic disease, most prominently at L4-L5 with chronic endplate changes and disc protrusion, resulting in moderate spinal canal stenosis with right lateral recess effacement and compression of the right transiting L5 nerve root. Mild bilateral neuroforaminal stenosis. 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: Sagittal imaging demonstrates vertebral body heights and alignment to be maintained. Mildly T1 and markedly T2/STIR hyperintense signal at the L4-L5 anterior endplates, likely fatty conversion (Modic type II). Marrow signal otherwise appears maintained. Multilevel degenerative disc desiccation at L3-L5 with moderate intervertebral disc space height loss at L4-L5. The conus terminates at the pedicle level of L1. Axial images are evaluated on a level by level basis: T12-L1: Normal. L1-2: Normal. L2-3: Normal. L3-4: Minimal diffuse disc bulge without significant central canal or neural foraminal narrowing. L4-5: Moderate right subarticular disc protrusion with moderate spinal canal stenosis and complete effacement of the right lateral recess. Displacement of the cauda equina nerve roots with compression of the transiting right L5 nerve root. Hypertrophic bilateral ligamentum flavum and mild facet arthropathy, resulting in mild bilateral neuroforaminal stenosis. L5-S1: Minimal disc bulge and mild bilateral facet arthropathy. No significant spinal canal or neuroforaminal stenosis.. The visualized paraspinal structures appear otherwise within normal limits. The remaining visualized osseous and soft tissue structures demonstrate normal MR signal characteristics. _________________________
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Diffuse bilateral groundglass opacities. DISTAL ESOPHAGUS: Small hiatal hernia. HEART / VESSELS: Coronary artery calcifications. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis without cholecystitis. PANCREAS: Unchanged pancreatic head cystic lesion, probably side branch IPMN. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Diffuse cortical thinning of the left kidney with wedge-shaped hyperattenuation consistent with prior injury. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Moderate fecal burden within the rectum. Mild perirectal/presacral stranding. Scattered diverticuli without inflammation. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerotic calcifications of the abdominal aorta and branches. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Gas within the vagina. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: Mild multilevel degenerative changes of the spine. No aggressive osseous lesion identified.
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EXAM: MR Brain wo+w contrast 1/20/2022 3:09 PM CLINICAL INFORMATION: Pineal lesion. Per chart review, complex neurological history including conversion disorder manifested as nonepileptic spells, now wheelchair bound with intermittent partial paralysis, recurrent headaches. COMPARISON: CT head dated 12/11/2019, 3/8/2019. MRI brain dated 3/8/2019, 4/7/2018. TECHNIQUE: Multiple T1 and T2-weighted MR sequence images of the brain were obtained in the sagittal axial and coronal planes pre- and post administration of intravenous contrast per departmental protocol. Patient weight: 260 lbs. IV contrast: ProHance, 20 ml, per protocol. FINDINGS: Redemonstration of the small pineal cystic lesion with peripheral enhancement, measures approximately 9 x 7 mm. There is no significant mass effect on adjacent tectal plate. No evidence of hydrocephalus. No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, space-occupying lesion, or mass effect. Postcontrast series demonstrates no focal enhancing lesion. The ventricular system is normal in caliber and configuration. The basal cisterns are clear. The visualized proximal cerebrovascular flow voids appear normal. The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. The paranasal sinuses and mastoid air cells are clear. Both orbits are unremarkable. _________________________ CONCLUSION: No acute intracranial process. Subcentimeter pineal cystic lesion with peripheral enhancement without significant mass effect on adjacent structures. No pathologic enhancement is appreciated. 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: Redemonstration of the small pineal cystic lesion with peripheral enhancement, measures approximately 9 x 7 mm. There is no significant mass effect on adjacent tectal plate. No evidence of hydrocephalus. No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, space-occupying lesion, or mass effect. Postcontrast series demonstrates no focal enhancing lesion. The ventricular system is normal in caliber and configuration. The basal cisterns are clear. The visualized proximal cerebrovascular flow voids appear normal. The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. The paranasal sinuses and mastoid air cells are clear. Both orbits are unremarkable. _________________________
FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: Evaluation limited by streak artifact from implantable cardiac device. Within these limits no significant abnormality identified. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Diffuse patchy groundglass opacities and focal areas of consolidation in the lungs. Trace pleural effusion on the left. Small amount of dependent mucus within the trachea. HEART / OTHER VESSELS: Cardiomegaly. Coronary artery calcifications. Implantable cardiac device. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. LYMPH NODES: Prominent reactive hilar lymph nodes. CHEST WALL: Left implantable cardiac device. Midline sternotomy wires. Gynecomastia. UPPER ABDOMEN: Scattered diverticuli without inflammation. MUSCULOSKELETAL: Multilevel degenerative changes of the spine. No aggressive osseous lesions identified. CABG changes.
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Clinical history:Follow-up multiple sclerosis Comparison:MRI 5/20/2021, 10/8/2020 Technique: Multiplanar multisequence pre and postcontrast images of the brain were acquired using the multiple sclerosis protocol. Patient weight: 165 lbs. IV contrast: ProHance, 16 ml, per protocol. Findings: Accounting for differences in technique, there has been no significant change in the periventricular, deep and some cord, T2/FLAIR hyperintensities involving the bilateral cerebral hemispheres, most concentrated in the periventricular right frontal lobe. These demonstrate enhancement, restricted diffusion. There is no new lesion. The ventricles are stable in for caliber and configuration. The intracranial vascular flow voids are present. Minor scattered paranasal mucosal thickening. Mastoid air cells are clear. The orbits are within normal limits. No suspicious calvarial lesion is noted. Impression: Accounting for differences in technique, no significant change in the T2/FLAIR hyperintensities in the supratentorial brain, consistent with the submitted history of multiple sclerosis. No new lesions or imaging findings
Findings: Accounting for differences in technique, there has been no significant change in the periventricular, deep and some cord, T2/FLAIR hyperintensities involving the bilateral cerebral hemispheres, most concentrated in the periventricular right frontal lobe. These demonstrate enhancement, restricted diffusion. There is no new lesion. The ventricles are stable in for caliber and configuration. The intracranial vascular flow voids are present. Minor scattered paranasal mucosal thickening. Mastoid air cells are clear. The orbits are within normal limits. No suspicious calvarial lesion is noted.
FINDINGS: BRAIN PARENCHYMA: Encephalomalacia of the right greater than left frontal lobes. No discrete peripheral enhancing intracranial lesion is identified within the field-of-view. No significant mass effect, edema, or midline shift. EXTRA-AXIAL SPACES: Normal as visualized. SKULL AND SKULL BASE: Frontal bone prosthesis is stable in appearance. No new acute fracture is identified. Progressive destructive changes of the maxilla related to prior radiation therapy. VENTRICULAR SYSTEM: Normal. Maxillofacial: ORBITS: Stable extension of paranasal sinus mass into the left orbit with intraconal extension which appears to encapsulate the optic nerve and involve the extraocular muscles, specifically the left superior rectus, medial rectus. There is no significant proptosis. PARANASAL SINUSES/MASTOID AIR CELLS: Stable advanced post surgical changes status post rhinectomy, antrectomy, and ethmoidectomy. No mastoid effusion. FACIAL SOFT TISSUES: No acute abnormality. No peripheral enhancing maxillofacial soft tissue lesion. Temporomandibular joints: Normal.
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MR Brain wo+w contrast HISTORY: Evaluation for retinal artery occlusion TECHNIQUE: Multiplanar, multisequence MRI of the brain was performed without and after intravenous contrast. Patient weight: 134 lbs. IV contrast: ProHance, 6 ml, per protocol. COMPARISON: CT of 1/19/2022 FINDINGS: INTRACRANIAL FINDINGS: There is mild diffuse cerebral volume loss. Mild ventriculomegaly is likely excavatum dilation. There is confluent periventricular FLAIR hyper signal intensity most consistent with advanced microvascular angiopathy. There is an old lacunar infarction of right basal ganglia. There is a small old lacunar infarction of the left caudate head. The brain parenchyma appears normal without evidence for acute ischemia, hemorrhage, or mass lesion. The ventricles are normal in size. There is no abnormal extra-axial collection. The flow voids at the skull base are normal. The cerebellar tonsils are normal in position. EXTRACRANIAL FINDINGS: The orbital contents are unremarkable. The visualized paranasal sinuses and mastoid air cells are well aerated. IMPRESSION: Suboptimal study because of motion artifact. No acute intracranial lesion. Advanced microvascular angiopathy. Old lacunar infarctions of the right basal ganglia and left caudate head.
FINDINGS: INTRACRANIAL FINDINGS: There is mild diffuse cerebral volume loss. Mild ventriculomegaly is likely excavatum dilation. There is confluent periventricular FLAIR hyper signal intensity most consistent with advanced microvascular angiopathy. There is an old lacunar infarction of right basal ganglia. There is a small old lacunar infarction of the left caudate head. The brain parenchyma appears normal without evidence for acute ischemia, hemorrhage, or mass lesion. The ventricles are normal in size. There is no abnormal extra-axial collection. The flow voids at the skull base are normal. The cerebellar tonsils are normal in position. EXTRACRANIAL FINDINGS: The orbital contents are unremarkable. The visualized paranasal sinuses and mastoid air cells are well aerated.
Findings: CT head: BRAIN PARENCHYMA: Unchanged trace hemorrhage and edema posterior to the left ventriculostomy catheter in the left frontal horn.Slight decreased Gray-white matter differentiation maintained. Stable Chiari malformation changes. EXTRA-AXIAL SPACES: No collection. SKULL AND SKULL BASE: No acute fracture or aggressive osseous lesion. Suboccipital craniectomy changes. VENTRICULAR SYSTEM: Unchanged position of bifrontal approach EVD catheters with tips terminating in the frontal horns. Unchanged enlargement of the lateral ventricles. For example the left temporal horn measures 18 mm transverse dimension, previously 18 mm. The 3rd ventricle measures 15 mm, previously 14 mm in transverse dimension. ORBITS: Normal. SINUSES: Unchanged left greater than right maxillary sinus partial opacification with air-fluid levels. Small bilateral mastoid effusions.
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MR Brain wo+w contrast 1/22/2022 11:02 PM CLINICAL INFORMATION: 70 years Female RIGHT petrous apex lesion Spec Inst: Prior scan not sufficient due to motion artifact and thick cuts. Please perform IAC protocol and pre-medicate with Ativan COMPARISON: MR brain 1/19/2022 TECHNIQUE: Multiplanar multisequence MR images of the brain were obtained before and after the administration of intravenous contrast. Patient weight: 120 lbs. IV contrast: ProHance, 6 ml, per protocol. FINDINGS: Examination is again degraded by motion artifact No acute intracranial hemorrhage or infarct. Redemonstrated confluent encephalomalacia and adjacent gliosis involving primarily the right parietal and temporal lobes, and to a lesser degree the right frontal and occipital lobes, with associated asymmetric ex vacuo dilation of the adjacent right lateral horn. Moderate diffuse cerebral volume loss with similar confluent nonenhancing periventricular T2/FLAIR signal hyperintensity. Ex vacuo ventricular dilation without hydrocephalus. On FLAIR images, there is homogeneous intermediate intensity signal within the ventricular system and extra-axial spaces, with normal fluid signal demonstrated on alternative sequences no associated ventricular or meningeal enhancement on postcontrast images. Overall, these findings likely reflect technical artifact with incomplete fluid suppression. There are redemonstrated bilateral, right greater than left, mastoid effusions. There is heterogeneous T1 hyperintense and hypointense signal and T2 hypo and hyperintense signal within the right petrous apex. There is focal destruction of the right clivus. There is patchy enhancement of ill-defined lesion extending from the right petrous apex to the right mastoid air cells. There is also inferior extension to the jugular foramen and superior extension to the right middle ear.. There are destructive changes of the right mastoid air cells better seen on CT. The lesion measures approximately 1.7 x 3.5 cm in the axial plane and approximately 1.7 cm in craniocaudal dimension. There is also enhancing soft tissue within the right middle ear. The semicircular canals and cochlea do not appear involved. There is suggestion of mild extension of enhancement adjacent to the right carotid canal. There is edema and enhancement enhancement of the upper prevertebral soft tissues at the skull base skull base and also mild enhancement within the right masticator space. No organized/strain fluid collection. There is faint dural enhancement within the right posterior fossa. There is similar within the right transverse and sigmoid sinus, with questionable nonocclusive filling defect in the sigmoid sinus on postcontrast images (axial postcontrast series 1001, image 10). The remaining visualized paranasal sinuses are clear. Orbits and globes are unremarkable. CONCLUSION: 1. Examination again significantly degraded secondary to motion artifact. There is ill-defined destructive enhancing lesion within the right skull base with focal destructive changes involving the clivus and right temporal bone including the right mastoid air cells.. Enhancement appears to be heterogeneous but without discrete fluid component. There are adjacent inflammatory changes within the prevertebral soft tissues. There is also mild asymmetric dural enhancement within the right posterior fossa. Findings may represent advanced infectious mastoiditis but no definite drainable abscess is identified. Given location near the right jugular foramen and extending into right middle ear this could also represent a glomus tumor, i.e jugulotympanicum,. Alternatively could represent aggressive skull base lesion including metastases.. 2. There is faint dural enhancement within the right posterior fossa. There is questionable nonocclusive thrombus within the right transverse sinus. 3. Stable chronic Large amount of right cerebral hemisphere encephalomalacia 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: Examination is again degraded by motion artifact No acute intracranial hemorrhage or infarct. Redemonstrated confluent encephalomalacia and adjacent gliosis involving primarily the right parietal and temporal lobes, and to a lesser degree the right frontal and occipital lobes, with associated asymmetric ex vacuo dilation of the adjacent right lateral horn. Moderate diffuse cerebral volume loss with similar confluent nonenhancing periventricular T2/FLAIR signal hyperintensity. Ex vacuo ventricular dilation without hydrocephalus. On FLAIR images, there is homogeneous intermediate intensity signal within the ventricular system and extra-axial spaces, with normal fluid signal demonstrated on alternative sequences no associated ventricular or meningeal enhancement on postcontrast images. Overall, these findings likely reflect technical artifact with incomplete fluid suppression. There are redemonstrated bilateral, right greater than left, mastoid effusions. There is heterogeneous T1 hyperintense and hypointense signal and T2 hypo and hyperintense signal within the right petrous apex. There is focal destruction of the right clivus. There is patchy enhancement of ill-defined lesion extending from the right petrous apex to the right mastoid air cells. There is also inferior extension to the jugular foramen and superior extension to the right middle ear.. There are destructive changes of the right mastoid air cells better seen on CT. The lesion measures approximately 1.7 x 3.5 cm in the axial plane and approximately 1.7 cm in craniocaudal dimension. There is also enhancing soft tissue within the right middle ear. The semicircular canals and cochlea do not appear involved. There is suggestion of mild extension of enhancement adjacent to the right carotid canal. There is edema and enhancement enhancement of the upper prevertebral soft tissues at the skull base skull base and also mild enhancement within the right masticator space. No organized/strain fluid collection. There is faint dural enhancement within the right posterior fossa. There is similar within the right transverse and sigmoid sinus, with questionable nonocclusive filling defect in the sigmoid sinus on postcontrast images (axial postcontrast series 1001, image 10). The remaining visualized paranasal sinuses are clear. Orbits and globes are unremarkable.
FINDINGS: No shunt catheter identified within the neck soft tissues. Please refer to the CT head for the assessment ventriculomegaly. There is also a upper cervical canal syrinx (best seen on series 404 image 160, series 402 image 487) with diameter measuring up to 2.5 cm. Normal aortic arch, bilateral carotids, and bilateral vertebral arteries. Right upper extremity PICC line tip not visualized. Patchy nodular and tree-in-bud opacities within bilateral lung apices. Partially visualized circumferential esophageal thickening. Unchanged midline anterior chest wall subcutaneous fluid collection measures up to 2.8 x 1.0 cm in greatest axial dimension (series 401, image 29) the caudal extent of collection is imaged with dedicated chest CT, see separate dictation. Please refer to the CT chest.
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Clinical history:Assess for cause of right inferior quadrant-anopida Comparison:None Available Technique: Multiplanar multisequence pre and post contrast MRI images of the brain and orbits were acquired Patient weight: 155 lbs. IV contrast: ProHance, 10 ml, per protocol. IV contrast injection rate: 0.50 ml per sec. Findings: There is no enhancing intracranial mass or abnormal enhancement. There is no restricted diffusion to suggest an acute infarct. The bilateral optic nerves and intraorbital contents are unremarkable. Rightward directed gaze. There are no appreciable T2/FLAIR lesions in the brain. There is no evidence of acute hemorrhage on the susceptibility weighted images. The ventricles are within normal limits for caliber and configuration. The intracranial vascular flow voids are present. Moderate size mucus retention cyst in the bilateral maxillary sinuses. Mastoid air cells are clear. The orbits are within normal limits. No suspicious calvarial lesion is noted. Impression: No appreciable intracranial or orbital abnormality.
Findings: There is no enhancing intracranial mass or abnormal enhancement. There is no restricted diffusion to suggest an acute infarct. The bilateral optic nerves and intraorbital contents are unremarkable. Rightward directed gaze. There are no appreciable T2/FLAIR lesions in the brain. There is no evidence of acute hemorrhage on the susceptibility weighted images. The ventricles are within normal limits for caliber and configuration. The intracranial vascular flow voids are present. Moderate size mucus retention cyst in the bilateral maxillary sinuses. Mastoid air cells are clear. The orbits are within normal limits. No suspicious calvarial lesion is noted.
Findings: CT head: 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 acute fracture. No aggressive osseous lesion. Bilateral carotid siphon calcifications. VENTRICULAR SYSTEM: No hydrocephalus. Unchanged 8 x 7 mm peripherally calcified lesion along the ride side of the floor the 4th ventricle (series 2, image 17). ORBITS: Left scleral band. Otherwise normal. SINUSES: Small bilateral maxillary mucus retention cysts.
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Clinical history:Assess for cause of right inferior quadrant-anopida Comparison:None Available Technique: Multiplanar multisequence pre and post contrast MRI images of the brain and orbits were acquired Patient weight: 155 lbs. IV contrast: ProHance, 10 ml, per protocol. IV contrast injection rate: 0.50 ml per sec. Findings: There is no enhancing intracranial mass or abnormal enhancement. There is no restricted diffusion to suggest an acute infarct. The bilateral optic nerves and intraorbital contents are unremarkable. Rightward directed gaze. There are no appreciable T2/FLAIR lesions in the brain. There is no evidence of acute hemorrhage on the susceptibility weighted images. The ventricles are within normal limits for caliber and configuration. The intracranial vascular flow voids are present. Moderate size mucus retention cyst in the bilateral maxillary sinuses. Mastoid air cells are clear. The orbits are within normal limits. No suspicious calvarial lesion is noted. Impression: No appreciable intracranial or orbital abnormality.
Findings: There is no enhancing intracranial mass or abnormal enhancement. There is no restricted diffusion to suggest an acute infarct. The bilateral optic nerves and intraorbital contents are unremarkable. Rightward directed gaze. There are no appreciable T2/FLAIR lesions in the brain. There is no evidence of acute hemorrhage on the susceptibility weighted images. The ventricles are within normal limits for caliber and configuration. The intracranial vascular flow voids are present. Moderate size mucus retention cyst in the bilateral maxillary sinuses. Mastoid air cells are clear. The orbits are within normal limits. No suspicious calvarial lesion is noted.
Findings: Stable left frontal approach ventriculostomy catheter with the tip in the left frontal horn. No hydrocephalus. No herniation of the right frontoparietal lobe through the craniectomy defect. Slight interval decrease in small volume extra-axial hemorrhage along the right frontotemporal lobe. No mass effect or midline shift. Stable small volume subdural hematoma along the right parietal convexity. No intraparenchymal infarction or hemorrhage. Orbits are unremarkable. Paranasal sinuses and mastoid air cells are clear.
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MR Breast Diagnostic Bil wo+w contrast CLINICAL INFORMATION: persistent right nipple discharge, N64.52 Nipple discharge Spec Inst: fluid subareolar. TECHNIQUE: T1 axial, FSE T2 fat sat axial, pre and post contrast vibrant sequence with 3D reconstructions and time intensity curves. Delayed post contrast sagittals. A dedicated 8 channel breast imaging coil was utilized. Patient weight: 260 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: No prior breast MRI. Most recent bilateral mammogram and right breast ultrasound 1/4/2022 MRI FINDINGS: The breasts are composed of scattered fibroglandular tissue. Following contrast administration, there is mild background enhancement. RIGHT BREAST: In the 3:00 subareolar breast, there is approximately 20 mm of focal ductal dilatation with peripheral enhancement of the duct wall, likely inflamed (series 400, image 135 and series 6, image 88-92). There is a focus of susceptibility artifact immediately posterior to the duct consistent with postbiopsy clip. There is no enhancing intraductal mass. In the 3:00 breast, anterior depth, there is a 24 x 24 x 24 mm (AP x TV x CC) peripherally enhancing T2 hyperintense cyst consistent with an inflamed cyst (series 400, image 143 and series 6, image 75). LEFT BREAST: There is no suspicious enhancing mass or nonmass enhancement. LYMPH NODES: There is no axillary or internal mammary adenopathy. IMPRESSION: RIGHT BREAST: Findings consistent with inflamed focally dilated subareolar duct and inflamed cyst in the 3:00 breast. No enhancing intraductal component seen. BI-RADS 2: Benign. Consider duct excision if clear nipple discharge persists. LEFT BREAST: No MRI evidence of malignancy. BI-RADS 1: Negative. OVERALL BI-RADS ASSESSMENT: BI-RADS 2: Benign.
FINDINGS: The breasts are composed of scattered fibroglandular tissue. Following contrast administration, there is mild background enhancement. RIGHT BREAST: In the 3:00 subareolar breast, there is approximately 20 mm of focal ductal dilatation with peripheral enhancement of the duct wall, likely inflamed (series 400, image 135 and series 6, image 88-92). There is a focus of susceptibility artifact immediately posterior to the duct consistent with postbiopsy clip. There is no enhancing intraductal mass. In the 3:00 breast, anterior depth, there is a 24 x 24 x 24 mm (AP x TV x CC) peripherally enhancing T2 hyperintense cyst consistent with an inflamed cyst (series 400, image 143 and series 6, image 75). LEFT BREAST: There is no suspicious enhancing mass or nonmass enhancement. LYMPH NODES: There is no axillary or internal mammary adenopathy.
FINDINGS: BONES/JOINTS: Interval placement of distal femoral intramedullary fixation rod and extrinsic fixation hardware. Internal and external fixation hardware projects in expected position. Femoral diaphyseal fracture is incompletely imaged, persistent slight peripheral displacement of the visualized fracture fragments. Expected postoperative changes associated with placement of intramedullary rod. Redemonstration of severely comminuted patellar fracture, not significantly changed in appearance or alignment since the prior exam, given differences in technique. Redemonstration of severely comminuted and mildly impacted intra-articular proximal tibial fractures. The fractures extend to the proximal metaphysis and diaphysis. There continue be areas of incongruity and depression associated with the lateral tibial plateau articular surfaces, a few fracture fragments displaced into the joint space. SOFT TISSUES: There is hematoma around fractures and hardware. Small amount of gas within the joint space and adjacent to the femoral diaphyseal fracture is likely related to placement of recent hardware. Diffuse soft tissue edema. Small volume lipohemarthrosis.
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EXAM: MR Hip Right wo contrast CLINICAL INFORMATION: Right hip pain and instability COMPARISON: None. TECHNIQUE: Multiplanar and multisequence MRI of the right hip was obtained without intravenous contrast. FINDINGS: BONES: No fracture, marrow replacement or aggressive osseous lesion. Small amount of marrow edema is noted within the right femoral head and acetabular roof, likely reactive. RIGHT HIP JOINT: Alignment: Normal. Effusion: Moderate with synovitis. Labrum: Degenerative signal of the anterior and superior labrum. Cartilage: Thinning of the articular cartilage of the superior femoral head and acetabular roof. Marginal osteophytes are noted along the femoral head. Capsule and ligaments:Normal. LEFT HIP JOINT: Normal alignment. No joint effusion. The articular cartilage is unremarkable. MUSCLES/TENDON: Normal. VESSELS:No significant disease. NERVES: Normal. INTRAPELVIC: No visceral or solid organ abnormality within the pelvis. No lymphadenopathy. No free fluid in the pelvis. CONCLUSION: Moderate degenerative changes of the right hip with degenerative labral tear, subchondral marrow edema and moderate joint effusion/synovitis. 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: BONES: No fracture, marrow replacement or aggressive osseous lesion. Small amount of marrow edema is noted within the right femoral head and acetabular roof, likely reactive. RIGHT HIP JOINT: Alignment: Normal. Effusion: Moderate with synovitis. Labrum: Degenerative signal of the anterior and superior labrum. Cartilage: Thinning of the articular cartilage of the superior femoral head and acetabular roof. Marginal osteophytes are noted along the femoral head. Capsule and ligaments:Normal. LEFT HIP JOINT: Normal alignment. No joint effusion. The articular cartilage is unremarkable. MUSCLES/TENDON: Normal. VESSELS:No significant disease. NERVES: Normal. INTRAPELVIC: No visceral or solid organ abnormality within the pelvis. No lymphadenopathy. No free fluid in the pelvis.
FINDINGS: BONES/JOINTS: Comminuted, mildly impacted, intra-articular calcaneal fracture, fractures extending to the subtalar joint. No definite extension to the calcaneocuboid articulation. Minimally displaced intra-articular fracture along the medial aspect of the great toe proximal phalanx, extending to the IP joint. No acute displaced fracture involving the remaining bones and joints of the visualized right foot appreciated. SOFT TISSUES: Small amount of edema in the soft tissues around fractures..
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EXAM: CV MR Cardiac w contrast PATIENT DATA Date of Study: 1/21/2022 10:20 AM Referring MD: Sarah Sandberg Height: 168 cm. Patient weight: 89 kg. BSA: 1.99 Blood Pressure: 129/81 Heart Rate: 74 bpm. EGFR 60. The patient's creatinine was 0.9 on 01/21/2022. The patient received 18 cc's of Gadavist at a rate of 2 ml per second without immediate complication. CLINICAL INFORMATION: Patient studied for evaluation of: sarcoid, D86.9 Sarcoidosis, unspecified History: 47 year old woman with PMHx of mixed connective tissue disease, DM and asthma with chest pain and palpitations presenting for cardiac MRI to rule out cardiac sarcoidosis. COMPARISON: No prior CMR TECHNIQUE: CV MR Cardiac w contrast FINDINGS: IMAGING DATA Imaging System: GE 1.5T Overall Image Quality: Excellent CARDIAC MORPHOLOGY AND VENTRICULAR FUNCTION Views: Axial Two chamber Four chamber Short axis LV LVOT Ascending aorta Short AX T2 Sequences: FSE 2IR FSE 3IR SSFP FGRE ET Additional views: Delayed Contrast Enhancement, Perfusion General: ECG gated: YES MEASUREMENTS: In Millimeters Left Atrium: 33 LV End Diastolic Dimension: 46 LV End Systolic Dimension: 33 LV Posterior Wall: 6 Right Atrium 46 RV End Diastolic Dimension: 44 Interventricular Septum: 9 Left Ventricle (short axis): Volumes in mL, Index volumes in mL per square meter End Diastolic Volume: 141 ED Index 71 End Systolic Volume: 55 ES Index 28 Stroke Volume: 86 SV Index 43 Ejection Fraction: 61.0% Morphology: There is normal left ventricular size and function. There is no increased T2 signal to suggest any myocardial edema. There is normal first pass gadolinium perfusion. There is no abnormal late gadolinium enhancement to suggest myocardial fibrosis. Right Ventricle (short axis):Volumes in mL, Index volumes in mL per square meter End Diastolic Volume: 146 ED Index 73 End Systolic Volume: 66 ES Index 33 Stroke Volume: 80 SV Index 39 Ejection Fraction: 54.8% Morphology: There is normal right ventricular size and systolic function. Pericardium: Thickness: 2mm (1-3 mm) Effusion: None Pleural: Regional Abnormalities: None VALVULAR MORPHOLOGY Valve: No significant valvular stenosis or regurgitation Vessel dimensions: (In mm normal range dimensions mm) Main Pulmonary Artery 23 Aortic Root 27 Aortic Arch 27 [18-37] Right Pulmonary Artery 16 Ascending Aorta 34 [19-37] Left Pulmonary Artery 18 Inferior Vena Cava 29 Descending Aorta 23 [16-29] INCIDENTAL FINDINGS: None CONCLUSION: 1. Normal cardiac MRI without any sign of cardiac sarcoidosis Cardiac MRI Technologist: Trina Corbitt 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: IMAGING DATA Imaging System: GE 1.5T Overall Image Quality: Excellent CARDIAC MORPHOLOGY AND VENTRICULAR FUNCTION Views: Axial Two chamber Four chamber Short axis LV LVOT Ascending aorta Short AX T2 Sequences: FSE 2IR FSE 3IR SSFP FGRE ET Additional views: Delayed Contrast Enhancement, Perfusion General: ECG gated: YES MEASUREMENTS: In Millimeters Left Atrium: 33 LV End Diastolic Dimension: 46 LV End Systolic Dimension: 33 LV Posterior Wall: 6 Right Atrium 46 RV End Diastolic Dimension: 44 Interventricular Septum: 9 Left Ventricle (short axis): Volumes in mL, Index volumes in mL per square meter End Diastolic Volume: 141 ED Index 71 End Systolic Volume: 55 ES Index 28 Stroke Volume: 86 SV Index 43 Ejection Fraction: 61.0% Morphology: There is normal left ventricular size and function. There is no increased T2 signal to suggest any myocardial edema. There is normal first pass gadolinium perfusion. There is no abnormal late gadolinium enhancement to suggest myocardial fibrosis. Right Ventricle (short axis):Volumes in mL, Index volumes in mL per square meter End Diastolic Volume: 146 ED Index 73 End Systolic Volume: 66 ES Index 33 Stroke Volume: 80 SV Index 39 Ejection Fraction: 54.8% Morphology: There is normal right ventricular size and systolic function. Pericardium: Thickness: 2mm (1-3 mm) Effusion: None Pleural: Regional Abnormalities: None VALVULAR MORPHOLOGY Valve: No significant valvular stenosis or regurgitation Vessel dimensions: (In mm normal range dimensions mm) Main Pulmonary Artery 23 Aortic Root 27 Aortic Arch 27 [18-37] Right Pulmonary Artery 16 Ascending Aorta 34 [19-37] Left Pulmonary Artery 18 Inferior Vena Cava 29 Descending Aorta 23 [16-29] INCIDENTAL FINDINGS: None
Findings: In the interim, there has been removal of the previous EVD catheter in the right paramedian frontal region and placement of a ventricular shunt catheter through the right frontal craniotomy with its tip terminating in the resection cavity adjacent to the frontal horn of right lateral ventricle. Stable post surgical changes and small hemorrhagic foci in the right inferior frontal lobe along the resection cavity margins. No definite new hemorrhage. There is persistent vasogenic edema and mass effect with leftward midline shift by 4 mm.
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EXAM: CV MR Cardiac w contrast PATIENT DATA Date of Study: 1/21/2022 12:57 PM Referring MD: Efstathia Andrikopoulou Height: 165 cm. Patient weight: 63 kg. BSA: 1.69 Blood Pressure: 118/72 Heart Rate: 94 bpm. EGFR 59. The patient's creatinine was 1.0 on 01/03/2022. The patient received 12 cc's of Gadavist at a rate of 2 ml per second without immediate complication. CLINICAL INFORMATION: Patient studied for evaluation of: ra mass, D15.1 Benign neoplasm of heart History: 47 year old woman with a past medical history of metastatic angiosarcoma with paraneoplastic syndrome and atrial thrombus s/p angiovac debulking 10/2020 COMPARISON: CMR 6/4/2020 TECHNIQUE: CV MR Cardiac w contrast FINDINGS: IMAGING DATA Imaging System: GE 1.5T Overall Image Quality: Excellent CARDIAC MORPHOLOGY AND VENTRICULAR FUNCTION Views: Axial Coronal Two chamber Four chamber Right two chamber Short axis LV Short axis atria LVOT Ascending aorta 4CH T1/T2 Sequences: FSE 2IR FSE 3IR SSFP FGRE ET Additional views: Delayed Contrast Enhancement, Perfusion MS Axial General: ECG gated: YES MEASUREMENTS: In Millimeters Left Atrium: 20 LV End Diastolic Dimension: 41 LV End Systolic Dimension: 31 LV Posterior Wall: 6 Right Atrium 30 RV End Diastolic Dimension: 36 Interventricular Septum: 7 Left Ventricle (short axis):Volumes in mL, Index volumes in mL per square meter End Diastolic Volume: 100 ED Index 59 End Systolic Volume: 41 ES Index 24 Stroke Volume: 59 SV Index 35 Ejection Fraction: 59.0% Morphology: Normal left ventricular (LV) volumes and wall thickness. Normal left ventricular systolic function. No LV myocardial signal abnormality on edema sequences (T2 and triple IR). No evidence of LV myocardial persistent perfusion defect on first pass rest perfusion images or enhancement on late gadolinium enhancement (LGE) images. Right Ventricle (short axis):Volumes in mL, Index volumes in mL per square meter End Diastolic Volume: 97 ED Index 57 End Systolic Volume: 46 ES Index 27 Stroke Volume: 51 SV Index 30 Ejection Fraction: 52.6% Morphology: Normal right ventricular (RV) volumes and wall thickness. Normal right ventricular systolic function. No evidence of regional wall motion abnormalities. No RV myocardial signal abnormality on edema sequences (T2 and triple IR). No evidence of RV myocardial abnormal signal intensity on all pulse sequences. Atria: The left atria appears normal in size without any visualized mass with four pulmonary veins draining into it. The right atria has a small lesion of 1x1.3x2.4 cm at the inferiolateral wall near the opening to the IVC similar to prior imaging. There is no significant T1 or T2 enhancement and no late gadolinium enhancement noted. It is not well seen on first pass gadolinium images, however there is no obvious early contrast uptake. Pericardium: Thickness: 2mm (1-3 mm) Effusion: none Pleural: No pleural effusion noted VALVULAR MORPHOLOGY Valve: No significant valvular stenosis or regurgitation noted. There is mild central tricuspid regurgtitation There is mild mitral valve anterior leaflet thickening. Vessel dimensions: (In mm normal range dimensions mm) Main Pulmonary Artery 22 Aortic Root 32 Aortic Arch 21 [18-37] Right Pulmonary Artery 14 Ascending Aorta 25 [19-37] Left Pulmonary Artery 18 Inferior Vena Cava 15 Descending Aorta 16 [16-29] INCIDENTAL FINDINGS: Bilateral breast implants right chest wall port CONCLUSION: 1. There is normal left and right ventricular size, function and morphology. 2. There is significant interval decrease in size in RA mass as above since 6/4/2020 CMR. 3. Difficult to characterize mass given small size however could be calcified thrombus given decreased signal intensity and lack of early contrast uptake. This is consistent with pathology report from 11/1/2020. Cardiac MRI Technologist: Billy Fisher 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: IMAGING DATA Imaging System: GE 1.5T Overall Image Quality: Excellent CARDIAC MORPHOLOGY AND VENTRICULAR FUNCTION Views: Axial Coronal Two chamber Four chamber Right two chamber Short axis LV Short axis atria LVOT Ascending aorta 4CH T1/T2 Sequences: FSE 2IR FSE 3IR SSFP FGRE ET Additional views: Delayed Contrast Enhancement, Perfusion MS Axial General: ECG gated: YES MEASUREMENTS: In Millimeters Left Atrium: 20 LV End Diastolic Dimension: 41 LV End Systolic Dimension: 31 LV Posterior Wall: 6 Right Atrium 30 RV End Diastolic Dimension: 36 Interventricular Septum: 7 Left Ventricle (short axis):Volumes in mL, Index volumes in mL per square meter End Diastolic Volume: 100 ED Index 59 End Systolic Volume: 41 ES Index 24 Stroke Volume: 59 SV Index 35 Ejection Fraction: 59.0% Morphology: Normal left ventricular (LV) volumes and wall thickness. Normal left ventricular systolic function. No LV myocardial signal abnormality on edema sequences (T2 and triple IR). No evidence of LV myocardial persistent perfusion defect on first pass rest perfusion images or enhancement on late gadolinium enhancement (LGE) images. Right Ventricle (short axis):Volumes in mL, Index volumes in mL per square meter End Diastolic Volume: 97 ED Index 57 End Systolic Volume: 46 ES Index 27 Stroke Volume: 51 SV Index 30 Ejection Fraction: 52.6% Morphology: Normal right ventricular (RV) volumes and wall thickness. Normal right ventricular systolic function. No evidence of regional wall motion abnormalities. No RV myocardial signal abnormality on edema sequences (T2 and triple IR). No evidence of RV myocardial abnormal signal intensity on all pulse sequences. Atria: The left atria appears normal in size without any visualized mass with four pulmonary veins draining into it. The right atria has a small lesion of 1x1.3x2.4 cm at the inferiolateral wall near the opening to the IVC similar to prior imaging. There is no significant T1 or T2 enhancement and no late gadolinium enhancement noted. It is not well seen on first pass gadolinium images, however there is no obvious early contrast uptake. Pericardium: Thickness: 2mm (1-3 mm) Effusion: none Pleural: No pleural effusion noted VALVULAR MORPHOLOGY Valve: No significant valvular stenosis or regurgitation noted. There is mild central tricuspid regurgtitation There is mild mitral valve anterior leaflet thickening. Vessel dimensions: (In mm normal range dimensions mm) Main Pulmonary Artery 22 Aortic Root 32 Aortic Arch 21 [18-37] Right Pulmonary Artery 14 Ascending Aorta 25 [19-37] Left Pulmonary Artery 18 Inferior Vena Cava 15 Descending Aorta 16 [16-29] INCIDENTAL FINDINGS: Bilateral breast implants right chest wall port
Findings: There is no evidence of acute intracranial hemorrhage, infarction, brain edema, mass effect or hydrocephalus. Diffuse brain volume loss with ex vacuo ventricular dilatation and mild white matter microangiopathic changes, stable. The visualized paranasal sinuses, mastoid air cells and middle ear cavities are clear. Both orbits appear normal.
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MR Brain wo+w contrast 1/20/2022 5:08 PM Clinical Information: brain tumor Spec Inst: stealth Comparison: MR brain 1/5/2022 and CT head from earlier today Technique: Axial diffusion, axial FLAIR, sagittal T1, axial T2, SWI, post contrast axial and coronal T1, sagittal 3-D T1 post contrast with coronal and sagittal reformats. Patient weight: 128 lbs. IV contrast: ProHance, 6 ml, per protocol. IV contrast injection rate: 1 ml per sec. Findings: Again seen are left parietal craniectomy changes. There is interval further decrease in size of mass in the left parietal lobe contiguous with the posterior falx. Mass measures 4.9 x 4.0 cm in maximum dimension and 6.2 cm in the craniocaudal dimension, previously 4.5 x 3.6 x 5.7 cm. Mass is seen extending to the parietal bone defect and scalp with suspected overlying ulceration. There is dural thickening and enhancement along the left parietal convexity, stable Enhancing lesion within the left occipital horn has also increase in size and measures 4.1 x 2.1 x 2.4 cm, previously 3.6 x 1.7 x 2.1 cm. Enhancing foci within the frontal horns of both lateral ventricles also appear marginally larger in size. The left temporal horn lesion is also larger measuring 1.6 x 1.1 cm in maximum dimension. No new focus of abnormal enhancement is identified. There is worsening vasogenic edema in the left cerebral hemisphere with associated mass effect effacing the left lateral ventricle. No significant midline shift. There are also worsening microhemorrhages involving these lesions on SWI. Impression: 1. Interval increase in size of the heterogeneously enhancing mass in the left parietal lobe in the previous surgical bed with slight increase in surrounding vasogenic edema and mass effect. Mass is seen extending to the overlying bone defect and scalp muscle similar to prior. 2. Enlargement of tumor within the left occipital horn, left temporal and bilateral frontal horns of lateral ventricles. No hydrocephalus. No new lesion is identified.
Findings: Again seen are left parietal craniectomy changes. There is interval further decrease in size of mass in the left parietal lobe contiguous with the posterior falx. Mass measures 4.9 x 4.0 cm in maximum dimension and 6.2 cm in the craniocaudal dimension, previously 4.5 x 3.6 x 5.7 cm. Mass is seen extending to the parietal bone defect and scalp with suspected overlying ulceration. There is dural thickening and enhancement along the left parietal convexity, stable Enhancing lesion within the left occipital horn has also increase in size and measures 4.1 x 2.1 x 2.4 cm, previously 3.6 x 1.7 x 2.1 cm. Enhancing foci within the frontal horns of both lateral ventricles also appear marginally larger in size. The left temporal horn lesion is also larger measuring 1.6 x 1.1 cm in maximum dimension. No new focus of abnormal enhancement is identified. There is worsening vasogenic edema in the left cerebral hemisphere with associated mass effect effacing the left lateral ventricle. No significant midline shift. There are also worsening microhemorrhages involving these lesions on SWI.
FINDINGS: STRUCTURED REPORT: CTA Aorta Runoff VASCULATURE: Extensive vascular calcifications throughout. DISTAL DESCENDING THORACIC AORTA: Moderate atherosclerosis. No other significant abnormality. ABDOMINAL AORTA: Moderate atherosclerosis. No other significant abnormality. CELIAC AXIS: Moderate atherosclerotic disease. No other significant abnormality. SMA: Mild atherosclerotic disease. No other significant abnormality. RIGHT RENAL: Mild atherosclerotic disease at the renal artery origin. No other significant abnormality. Two right renal arteries. LEFT RENAL: Severe luminal narrowing of the proximal renal artery with poststenotic dilatation. IMA: Patent. RIGHT ILIAC ARTERIES: Moderate atherosclerotic disease in the common iliac and internal iliac arteries No other significant abnormality. RIGHT FEMORAL \T\ POPLITEAL ARTERIES: Multifocal regions of narrowing involving the proximal femoral artery. Short segment complete occlusion of the right superficial femoral artery on axial series 8 image 228. RIGHT TIBIAL AND PERONEAL ARTERIES: Multifocal regions of extensive calcification and intermittent loss of contrast opacification involving the anterior tibial and posterior tibial arteries. Proximal posterior tibial artery is occluded. RIGHT FOOT ARTERIES: The dorsalis pedis and peroneal artery are patent through the level the ankle to the foot. LEFT ILIAC ARTERIES: Moderate atherosclerotic disease in the common iliac and internal iliac arteries No other significant abnormality. LEFT FEMORAL \T\ POPLITEAL ARTERIES: Multifocal narrowing of the SFA most notable distally there is approximately 50% luminal narrowing on image 226 series 8. LEFT TIBIAL AND PERONEAL ARTERIES: Complete occlusion of the anterior tibial artery just after its bifurcation. There is distal reconstitution of the lateral ankle with appropriate opacification of the dorsalis pedis area. Multifocal occlusion of the distal posterior tibial artery with distal reconstitution at the level of the foot. The peroneal artery is patent to the ankle. LEFT FOOT ARTERIES: The dorsalis pedis and distal posterior tibial arteries are patent at the level of the foot. ------------------------------------------------------------- LOWER CHEST: LUNG BASES / PLEURA: Unchanged solid pulmonary nodule right middle lobe. Dependent atelectasis. DISTAL ESOPHAGUS: Small hiatal hernia. HEART / VESSELS: The heart is enlarged. Vascular calcifications of the coronary arteries and valve leaflets. ABDOMEN and PELVIS: LIVER: Small hyperenhancing lesion in the periphery of the right hepatic lobe on axial series 8 image 39. Scattered simple hepatic cysts. BILIARY TRACT: Left hepatic lobe pneumobilia, unchanged from 2018. Gas is also noted with a mildly distended common bile duct, unchanged. GALLBLADDER: No abnormality. PANCREAS: Diffuse pancreatic atrophy. 14 mm Lobular cystic lesion at pancreatic neck on image 56 series 8. Additional cystic lesions about the uncinate process. SPLEEN: Normal. ADRENALS: Right adrenal nodule is unchanged 2018. KIDNEYS: Asymmetric atrophy of the left kidney with respect to the right. Redemonstrated left inferior pole nonobstructing renal calculus. Scattered left renal cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Extensive distal colonic diverticulosis. Postsurgical changes of right hemicolectomy with anastomosis in the midline abdomen. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is absent. No adnexal mass. Both ovaries are noted. BODY WALL: Normal. MUSCULOSKELETAL: Mildly lytic focus in the posterior aspect of the left iliac bone on axial series 8 image 104, unchanged from prior. Mild multilevel discogenic degenerative change.
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EXAM: CV MR Cardiac w contrast, CV MR for Velocity Flow PATIENT DATA Date of Study: 1/21/2022 2:17 PM Referring MD: Sushant Khaire Height: 185 cm. Patient weight: 68 kg. BSA: 1.86934 Heart Rate: 86 bpm. EGFR 60. The patient's creatinine was 1.2 on 01-21-2022. The patient received 14 cc's of gadavist at a rate of 2 ml per second without immediate complication. CLINICAL INFORMATION: Patient studied for evaluation of: cardiomyopathy, I42.9 Cardiomyopathy, unspecified History: 36 year old man with prior history of HIV, noncompaction cardiomyopathy, lymphadenopathy and syphilis. COMPARISON: CMR 8/22/2013 TECHNIQUE: CV MR Cardiac w contrast, CV MR for Velocity Flow . Height: 185 cm. Patient weight: 68 kg. BSA: 1.86934 Heart Rate: 86 bpm. FINDINGS: IMAGING DATA Imaging System: GE 1.5T Overall Image Quality: Excellent CARDIAC MORPHOLOGY AND VENTRICULAR FUNCTION Views: Axial Two chamber Four chamber Short axis LV LVOT Ascending aorta RVOT Short T2, phase contrast flow velocity mapping, perfusion delayed enhancement Sequences: FSE 2IR FSE 3IR SSFP FGRE ET Additional views: General: ECG gated: yes MEASUREMENTS: in millimeters Left Atrium: 50 LV End Diastolic Dimension: 53 LV End Systolic Dimension: 43 LV Posterior Wall: 15 Right Atrium 50 RV End Diastolic Dimension: 45 Interventricular Septum: 9 Left Ventricle (short axis): volumes in mL, index in mL per square meter End Diastolic Volume: 231 ED index=126 End Systolic Volume: 152 ES index=83 Stroke Volume: 79 SV index=43 Ejection Fraction: 34% LA volume 50 ml/sq. m. the left atrium is severely enlarged. Morphology: The left ventricule is severely dilated with severely reduced systolic function. There is increased left ventricular trabeculation. There are no regional wall motion abnormalities. There is no increased T2 signial. There is normal first pass resting gadolinium enhancement. There is no late gadolinium enhancement. Right Ventricle (short axis):volumes in mL, index in mL per square meter End Diastolic Volume: 224 ED index=118 End Systolic Volume: 137 ES index=71 Stroke Volume: 87 SV index=46 Ejection Fraction: 39% Morphology: There is moderate right ventricular systolic dysfunction with no regional wall motion abnormalities. Pericardium: Thickness: 2mm (1-3 mm) Effusion: Small pericardial effusion measuring up to 2cm mostly posterior and inferior without sign of RA collapse. VALVULAR MORPHOLOGY Valve: Mitral: Regurgitation: moderate to severe Fraction: Stenosis: none Aortic: Regurgitation: none Fraction: Stenosis: none Tricuspid: Regurgitation: mild to moderate Fraction: Stenosis: none Pulmonary: Regurgitation: trace Fraction: Stenosis: none Vessel dimensions: (In mm normal range dimensions mm) Main Pulmonary Artery 38 Aortic Root 32 Aortic Arch 27 [18-37] Right Pulmonary Artery 19 Ascending Aorta 28 [19-37] Left Pulmonary Artery 18 Inferior Vena Cava 38 Descending Aorta 24 [16-29] Phase contrast flow analysis was performed, which showed Ao forward flow of 61ml Cardiac Output 4.35 l/min The main pulmonary artery is mildly dilated. The aortic root, arch and is ascending aorta are normal in caliber. INCIDENTAL FINDINGS: Bilateral small pleural effusions Right chest wall port with minimal suseptibility artifact Main pulmonary artery dilation to 35mm CONCLUSION: 1. Severely reduced left and moderately reduced right sided ventricular systolic function. The left ventricle has increased trabeculations but do not meet criteria for LV noncompaction. 2. There is moderate to severe central mitral regurgitation likely due to mitral annular dilation. 3. Pericardial effusion, mostly posterior. 4. Mild main pulmonary artery dilation, which can be see in pulmonary hypertension. 4. Since prior CMR 8/22/2013, the systolic function has significantly worsened and there are new pleural and pericardial effusions. Cardiac MRI Technologist: Cathy Gunn 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: IMAGING DATA Imaging System: GE 1.5T Overall Image Quality: Excellent CARDIAC MORPHOLOGY AND VENTRICULAR FUNCTION Views: Axial Two chamber Four chamber Short axis LV LVOT Ascending aorta RVOT Short T2, phase contrast flow velocity mapping, perfusion delayed enhancement Sequences: FSE 2IR FSE 3IR SSFP FGRE ET Additional views: General: ECG gated: yes MEASUREMENTS: in millimeters Left Atrium: 50 LV End Diastolic Dimension: 53 LV End Systolic Dimension: 43 LV Posterior Wall: 15 Right Atrium 50 RV End Diastolic Dimension: 45 Interventricular Septum: 9 Left Ventricle (short axis): volumes in mL, index in mL per square meter End Diastolic Volume: 231 ED index=126 End Systolic Volume: 152 ES index=83 Stroke Volume: 79 SV index=43 Ejection Fraction: 34% LA volume 50 ml/sq. m. the left atrium is severely enlarged. Morphology: The left ventricule is severely dilated with severely reduced systolic function. There is increased left ventricular trabeculation. There are no regional wall motion abnormalities. There is no increased T2 signial. There is normal first pass resting gadolinium enhancement. There is no late gadolinium enhancement. Right Ventricle (short axis):volumes in mL, index in mL per square meter End Diastolic Volume: 224 ED index=118 End Systolic Volume: 137 ES index=71 Stroke Volume: 87 SV index=46 Ejection Fraction: 39% Morphology: There is moderate right ventricular systolic dysfunction with no regional wall motion abnormalities. Pericardium: Thickness: 2mm (1-3 mm) Effusion: Small pericardial effusion measuring up to 2cm mostly posterior and inferior without sign of RA collapse. VALVULAR MORPHOLOGY Valve: Mitral: Regurgitation: moderate to severe Fraction: Stenosis: none Aortic: Regurgitation: none Fraction: Stenosis: none Tricuspid: Regurgitation: mild to moderate Fraction: Stenosis: none Pulmonary: Regurgitation: trace Fraction: Stenosis: none Vessel dimensions: (In mm normal range dimensions mm) Main Pulmonary Artery 38 Aortic Root 32 Aortic Arch 27 [18-37] Right Pulmonary Artery 19 Ascending Aorta 28 [19-37] Left Pulmonary Artery 18 Inferior Vena Cava 38 Descending Aorta 24 [16-29] Phase contrast flow analysis was performed, which showed Ao forward flow of 61ml Cardiac Output 4.35 l/min The main pulmonary artery is mildly dilated. The aortic root, arch and is ascending aorta are normal in caliber. INCIDENTAL FINDINGS: Bilateral small pleural effusions Right chest wall port with minimal suseptibility artifact Main pulmonary artery dilation to 35mm
Findings: No acute infarct or acute intracranial hemorrhage. No brain edema, mass effect, or hydrocephalus. No extra-axial fluid collections. No abnormal parenchymal or meningeal enhancement. Mild to moderate chronic white matter microangiopathic changes. There is bilateral medial temporal lobe atrophy characterized by enlargement of the lateral ventricle temporal horns and loss of hippocampal height. CTA 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. There is no aneurysm or AVM. CTA Neck: There is no flow-limiting stenosis involving the carotid bifurcation or the proximal internal carotid arteries. Vertebral arteries are patent and normal in appearance. There is no flow-limiting stenosis.
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CV MR Rsh Lewis Brain wo I110112002 1/21/2022 9:00 AM Clinical information: CARDIA research study Comparison: None available. Technique: Sprint protocol without contrast. Findings: There is no infarction, intracranial hemorrhage, brain edema, mass effect or hydrocephalus. Mild white matter microangiopathic changes and mild brain volume loss. No abnormal signal loss on SWI. There is a bony protuberance in the right frontal bone with widening of the diploic space, likely a mature osteoma. Recommend correlation with history and physical exam. Small right maxillary sinus. No significant mucosal thickening in the paranasal sinuses. Impression: Mild white matter microangiopathic changes. No acute intracranial process. Bony protuberance in the right frontal bone suggest, possibly a mature osteoma. Recommend further imaging with CT and correlation with history. Small right maxillary sinus.
Findings: There is no infarction, intracranial hemorrhage, brain edema, mass effect or hydrocephalus. Mild white matter microangiopathic changes and mild brain volume loss. No abnormal signal loss on SWI. There is a bony protuberance in the right frontal bone with widening of the diploic space, likely a mature osteoma. Recommend correlation with history and physical exam. Small right maxillary sinus. No significant mucosal thickening in the paranasal sinuses.
Findings: No acute infarct or acute intracranial hemorrhage. No brain edema, mass effect, or hydrocephalus. No extra-axial fluid collections. No abnormal parenchymal or meningeal enhancement. Mild to moderate chronic white matter microangiopathic changes. There is bilateral medial temporal lobe atrophy characterized by enlargement of the lateral ventricle temporal horns and loss of hippocampal height. CTA 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. There is no aneurysm or AVM. CTA Neck: There is no flow-limiting stenosis involving the carotid bifurcation or the proximal internal carotid arteries. Vertebral arteries are patent and normal in appearance. There is no flow-limiting stenosis.
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CV MR Rsh Lewis Brain wo I110112002 1/21/2022 1:30 PM Clinical information: CARDIA research study Comparison: MR brain 6/29/2011 Technique: Sprint protocol without contrast. Findings: There is no visible infarction, intracranial hemorrhage, brain edema, mass effect or hydrocephalus. Minimal white matter microangiopathic changes. Partially empty sella. No abnormal signal loss on SWI. Impression: Normal brain MRI. No significant change compared to prior.
Findings: There is no visible infarction, intracranial hemorrhage, brain edema, mass effect or hydrocephalus. Minimal white matter microangiopathic changes. Partially empty sella. No abnormal signal loss on SWI.
FINDINGS: Left frontal approach VP shunt catheter projects in unchanged position, terminating at the level of the left foramen of Monro. Stable size of the ventricles without hydrocephalus. Unchanged mild hypoattenuation along the catheter tract. Stable postsurgical change from prior right frontotemporoparietal craniectomy. Unchanged size and appearance of the small mixed density, predominantly hypoattenuating right cerebral convexity extra-axial hemorrhage measuring up to 8 mm. No significant mass effect or midline shift. Gray-white matter differentiation is maintained. No evidence of acute infarction. Normal cerebral cortical volume. Basal cisterns are patent. Normal appearance of the orbits. Trace right mastoid air cell effusion. Mild mucosal thickening of the bilateral sphenoid sinuses.
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MRI brain with and without Indication: Transient ischemic attack (TIA), G45.9 Transient cerebral ischemic attack, unspecified Comparison: CT head from 8/6/2016 Technique: Multiple T1 and T2-weighted MR sequence images of the brain were obtained in the sagittal axial and coronal planes pre-and post administration of intravenous contrast per departmental protocol including MR perfusion. Patient weight: 160 lbs. IV contrast: ProHance, 15 ml, per protocol. Findings: There is no restricted diffusion. Supratentorial brain parenchyma shows mild diffuse cerebral atrophy and prominent CSF spaces.There is no hydrocephalus. There is a tiny T2 hyperintense lesion in the left cerebellum, likely chronic lacunar infarct. Postcontrast images demonstrate no abnormal enhancement. There is no increased susceptibility on SWI. There is no acute intracranial hemorrhage. Impression: No acute infarct is identified. No acute intracranial intracranial hemorrhage or mass effect.
Findings: There is no restricted diffusion. Supratentorial brain parenchyma shows mild diffuse cerebral atrophy and prominent CSF spaces.There is no hydrocephalus. There is a tiny T2 hyperintense lesion in the left cerebellum, likely chronic lacunar infarct. Postcontrast images demonstrate no abnormal enhancement. There is no increased susceptibility on SWI. There is no acute intracranial hemorrhage.
FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Mildly suboptimal quality with incomplete evaluation of subsegmental pulmonary arteries. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Positive for pulmonary embolus. - Pulmonary Embolus Distribution: Main right and left pulmonary arteries. Extending into the right upper, right middle and right lower lobe pulmonary arteries - Pulmonary Artery Diameter: Normal. - Ascending Aortic Diameter: Normal. - RV:LV Ratio: Normal. - Interventricular Septum: Normal. - Contrast reflux into IVC: Abnormal reflux into the IVC and hepatic veins. LUNGS / AIRWAYS / PLEURA: Moderate right and large left pleural effusions which appears partially loculated in the left lung apex. Well-defined mass in the left upper lobe along the major fissure measuring 3.5 x 2.7 cm on image 49 series 401. Additional noncalcified nodule along the major fissure measuring 11 mm on image 46 series 401. Patchy groundglass densities in the bilateral upper lobes, right greater than left. No pneumothorax. The tracheobronchial tree is patent. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Mildly enlarged periaortic and aorticopulmonary lymph nodes. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No acute osseous abnormality or focal aggressive osseous lesion. Thoracic dextroscoliosis.
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CV MR Rsh Lewis Brain wo I110112002 1/21/2022 2:40 PM Clinical information: CARDIA research study Comparison: MR brain 10/2/2015 Technique: Sprint protocol without contrast. Findings: There is no infarction, intracranial hemorrhage, brain edema, mass effect or hydrocephalus. Mild white matter microangiopathic changes and mild brain volume loss. No abnormal signal loss on SWI. Previously seen mucous retention cyst in the right frontal sinus is no longer seen. However, there is opacification of the right sphenoid sinus. Impression: Mild white matter microangiopathic changes. No significant change compared to prior. Mucous retention cyst in the right frontal sinus is no longer seen. There is new opacification of the right sphenoid sinus.
Findings: There is no infarction, intracranial hemorrhage, brain edema, mass effect or hydrocephalus. Mild white matter microangiopathic changes and mild brain volume loss. No abnormal signal loss on SWI. Previously seen mucous retention cyst in the right frontal sinus is no longer seen. However, there is opacification of the right sphenoid sinus.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis Exam is mildly limited secondary to motion artifact. LOWER CHEST: LUNG BASES / PLEURA: Calcified granuloma in the right lower lobe. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Coronary artery atherosclerosis. No other significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: Scattered minimally enlarged iliac chain lymph nodes, for example a right iliac chain lymph node measuring 1.6 x 1.0 cm (image 19, series #201). STOMACH / SMALL BOWEL: Crowding/tethering of small bowel along the right and anterior aspect of the uterus. No small bowel distention. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No free intraperitoneal fluid or air. No significant peritoneal nodularity identified. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerosis of the proximal celiac and superior mesenteric arteries without significant stenosis. Severe focal atherosclerosis of the proximal right renal artery with greater than 50% narrowing and appropriate distal opacification of the artery. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Enlarged, heterogeneous enhancing uterus with heterogeneously enhancing, partially calcified mass in the fundus measuring 8.3 x 6.8 cm. There is large amount of blood in the uterine cavity and vagina with scattered foci of gas which appears to emanate from the fundal mass. Tethering of small bowel along the right aspect of the uterus as above. Additionally there is a hypoattenuating tract from the uterine mass to adjacent tethering small bowel in the anterior aspect (image 23, series #201) which may communicate with the small bowel lumen. No adjacent adnexal mass. BODY WALL: Small fat-containing periumbilical hernia. Rectus diastasis. MUSCULOSKELETAL: No aggressive osseous lesions. Mild multilevel discogenic degenerative change of the visualized thoracolumbar spine.
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EXAM: MR Brain wo contrast 1/20/2022 3:19 PM CLINICAL INFORMATION: Seizure, abnormal neuro exam, epilepsy protocol extra temporal. Per chart review, history of staring seizures since childhood, recommended at age 12 with successful withdrawal of anti-epileptic therapy, later complicated by recurrence. Incidental left-sided weakness on neurological exam. EEG on 1/13/2022 noted underlying primary generalized epileptic trait, most likely juvenile myoclonic epilepsy. COMPARISON: None available. TECHNIQUE: Axial diffusion, axial FLAIR, axial/coronal/sagittal T1, axial T2 and SWI. At the termination of this study due to patient request FINDINGS: The study is degraded by motion artifact. No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, space-occupying lesion, or mass effect. Gray-white matter differentiation is normal. No evidence to suggest focal cortical dysplasia, neuronal migrational disorder, mesial temporal sclerosis, or vascular malformation. The ventricular system is normal in caliber and configuration. The basal cisterns are clear. The visualized proximal cerebrovascular flow voids appear normal. Well-circumscribed left posterior parietal scalp subcutaneous nodule, possibly sebaceous cyst. The visualized extracranial osseous and soft tissue structures otherwise demonstrate normal signal characteristics. Visualized paranasal sinuses and mastoid air cells are clear. Both orbits are unremarkable. _________________________ CONCLUSION: 1. No acute intracranial process. 2. No evidence to explain patient's history of epilepsy, including focal cortical dysplasia, neuronal migration disorder, or vascular malformation, given the limitation of technique. 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: The study is degraded by motion artifact. No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, space-occupying lesion, or mass effect. Gray-white matter differentiation is normal. No evidence to suggest focal cortical dysplasia, neuronal migrational disorder, mesial temporal sclerosis, or vascular malformation. The ventricular system is normal in caliber and configuration. The basal cisterns are clear. The visualized proximal cerebrovascular flow voids appear normal. Well-circumscribed left posterior parietal scalp subcutaneous nodule, possibly sebaceous cyst. The visualized extracranial osseous and soft tissue structures otherwise demonstrate normal signal characteristics. Visualized paranasal sinuses and mastoid air cells are clear. Both orbits are unremarkable. _________________________
FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Mildly suboptimal quality with incomplete evaluation of subsegmental pulmonary arteries. LOWER NECK: Nodular thyroid enlargement. CHEST: PULMONARY ARTERIES: The main pulmonary artery is dilated. Ill-defined decreased attenuation within the right lower lobe are artery best appreciated on axial series 401 image 72. There is severe reflux into the inferior vena cava and hepatic veins. LUNGS / AIRWAYS / PLEURA: Incidentally noted azygos lobe. Trachea and central airways are patent. Scattered mild mosaic attenuation of both lungs with basilar predominant mild septal thickening. Moderately sized right pleural effusion with associated overlying atelectasis. HEART / OTHER VESSELS: The heart is enlarged with significantly dilated right atrium. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Mildly prominent axillary lymph nodes. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Significantly dilated proximal hepatic veins with moderate reflux. MUSCULOSKELETAL: No significant abnormality.
15,037
EXAM: MR Brain wo+w contrast 1/20/2022 4:01 PM CLINICAL INFORMATION: Seizure, Epilepsy Protocol. Per chart review, history of two seizures as a teenager started on antiepileptic therapy, discontinued due to remission for 35 years, then recurrent seizure in 2015 and restarted on medication therapy. Admitted on 11/29/2021 for suspected breakthrough seizure in setting of medication noncompliance. Patient reports he blacked out; coworkers noticed bilateral limb shaking, bite injury to left lateral tongue, and left parieto-occipital scalp contusion. EEG pending. COMPARISON: CT head dated 11/29/2021. TECHNIQUE: Axial diffusion, axial FLAIR, sagittal T1, axial T2 and SWI. Patient weight: 200 lbs. IV contrast: ProHance, 10 ml, per protocol. FINDINGS: No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, space-occupying lesion, or mass effect. Normal cerebral volume. Multiple rounded T2/FLAIR hyperintense foci in the bilateral frontal subcortical and deep white matter. No evidence to suggest focal cortical dysplasia, neuronal migration disorder, mesial temporal sclerosis, or vascular malformation. The ventricular system is normal in caliber and configuration. The basal cisterns are clear. The visualized proximal cerebrovascular flow voids appear normal. The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Visualized paranasal sinuses and mastoid air cells are clear. Both orbits are urnemarkable. _________________________ CONCLUSION: 1. No acute intracranial process. No pathologic enhancement is appreciated. 2. No evidence to explain patient's history of seizures, including focal cortical dysplasia, neuronal migration disorder, mesial temporal sclerosis, or vascular malformation. 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: No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, space-occupying lesion, or mass effect. Normal cerebral volume. Multiple rounded T2/FLAIR hyperintense foci in the bilateral frontal subcortical and deep white matter. No evidence to suggest focal cortical dysplasia, neuronal migration disorder, mesial temporal sclerosis, or vascular malformation. The ventricular system is normal in caliber and configuration. The basal cisterns are clear. The visualized proximal cerebrovascular flow voids appear normal. The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Visualized paranasal sinuses and mastoid air cells are clear. Both orbits are urnemarkable. _________________________
FINDINGS: BRAIN PARENCHYMA: Multiple parenchymal hemorrhages are seen in the temporal and bilateral inferior frontal lobes with surrounding vasogenic edema and mass effect. Small hemorrhagic focus is also seen in the right middle cerebral peduncle. There is mild effacement of the right lateral ventricle without significant midline shift. EXTRA-AXIAL SPACES: Bilateral cerebral convexity mixed attenuation extra-axial hemorrhages are seen, right greater than left with the right convexity hemorrhage having a maximum thickness of 1.5 cm. There are scattered diffuse subarachnoid hemorrhages throughout the cerebral convexities. Small focus of hemorrhage is also seen in the interpeduncular cistern. There is also a small focus of hemorrhage in the genu of corpus callosum protruding into the frontal horn of left lateral ventricle. SKULL AND SKULL BASE: No fracture. Left parietal scalp hematoma. VENTRICULAR SYSTEM: Small layering hemorrhage in the left occipital horn. ORBITS: Normal. SINUSES: Normal.
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EXAM: MR Brain wo+w contrast 1/20/2022 4:25 PM CLINICAL INFORMATION: Low testosterone. COMPARISON: None available. TECHNIQUE: Multiple T1 and T2-weighted MR sequence images of the brain were obtained in the sagittal axial and coronal planes pre- and post administration of intravenous contrast per departmental protocol. Patient weight: 335 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: The study is degraded by motion artifact. There is a subtle hypoenhancing lesion located in the left side of the pituitary gland and measures approximately 5 x 6 mm, concern for pituitary microadenoma. Remaining pituitary gland is normal in appearance and enhancement pattern. Suprasellar and parasellar structures are within normal limits. The cavernous sinuses are well opacified. The imaged brain parenchyma and ventricular system are within normal limits. The imaged osseous and soft tissue structures are normal-appearing. _________________________ CONCLUSION: Approximately 5 x 6 mm hypoenhancing lesion in the left side of the pituitary gland, concern for microadenoma. Suprasellar and parasellar structures are within normal limits. 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: The study is degraded by motion artifact. There is a subtle hypoenhancing lesion located in the left side of the pituitary gland and measures approximately 5 x 6 mm, concern for pituitary microadenoma. Remaining pituitary gland is normal in appearance and enhancement pattern. Suprasellar and parasellar structures are within normal limits. The cavernous sinuses are well opacified. The imaged brain parenchyma and ventricular system are within normal limits. The imaged osseous and soft tissue structures are normal-appearing. _________________________
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: The thyroid gland is symmetrical. Endotracheal tube in place. CHEST: LUNGS / AIRWAYS / PLEURA: Scattered emphysematous changes are seen. No definite pneumonic consolidation or masses. The pleural spaces are clear. No pneumothorax. HEART / VESSELS: The heart is normal in size. Patient is status post CABG. Extensive coronary artery atherosclerotic calcifications noted. MEDIASTINUM / ESOPHAGUS: Esophagogastric tube reaches the stomach. DIAPHRAGM: Intact. Small left omental fat-containing Bochdalek hernia. LYMPH NODES: None enlarged. CHEST WALL: Sternotomy suture wires in place. Nonunion of the sternum is noted. ABDOMEN and PELVIS: LIVER: There is no evidence of masses or definite laceration. BILIARY TRACT: Minimal intrahepatic biliary ductal dilatation in the setting of cholecystectomy. GALLBLADDER: Absent with several metallic clips of the gallbladder fossa. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: There is mild bilateral hydronephrosis. Punctate regions of contrast excretion/small nonobstructing renal calculi are seen bilaterally. Tortuosity of the ureters is observed without evidence of ureterolithiasis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered colonic diverticula without focal inflammatory changes. No signs of obstruction. Status post right hemicolectomy. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Extensive atherosclerotic calcifications of the aorta and its branches. URINARY BLADDER: Well-distended without acute abnormalities. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Marginal osteophytes are seen throughout the thoracic and lumbar spine. There are several old healed bilateral rib fractures more evident at the right posterior rib cage. No acute displaced fractures are seen.
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MRI brain with and without contrast Clinical Information: Female aged 60 years with small cell lung cancer treatment response evaluation Comparison: MR dated 2/25/2020 Technique: Multiplanar, multisequence MRI of the brain were obtained in multiple planes pre-and post administration of intravenous contrast per departmental protocol. Patient weight: 167 lbs. IV contrast: ProHance, 15 ml, per protocol. IV contrast injection rate: 1 ml per sec. Findings: New cortical/subcortical round ring-enhancing lesions in the left lateral cerebellum with corresponding hyperintensities on T2/FLAIR. The larger measures 9 x 7 mm and the smaller measures 8 x 5 mm (series 903, image 12). No significant mass effect or midline shift. There are additional two nodular enhancement lesions in the posterior right temporal lobe and right occipital subcortical region. No acute infarct or intracranial hemorrhage. Chronic T2 hyperintensities in the periventricular and deep white matter consistent with chronic microangiopathic disease. No hydrocephalus. No abnormal leptomeningeal enhancement. Mucosal thickening of the right maxillary sinus, anterior ethmoid air cells, and frontal sinuses. No significant abnormality of the extracranial osseous and soft tissue structures. Conclusion: New ring-enhancing lesions in the left lateral cerebellum and nodular enhancing lesions in the right posterior temporal lobe and right occipital lobe as described above consistent with metastatic disease in the setting of patient's known small cell lung cancer. 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: New cortical/subcortical round ring-enhancing lesions in the left lateral cerebellum with corresponding hyperintensities on T2/FLAIR. The larger measures 9 x 7 mm and the smaller measures 8 x 5 mm (series 903, image 12). No significant mass effect or midline shift. There are additional two nodular enhancement lesions in the posterior right temporal lobe and right occipital subcortical region. No acute infarct or intracranial hemorrhage. Chronic T2 hyperintensities in the periventricular and deep white matter consistent with chronic microangiopathic disease. No hydrocephalus. No abnormal leptomeningeal enhancement. Mucosal thickening of the right maxillary sinus, anterior ethmoid air cells, and frontal sinuses. No significant abnormality of the extracranial osseous and soft tissue structures.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: The thyroid gland is symmetrical. Endotracheal tube in place. CHEST: LUNGS / AIRWAYS / PLEURA: Scattered emphysematous changes are seen. No definite pneumonic consolidation or masses. The pleural spaces are clear. No pneumothorax. HEART / VESSELS: The heart is normal in size. Patient is status post CABG. Extensive coronary artery atherosclerotic calcifications noted. MEDIASTINUM / ESOPHAGUS: Esophagogastric tube reaches the stomach. DIAPHRAGM: Intact. Small left omental fat-containing Bochdalek hernia. LYMPH NODES: None enlarged. CHEST WALL: Sternotomy suture wires in place. Nonunion of the sternum is noted. ABDOMEN and PELVIS: LIVER: There is no evidence of masses or definite laceration. BILIARY TRACT: Minimal intrahepatic biliary ductal dilatation in the setting of cholecystectomy. GALLBLADDER: Absent with several metallic clips of the gallbladder fossa. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: There is mild bilateral hydronephrosis. Punctate regions of contrast excretion/small nonobstructing renal calculi are seen bilaterally. Tortuosity of the ureters is observed without evidence of ureterolithiasis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered colonic diverticula without focal inflammatory changes. No signs of obstruction. Status post right hemicolectomy. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Extensive atherosclerotic calcifications of the aorta and its branches. URINARY BLADDER: Well-distended without acute abnormalities. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Marginal osteophytes are seen throughout the thoracic and lumbar spine. There are several old healed bilateral rib fractures more evident at the right posterior rib cage. No acute displaced fractures are seen.
15,040
MRI brain without contrast Clinical Information:Female aged 59 years. Dementia, Alzheimer s suspected, G31.84 Mild cognitive impairment, so stated Spec Inst: per memory protocol Comparison: MR 7/1/2019 Technique: Multiplanar, multisequence images of the brain were obtained in the sagittal, axial and coronal planes without the use of intravenous contrast per departmental memory protocol. Findings: No acute infarct or intracranial hemorrhage. Mild frontoparietal predominant chronic parenchymal volume loss. Bilateral grade 1 hippocampal atrophy by Duara et al scale. Mild periventricular white matter hyperintensities consistent with mild chronic microangiopathic disease. No midline shift, hydrocephalus, mass effect, or other space-occupying lesion. No significant abnormality of the extracranial osseous and soft tissue structures. Conclusion: 1. No acute intracranial process. 2. Mild frontoparietal predominant chronic parenchymal volume loss. Bilateral grade 1 hippocampal atrophy by Duara et al scale. 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: No acute infarct or intracranial hemorrhage. Mild frontoparietal predominant chronic parenchymal volume loss. Bilateral grade 1 hippocampal atrophy by Duara et al scale. Mild periventricular white matter hyperintensities consistent with mild chronic microangiopathic disease. No midline shift, hydrocephalus, mass effect, or other space-occupying lesion. No significant abnormality of the extracranial osseous and soft tissue structures.
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 (
15,041
MR Brain wo+w contrast 1/20/2022 5:02 PM CLINICAL INFORMATION: Hearing loss, focal neuro deficit, H90.3 Sensorineural hearing loss, bilateral Spec Inst: cochlear implant evaluation COMPARISON: None. TECHNIQUE: Multiplanar, multisequence MR images of the brain were obtained before and the administration of intravenous contrast. Patient weight: 160 lbs. IV contrast: ProHance, 8 ml, per protocol. FINDINGS: There is no restricted diffusion. There are extensive T2/FLAIR signal hyperintensities in the periventricular white matter likely secondary to microangiopathic degenerative change, Fazekas grade 3. The ventricles are normal in size for age, and there is no midline shift. There is a tiny chronic left cerebellar infarct. There is mild, nonspecific enhancement in the right mid pons (series 12 image 11) without other corresponding signal abnormality, suggestive of a capillary telangiectasia. Otherwise, there is no abnormal enhancing lesion is seen on postcontrast images. The bilateral cerebellopontine angles are clear. The inner ear structures demonstrate normal fluid signal on T2-weighted images. The bilateral orbits are within normal limits. The visualized paranasal sinuses and mastoid air cells are clear. CONCLUSION: 1. No acute intracranial abnormality. Normal bilateral inner ear structures. 2. Small capillary telangiectasia in the pons. 3. Advanced age-related degenerative changes, Fazekas grade 3. 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: There is no restricted diffusion. There are extensive T2/FLAIR signal hyperintensities in the periventricular white matter likely secondary to microangiopathic degenerative change, Fazekas grade 3. The ventricles are normal in size for age, and there is no midline shift. There is a tiny chronic left cerebellar infarct. There is mild, nonspecific enhancement in the right mid pons (series 12 image 11) without other corresponding signal abnormality, suggestive of a capillary telangiectasia. Otherwise, there is no abnormal enhancing lesion is seen on postcontrast images. The bilateral cerebellopontine angles are clear. The inner ear structures demonstrate normal fluid signal on T2-weighted images. The bilateral orbits are within normal limits. The visualized paranasal sinuses and mastoid air cells are clear.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: The thyroid gland is symmetrical. Endotracheal tube in place. CHEST: LUNGS / AIRWAYS / PLEURA: Scattered emphysematous changes are seen. No definite pneumonic consolidation or masses. The pleural spaces are clear. No pneumothorax. HEART / VESSELS: The heart is normal in size. Patient is status post CABG. Extensive coronary artery atherosclerotic calcifications noted. MEDIASTINUM / ESOPHAGUS: Esophagogastric tube reaches the stomach. DIAPHRAGM: Intact. Small left omental fat-containing Bochdalek hernia. LYMPH NODES: None enlarged. CHEST WALL: Sternotomy suture wires in place. Nonunion of the sternum is noted. ABDOMEN and PELVIS: LIVER: There is no evidence of masses or definite laceration. BILIARY TRACT: Minimal intrahepatic biliary ductal dilatation in the setting of cholecystectomy. GALLBLADDER: Absent with several metallic clips of the gallbladder fossa. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: There is mild bilateral hydronephrosis. Punctate regions of contrast excretion/small nonobstructing renal calculi are seen bilaterally. Tortuosity of the ureters is observed without evidence of ureterolithiasis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered colonic diverticula without focal inflammatory changes. No signs of obstruction. Status post right hemicolectomy. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Extensive atherosclerotic calcifications of the aorta and its branches. URINARY BLADDER: Well-distended without acute abnormalities. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Marginal osteophytes are seen throughout the thoracic and lumbar spine. There are several old healed bilateral rib fractures more evident at the right posterior rib cage. No acute displaced fractures are seen.
15,042
EXAM: MR Knee Left wo contrast CLINICAL INFORMATION: Left knee pain COMPARISON: 12/10/2021 TECHNIQUE: Multiplanar and multisequence MRI of the left knee was obtained without intravenous contrast. FINDINGS: BONES: Extensive marrow edema seen within the medial tibial plateau. No definite fracture plane is seen. Small amount of marrow edema is noted within the femoral condyle, likely reactive. Benign-appearing cartilaginous lesion within the distal lateral femoral metaphysis, likely representing an enchondroma. ARTICULATIONS: Effusion:Moderate effusion. Popliteal cyst is present. Patellofemoral compartment:Mild thinning and fissuring of the lateral patellar facet without full-thickness defect. Medial compartment:Full-thickness articular cartilage loss of the medial femoral condyle and medial tibial plateau. Lateral compartment: Articular cartilage thinning without full thickness defect.. MENISCI: Medial meniscus:Complete radial tear of the body. The anterior fragment is displaced medially and proximally along the medial femoral condyle. Lateral meniscus:Intact. LIGAMENTS: Cruciate ligaments:Intact. Medial collateral ligament:There is thickening of the proximal ligament with edema along the superficial margin. The ligament is intact. Lateral collateral ligament:Intact. Posterolateral corner structures:Intact. Edema seen within the popliteus muscle likely representing low grade strain. EXTENSOR MECHANISM:The distal quadriceps and patellar tendons are intact. Edema seen along the distal aspect of the vastus medialis. CONCLUSION: 1. Complete radial tear of the body of the medial meniscus with medial and proximal displacement of the anterior fragment. 2. Marrow edema within the medial tibial plateau may represent a subchondral insufficiency fracture. No definitive fracture plane is identified. 3. Enchondroma of the distal lateral femoral metaphysis. 4. Low-grade strains of the popliteus and vastus medialis muscles. 5. Tricompartmental degenerative changes of the knee, most prominent in the medial femorotibial compartment with associated joint effusion. 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: BONES: Extensive marrow edema seen within the medial tibial plateau. No definite fracture plane is seen. Small amount of marrow edema is noted within the femoral condyle, likely reactive. Benign-appearing cartilaginous lesion within the distal lateral femoral metaphysis, likely representing an enchondroma. ARTICULATIONS: Effusion:Moderate effusion. Popliteal cyst is present. Patellofemoral compartment:Mild thinning and fissuring of the lateral patellar facet without full-thickness defect. Medial compartment:Full-thickness articular cartilage loss of the medial femoral condyle and medial tibial plateau. Lateral compartment: Articular cartilage thinning without full thickness defect.. MENISCI: Medial meniscus:Complete radial tear of the body. The anterior fragment is displaced medially and proximally along the medial femoral condyle. Lateral meniscus:Intact. LIGAMENTS: Cruciate ligaments:Intact. Medial collateral ligament:There is thickening of the proximal ligament with edema along the superficial margin. The ligament is intact. Lateral collateral ligament:Intact. Posterolateral corner structures:Intact. Edema seen within the popliteus muscle likely representing low grade strain. EXTENSOR MECHANISM:The distal quadriceps and patellar tendons are intact. Edema seen along the distal aspect of the vastus medialis.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: The thyroid gland is symmetrical. Endotracheal tube in place. CHEST: LUNGS / AIRWAYS / PLEURA: Scattered emphysematous changes are seen. No definite pneumonic consolidation or masses. The pleural spaces are clear. No pneumothorax. HEART / VESSELS: The heart is normal in size. Patient is status post CABG. Extensive coronary artery atherosclerotic calcifications noted. MEDIASTINUM / ESOPHAGUS: Esophagogastric tube reaches the stomach. DIAPHRAGM: Intact. Small left omental fat-containing Bochdalek hernia. LYMPH NODES: None enlarged. CHEST WALL: Sternotomy suture wires in place. Nonunion of the sternum is noted. ABDOMEN and PELVIS: LIVER: There is no evidence of masses or definite laceration. BILIARY TRACT: Minimal intrahepatic biliary ductal dilatation in the setting of cholecystectomy. GALLBLADDER: Absent with several metallic clips of the gallbladder fossa. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: There is mild bilateral hydronephrosis. Punctate regions of contrast excretion/small nonobstructing renal calculi are seen bilaterally. Tortuosity of the ureters is observed without evidence of ureterolithiasis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered colonic diverticula without focal inflammatory changes. No signs of obstruction. Status post right hemicolectomy. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Extensive atherosclerotic calcifications of the aorta and its branches. URINARY BLADDER: Well-distended without acute abnormalities. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Marginal osteophytes are seen throughout the thoracic and lumbar spine. There are several old healed bilateral rib fractures more evident at the right posterior rib cage. No acute displaced fractures are seen.
15,043
MR Brain wo contrast 1/20/2022 5:05 PM CLINICAL INFORMATION: Cerebrospinal fluid leak, Q01.9 Encephalocele, unspecified, H90.12 Conductive hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side Spec Inst: History of MCF encephalocele sp repair by Dr. Woodworth in 2018 with known left tegmen encephalocele .br .br MRI cisternogram (high resolution T2 sequence in the coronal plane) COMPARISON: Most recent CT head 1/20/2022, and MR brain 6/28/2018. TECHNIQUE: Multiplanar, multisequence MR images of the brain were obtained without the administration of intravenous contrast. FINDINGS: There is no focal restricted diffusion. The ventricles appear normal in size for age, and there is no midline shift. There is age-appropriate cerebral atrophy with multiple foci of increased T2 signal in the periventricular white matter likely related to microangiopathic degenerative change. There is a small area of encephalomalacia along the anterior right temporal lobe in the area of previous encephalocele repair. Again noted is a large left mastoid air cell effusion with an apparent defect in the left tegmen tympani seen on series 701 image 15 and series 802 image 47 (also seen on CT head from 1/20/2022). There is associated fluid within the left middle ear. There is opacification/fluid in the left eustachian tube is well. The left inner ear structures are overall intact. A prominent sulcus extends to the level of the tegmen defect with contiguous adjacent fluid, which is however different in signal intensity compared to CSF. Subtle protrusion of the cortex is also noted into a defect (coronal series 801, image 188). The bilateral orbits are within normal limits. The remaining paranasal sinuses and right mastoid air cells are clear. CONCLUSION: 1. Defect in the left tegmen tympani with increased fluid in the left middle ear/mastoid. A prominent sulcus extends up to the defect, with contiguous mastoid fluid which is different in signal intensity than CSF, but a small leak is not excluded at this site. In addition, there is subtle cortical protrusion through a more posterior defect and an additional tiny cephalocele is not excluded. Otomastoiditis could however be still in the differential in the appropriate clinical context and a follow-up exam after treatment could be considered to reevaluate. 2. Postsurgical changes of middle cranial fossa encephalocele repair. 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: There is no focal restricted diffusion. The ventricles appear normal in size for age, and there is no midline shift. There is age-appropriate cerebral atrophy with multiple foci of increased T2 signal in the periventricular white matter likely related to microangiopathic degenerative change. There is a small area of encephalomalacia along the anterior right temporal lobe in the area of previous encephalocele repair. Again noted is a large left mastoid air cell effusion with an apparent defect in the left tegmen tympani seen on series 701 image 15 and series 802 image 47 (also seen on CT head from 1/20/2022). There is associated fluid within the left middle ear. There is opacification/fluid in the left eustachian tube is well. The left inner ear structures are overall intact. A prominent sulcus extends to the level of the tegmen defect with contiguous adjacent fluid, which is however different in signal intensity compared to CSF. Subtle protrusion of the cortex is also noted into a defect (coronal series 801, image 188). The bilateral orbits are within normal limits. The remaining paranasal sinuses and right mastoid air cells are clear.
Findings: There are no acute maxillofacial or mandibular fractures. There is no evidence of orbital soft tissue injury. Mild mucosal thickening of right frontal, right sphenoid and bilateral ethmoid sinuses. The remaining paranasal sinuses, middle ears, mastoid antra, and mastoid air cells are clear. Endotracheal and orogastric tubes noted.
15,044
EXAM: MR Brain wo contrast 1/20/2022 4:51 PM CLINICAL INFORMATION: Cerebral infarction. COMPARISON: None TECHNIQUE: Axial diffusion, axial FLAIR, sagittal T1, axial T2 and SWI. FINDINGS: No acute intraparenchymal infarct, hemorrhage, or hydrocephalus. Left frontal convexity 1.9 x 1.4 cm lesion with CSF cleft and white matter buckling, likely extra-axial in location (series 701, image 14). Associated extensive frontal vasogenic edema and mild mass effect on the left frontal lobe. Partial effacement of the left lateral ventricle frontal horn. Age-appropriate cerebral volume. Partial empty sella. The ventricular system is otherwise normal in caliber and configuration. The basal cisterns are clear. The visualized proximal cerebrovascular flow voids appear normal. The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Mild lateral maxillary sinus floor and left ethmoid sinus mucosal thickening. Visualized paranasal sinuses and mastoid air cells are otherwise clear. Both orbits are urnemarkable. _________________________ CONCLUSION: 1. Left frontal convexity extra-axial lesion with associated left frontal lobe moderate vasogenic edema and mild mass effect, possibly meningioma. Recommended postcontrast MRI brain for further characterization. No definite acute infarct is identified. 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: No acute intraparenchymal infarct, hemorrhage, or hydrocephalus. Left frontal convexity 1.9 x 1.4 cm lesion with CSF cleft and white matter buckling, likely extra-axial in location (series 701, image 14). Associated extensive frontal vasogenic edema and mild mass effect on the left frontal lobe. Partial effacement of the left lateral ventricle frontal horn. Age-appropriate cerebral volume. Partial empty sella. The ventricular system is otherwise normal in caliber and configuration. The basal cisterns are clear. The visualized proximal cerebrovascular flow voids appear normal. The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Mild lateral maxillary sinus floor and left ethmoid sinus mucosal thickening. Visualized paranasal sinuses and mastoid air cells are otherwise clear. Both orbits are urnemarkable. _________________________
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 (
15,045
CLINICAL HISTORY: Chronic of chronic headache COMPARISON: MRI and MRA performed on 2/15/2018, CT head 11/20/2019, 11/15/2018 TECHNIQUE: Multiplanar multisequence MRI images of the brain were acquired without intravenous contrast. Axial time-of-flight MR angiography of the brain was performed. Additional 3D post-processing was done with MIP and volume rendered images, which were reviewed for interpretation. FINDINGS: MRI BRAIN: There is no restricted diffusion to suggest an acute infarct. There are multiple lacunar infarcts in the left greater than right frontal lobe and bilateral basal ganglia. Associated small lacunar infarct in the right insula. There are patchy chronic microangiopathic changes. No mass effect by noncontrast evaluation. There is no evidence of acute hemorrhage on the susceptibility weighted images. The ventricles are within normal limits for size and caliber. There is mild scattered paranasal mucosal thickening. The mastoid air cells are relatively clear. There are postsurgical changes of bilateral lens replacement. No suspicious calvarial lesion is noted. MRA BRAIN: There is no occlusion, flow-limiting stenosis in either common carotid artery, anterior cerebral, middle cerebral, posterior cerebral, vertebral or basilar arteries. There is no intracranial aneurysm. IMPRESSION: 1. No acute intracranial abnormality. 2. Multiple small chronic lacunar infarcts and presumed patchy chronic microangiopathic changes. No mass effect by noncontrast evaluation. 3. No occlusion, or flow-limiting stenosis in the intracranial arteries. No intracranial aneurysm.
FINDINGS: MRI BRAIN: There is no restricted diffusion to suggest an acute infarct. There are multiple lacunar infarcts in the left greater than right frontal lobe and bilateral basal ganglia. Associated small lacunar infarct in the right insula. There are patchy chronic microangiopathic changes. No mass effect by noncontrast evaluation. There is no evidence of acute hemorrhage on the susceptibility weighted images. The ventricles are within normal limits for size and caliber. There is mild scattered paranasal mucosal thickening. The mastoid air cells are relatively clear. There are postsurgical changes of bilateral lens replacement. No suspicious calvarial lesion is noted. MRA BRAIN: There is no occlusion, flow-limiting stenosis in either common carotid artery, anterior cerebral, middle cerebral, posterior cerebral, vertebral or basilar arteries. There is no intracranial aneurysm.
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Diffuse brain volume loss with ex vacuo ventricular dilation and moderate white matter microangiopathic changes EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. SINUSES: Normal. CT maxillofacial:.There is a right periorbital soft tissue swelling and tiny subcutaneous emphysema in the right infraorbital/premaxillary soft tissues. No orbital hemorrhage or globe injury.
15,046
CLINICAL HISTORY: Chronic of chronic headache COMPARISON: MRI and MRA performed on 2/15/2018, CT head 11/20/2019, 11/15/2018 TECHNIQUE: Multiplanar multisequence MRI images of the brain were acquired without intravenous contrast. Axial time-of-flight MR angiography of the brain was performed. Additional 3D post-processing was done with MIP and volume rendered images, which were reviewed for interpretation. FINDINGS: MRI BRAIN: There is no restricted diffusion to suggest an acute infarct. There are multiple lacunar infarcts in the left greater than right frontal lobe and bilateral basal ganglia. Associated small lacunar infarct in the right insula. There are patchy chronic microangiopathic changes. No mass effect by noncontrast evaluation. There is no evidence of acute hemorrhage on the susceptibility weighted images. The ventricles are within normal limits for size and caliber. There is mild scattered paranasal mucosal thickening. The mastoid air cells are relatively clear. There are postsurgical changes of bilateral lens replacement. No suspicious calvarial lesion is noted. MRA BRAIN: There is no occlusion, flow-limiting stenosis in either common carotid artery, anterior cerebral, middle cerebral, posterior cerebral, vertebral or basilar arteries. There is no intracranial aneurysm. IMPRESSION: 1. No acute intracranial abnormality. 2. Multiple small chronic lacunar infarcts and presumed patchy chronic microangiopathic changes. No mass effect by noncontrast evaluation. 3. No occlusion, or flow-limiting stenosis in the intracranial arteries. No intracranial aneurysm.
FINDINGS: MRI BRAIN: There is no restricted diffusion to suggest an acute infarct. There are multiple lacunar infarcts in the left greater than right frontal lobe and bilateral basal ganglia. Associated small lacunar infarct in the right insula. There are patchy chronic microangiopathic changes. No mass effect by noncontrast evaluation. There is no evidence of acute hemorrhage on the susceptibility weighted images. The ventricles are within normal limits for size and caliber. There is mild scattered paranasal mucosal thickening. The mastoid air cells are relatively clear. There are postsurgical changes of bilateral lens replacement. No suspicious calvarial lesion is noted. MRA BRAIN: There is no occlusion, flow-limiting stenosis in either common carotid artery, anterior cerebral, middle cerebral, posterior cerebral, vertebral or basilar arteries. There is no intracranial aneurysm.
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Diffuse brain volume loss with ex vacuo ventricular dilation and moderate white matter microangiopathic changes EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. SINUSES: Normal. CT maxillofacial:.There is a right periorbital soft tissue swelling and tiny subcutaneous emphysema in the right infraorbital/premaxillary soft tissues. No orbital hemorrhage or globe injury.
15,047
EXAM: MR Knee Right wo contrast CLINICAL INFORMATION: 20-year-old male with acute injury three weeks ago, concern for medial meniscus tear. COMPARISON: Right knee radiograph 10/28/2021. TECHNIQUE: MR Knee Right wo contrast STRUCTURED REPORT: MRI Knee 1/2/2020 FINDINGS: BONES:No fracture, marrow replacement, or aggressive osseous lesion. There is mild bone marrow edema along the medial femoral condyle. Additional small amount of bone marrow edema within the medial patella. ARTICULATIONS: Effusion:None. Patellofemoral compartment:No cartilage defect. Medial compartment:Mild chondromalacia of the medial femoral condyle. Lateral compartment:No cartilage defect. MENISCI: Medial meniscus:Intact. Lateral meniscus:Intact. LIGAMENTS: Cruciate ligaments:Intact. Medial collateral ligament:Intact. Lateral collateral ligament:Intact. Posterolateral corner structures:Intact. EXTENSOR MECHANISM:The distal quadriceps and patellar tendons are intact. CONCLUSION: 1. No meniscal tear. 2. Mild bone marrow edema of the medial femoral epicondyle and medial patella without a discrete fracture. 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: BONES:No fracture, marrow replacement, or aggressive osseous lesion. There is mild bone marrow edema along the medial femoral condyle. Additional small amount of bone marrow edema within the medial patella. ARTICULATIONS: Effusion:None. Patellofemoral compartment:No cartilage defect. Medial compartment:Mild chondromalacia of the medial femoral condyle. Lateral compartment:No cartilage defect. MENISCI: Medial meniscus:Intact. Lateral meniscus:Intact. LIGAMENTS: Cruciate ligaments:Intact. Medial collateral ligament:Intact. Lateral collateral ligament:Intact. Posterolateral corner structures:Intact. EXTENSOR MECHANISM:The distal quadriceps and patellar tendons are intact.
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 (
15,048
EXAM: MR Abdomen wo+w contrast, MR Cholangiopancreatography MRCP CLINICAL INFORMATION: Possible bile leak COMPARISON: CT 1/12/2022 TECHNIQUE: MR Abdomen wo+w contrast, MR Cholangiopancreatography MRCP Patient weight: 162 lbs. IV contrast: Eovist, 20 ml, per protocol. IV contrast injection rate: 1.50 ml per sec. FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: Patchy nodular opacities in both lower lungs. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Normal. BILIARY TRACT: There is excretion of contrast on hepatobiliary phase imaging observed. There is evidence of leak with extrabiliary contrast observed in scattered areas in the upper abdomen, most notably in the region of the gallbladder fossa (see series 29 image 51 and series 31 image 36) and paracolic gutters. There is minimal dilatation of the common bile duct measuring about 7 mm. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: There is a small amount of free fluid within the abdomen consistent with demonstrated bile leak. There is peritoneal thickening and enhancement consistent with peritonitis. Areas of septation are observed in the right abdomen laterally. A few tiny foci of free air observed in the right upper quadrant. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: Bilateral breast prosthesis. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Exam is positive for bile leak as described. There is a small amount of peritoneal fluid with associated findings of peritonitis. 2. Patchy nodular opacities in both lower lungs, possibly infectious/inflammatory. Preliminary positive findings were discussed with Dr. Janet Julson by Dr. J. Paul Cook via telephone at 22:06 on 1/20/2022. 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: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: Patchy nodular opacities in both lower lungs. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Normal. BILIARY TRACT: There is excretion of contrast on hepatobiliary phase imaging observed. There is evidence of leak with extrabiliary contrast observed in scattered areas in the upper abdomen, most notably in the region of the gallbladder fossa (see series 29 image 51 and series 31 image 36) and paracolic gutters. There is minimal dilatation of the common bile duct measuring about 7 mm. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: There is a small amount of free fluid within the abdomen consistent with demonstrated bile leak. There is peritoneal thickening and enhancement consistent with peritonitis. Areas of septation are observed in the right abdomen laterally. A few tiny foci of free air observed in the right upper quadrant. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: Bilateral breast prosthesis. MUSCULOSKELETAL: No significant abnormality.
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 (
15,049
EXAM: MR Abdomen wo+w contrast, MR Cholangiopancreatography MRCP CLINICAL INFORMATION: Possible bile leak COMPARISON: CT 1/12/2022 TECHNIQUE: MR Abdomen wo+w contrast, MR Cholangiopancreatography MRCP Patient weight: 162 lbs. IV contrast: Eovist, 20 ml, per protocol. IV contrast injection rate: 1.50 ml per sec. FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: Patchy nodular opacities in both lower lungs. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Normal. BILIARY TRACT: There is excretion of contrast on hepatobiliary phase imaging observed. There is evidence of leak with extrabiliary contrast observed in scattered areas in the upper abdomen, most notably in the region of the gallbladder fossa (see series 29 image 51 and series 31 image 36) and paracolic gutters. There is minimal dilatation of the common bile duct measuring about 7 mm. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: There is a small amount of free fluid within the abdomen consistent with demonstrated bile leak. There is peritoneal thickening and enhancement consistent with peritonitis. Areas of septation are observed in the right abdomen laterally. A few tiny foci of free air observed in the right upper quadrant. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: Bilateral breast prosthesis. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Exam is positive for bile leak as described. There is a small amount of peritoneal fluid with associated findings of peritonitis. 2. Patchy nodular opacities in both lower lungs, possibly infectious/inflammatory. Preliminary positive findings were discussed with Dr. Janet Julson by Dr. J. Paul Cook via telephone at 22:06 on 1/20/2022. 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: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: Patchy nodular opacities in both lower lungs. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Normal. BILIARY TRACT: There is excretion of contrast on hepatobiliary phase imaging observed. There is evidence of leak with extrabiliary contrast observed in scattered areas in the upper abdomen, most notably in the region of the gallbladder fossa (see series 29 image 51 and series 31 image 36) and paracolic gutters. There is minimal dilatation of the common bile duct measuring about 7 mm. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: There is a small amount of free fluid within the abdomen consistent with demonstrated bile leak. There is peritoneal thickening and enhancement consistent with peritonitis. Areas of septation are observed in the right abdomen laterally. A few tiny foci of free air observed in the right upper quadrant. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: Bilateral breast prosthesis. MUSCULOSKELETAL: No significant abnormality.
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 (
15,050
EXAM: MR Knee Right wo contrast CLINICAL INFORMATION: 84-year-old male with concern for right knee medial meniscus tear. COMPARISON: Right knee radiograph 12/10/2021. TECHNIQUE: MR Knee Right wo contrast STRUCTURED REPORT: MRI Knee 1/2/2020 FINDINGS: BONES:No fracture, marrow replacement, or aggressive osseous lesion. ARTICULATIONS: Effusion:Trace suprapatellar effusion. Patellofemoral compartment:Full-thickness cartilage defect overlying the medial facet. Mild chondromalacia of the lateral facet. Medial compartment:Mild chondromalacia of the medial femoral articular cartilage. Lateral compartment:Mild chondromalacia of the lateral femoral articular cartilage. MENISCI: Medial meniscus: Complex tear of the body. Lateral meniscus:Small horizontal tear involving the meniscal body. . LIGAMENTS: Cruciate ligaments:Intact. Medial collateral ligament:Mild edema superficial to the medial collateral ligament. Lateral collateral ligament:Intact. Posterolateral corner structures:Intact. EXTENSOR MECHANISM:The distal quadriceps and patellar tendons are intact. There is complete fatty replacement of the visualized muscles with exception of the sartorius. CONCLUSION: 1. Complex tear of medial meniscal body with small horizontal tear of the lateral meniscal body 2. Moderate degenerative changes of the patellofemoral compartment and mild degenerative changes of the medial and lateral compartments. 3. Complete fatty replacement of the visualized muscles with exception of the sartorius. 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: BONES:No fracture, marrow replacement, or aggressive osseous lesion. ARTICULATIONS: Effusion:Trace suprapatellar effusion. Patellofemoral compartment:Full-thickness cartilage defect overlying the medial facet. Mild chondromalacia of the lateral facet. Medial compartment:Mild chondromalacia of the medial femoral articular cartilage. Lateral compartment:Mild chondromalacia of the lateral femoral articular cartilage. MENISCI: Medial meniscus: Complex tear of the body. Lateral meniscus:Small horizontal tear involving the meniscal body. . LIGAMENTS: Cruciate ligaments:Intact. Medial collateral ligament:Mild edema superficial to the medial collateral ligament. Lateral collateral ligament:Intact. Posterolateral corner structures:Intact. EXTENSOR MECHANISM:The distal quadriceps and patellar tendons are intact. There is complete fatty replacement of the visualized muscles with exception of the sartorius.
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 (
15,051
MR Lumbar Spine wo contrast 1/20/2022 5:05 PM CLINICAL INFORMATION: Low back pain, > 6 wks, M54.50 Low back pain, unspecified, Q05.9 Spina bifida, unspecified COMPARISON: Prior MR lumbar spine 11/5/2015. TECHNIQUE: Multiplanar, multisequence MR images of the lumbar spine were obtained without the administration of intravenous contrast. FINDINGS: The lumbar spine is normal in alignment. Vertebral body heights are maintained. Intervertebral disc spaces are relatively well-preserved with mild disc height loss in the lower lumbar spine especially at L4-5 and L5-S1 where there is also mild disc desiccation. There is an unchanged T1/T2 hyperintense lesion at the conus extending along the filum terminale, the bulk of which measures 2.7 x 1.0 x 1.2 cm (series 501 image 29, series 201 image 8). This lesion is hypointense on STIR sequence. Sequela of spina bifida are noted with abnormal development of the posterior elements within the proximal sacrum especially on S1 and S2. There is a focal T1 and T2 hyperintense well-defined lesion in the L4 vertebral body (series 501 image 18), which mostly retains signal on STIR sequence. Remaining marrow signal is unremarkable. Additional findings given on a segmental basis as below: T12-L1: Unremarkable. L1-L2: Unremarkable. L2-L3: There is no spinal canal stenosis or neural foraminal narrowing. However, the lesion and the conus displaces the distal cord and conus anteriorly with mild compression which is relatively unchanged from the prior examination given differences in technique. L3-L4: There is a mild broad-based disc bulge with paracentral mild narrowing of the left lateral recess. There is mild right neural foraminal stenosis. L4-5: There is a small broad-based disc bulge without spinal canal stenosis. There is mild right neural foraminal narrowing. L5-S1: No spinal canal stenosis or neural foraminal narrowing. Limited evaluation of the intra-abdominal structures shows no significant abnormality. The paraspinal musculature is within normal limits. There is a small amount of fluid in the back subcutaneous soft tissues. CONCLUSION: 1. Unchanged fat-containing lesion at the distal cord/conus medullaris consistent with a lipoma. 2. Sequela of spina bifida with irregular development of the proximal sacral posterior elements. 3. Mild degenerative changes with areas of mild neuroforaminal narrowing 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: The lumbar spine is normal in alignment. Vertebral body heights are maintained. Intervertebral disc spaces are relatively well-preserved with mild disc height loss in the lower lumbar spine especially at L4-5 and L5-S1 where there is also mild disc desiccation. There is an unchanged T1/T2 hyperintense lesion at the conus extending along the filum terminale, the bulk of which measures 2.7 x 1.0 x 1.2 cm (series 501 image 29, series 201 image 8). This lesion is hypointense on STIR sequence. Sequela of spina bifida are noted with abnormal development of the posterior elements within the proximal sacrum especially on S1 and S2. There is a focal T1 and T2 hyperintense well-defined lesion in the L4 vertebral body (series 501 image 18), which mostly retains signal on STIR sequence. Remaining marrow signal is unremarkable. Additional findings given on a segmental basis as below: T12-L1: Unremarkable. L1-L2: Unremarkable. L2-L3: There is no spinal canal stenosis or neural foraminal narrowing. However, the lesion and the conus displaces the distal cord and conus anteriorly with mild compression which is relatively unchanged from the prior examination given differences in technique. L3-L4: There is a mild broad-based disc bulge with paracentral mild narrowing of the left lateral recess. There is mild right neural foraminal stenosis. L4-5: There is a small broad-based disc bulge without spinal canal stenosis. There is mild right neural foraminal narrowing. L5-S1: No spinal canal stenosis or neural foraminal narrowing. Limited evaluation of the intra-abdominal structures shows no significant abnormality. The paraspinal musculature is within normal limits. There is a small amount of fluid in the back subcutaneous soft tissues.
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 (
15,052
MR Brachial Plexus wo+w contrast 1/20/2022 6:15 PM CLINICAL INFORMATION: Thoracic outlet syndrome, R29.898 Other symptoms and signs involving the musculoskeletal system Spec Inst: Please do both right and left sides prior thoracic outlet surgery on right similar symptoms now on the left positive EMG COMPARISON: None. TECHNIQUE: Multiplanar, multisequence MR images of the bilateral brachial plexus were obtained before and after the administration of intravenous contrast. Patient weight: 120 lbs. IV contrast: ProHance, 10 ml, per protocol. FINDINGS: There have been postsurgical changes of right first rib removal. The right scalene muscles appear mildly atrophic. Along the course of the right brachial plexus nerve trunk and division is poorly delineated with increased T2/STIR signal. On the left there is no focal abnormal signal along the course of the brachial plexus. There is no abnormal enhancement along the course of the bilateral brachial plexus. The visualized cervical soft tissues appear unremarkable. The lung parenchyma is within normal limits. The visualized thoracic spinal cord is unremarkable. CONCLUSION: 1. Postsurgical changes of right first rib removal with mild atrophy of the right scalene muscles. 2. Poorly delineated trunk and division of the right brachial plexus with edematous T2 hyperintensity. 3. Unremarkable left brachial plexus. 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: There have been postsurgical changes of right first rib removal. The right scalene muscles appear mildly atrophic. Along the course of the right brachial plexus nerve trunk and division is poorly delineated with increased T2/STIR signal. On the left there is no focal abnormal signal along the course of the brachial plexus. There is no abnormal enhancement along the course of the bilateral brachial plexus. The visualized cervical soft tissues appear unremarkable. The lung parenchyma is within normal limits. The visualized thoracic spinal cord is unremarkable.
FINDINGS: CT of the head with and without contrast: There is no acute infarction, hemorrhage, or cerebral edema. The gray-white matter differentiation is maintained. Periventricular white matter hypoattenuation consistent with chronic microangiopathic changes. Mild age-appropriate diffuse parenchymal volume loss with ex vacuo dilatation of ventricles. There is no space occupying intracranial lesion. No enhancing intracranial abnormality. There is no acute osseous or orbital abnormality. The paranasal sinuses and mastoid air cells are clear. CT angiogram of the brain: RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Unremarkable. Hypoplastic right ACA. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: Atherosclerotic calcification of the proximal ICA with approximately 68% stenosis by Nascet criteria. There is no evidence of occlusion or aneurysmal dilation. LEFT CAROTID: Mild atherosclerosis of the proximal ICA without flow-limiting stenosis. There is no evidence of occlusion or aneurysmal dilation. RIGHT VERTEBRAL ARTERY: Mild atherosclerosis at the origin without flow-limiting stenosis. There is no evidence of occlusion or aneurysmal dilation. LEFT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. Right ACA is hypoplastic. SOFT TISSUES: No soft tissue abnormality within the neck. CERVICAL SPINE: Normal cervical spine alignment. Mild multilevel discogenic degenerative change. No aggressive osseous lesions.
15,053
MR Cervical Spine wo+w contrast 1/20/2022 6:15 PM CLINICAL INFORMATION: Hand weakness, M54.12 Radiculopathy, cervical region, R29.898 Other symptoms and signs involving the musculoskeletal system Spec Inst: See recent EMG, history of thoracic outlet syndrome surgery on the right and similar symptoms on the left COMPARISON: Prior MR cervical spine 1/29/2020 TECHNIQUE: Multiplanar, multisequence MR images of the cervical spine were obtained before and after the administration of intravenous contrast. Patient weight: 120 lbs. IV contrast: ProHance, 10 ml, per protocol. FINDINGS: There is absence of the normal lordotic curvature of the cervical spine. There is no abnormal marrow signal. Advanced degenerative changes are seen at C4-C5, explained further below. The visualized intracranial structures are unremarkable. There is no abnormal increased signal within the cervical spinal cord. Additional findings are given on a segmental basis as below: C2-C3: There is no spinal canal stenosis. No neural foraminal narrowing appreciated. C3-C4: There is a small posterior disc/osteophyte complex which does not result in significant spinal canal stenosis. There is mild bilateral uncovertebral degenerative change without neural foraminal narrowing. C4-C5: There is a posterior disc/osteophyte complex again seen which abuts the ventral aspect of the cervical spinal cord with resultant and effacement and mild spinal canal narrowing. There is peripheral no central narrowing of the right lateral recess with moderate to severe right and moderate left neural foraminal narrowing at this level. C5-C6: There is a posterior disc osteophyte complex which is result in significant spinal canal stenosis. No significant neural foraminal narrowing bilaterally. C6-C7: Unremarkable. C7-T1: Unremarkable. No abnormal enhancement is seen on postcontrast images. The paraspinal soft tissues are within normal limits. Appropriate flow voids are identified as visualized. CONCLUSION: Multilevel degenerative changes most pronounced at C4-C5 where there is a large posterior disc/osteophyte complex which effaces the ventral aspect of the cervical spinal cord and results in moderate to severe right and moderate left neural foraminal narrowing similar to the 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: There is absence of the normal lordotic curvature of the cervical spine. There is no abnormal marrow signal. Advanced degenerative changes are seen at C4-C5, explained further below. The visualized intracranial structures are unremarkable. There is no abnormal increased signal within the cervical spinal cord. Additional findings are given on a segmental basis as below: C2-C3: There is no spinal canal stenosis. No neural foraminal narrowing appreciated. C3-C4: There is a small posterior disc/osteophyte complex which does not result in significant spinal canal stenosis. There is mild bilateral uncovertebral degenerative change without neural foraminal narrowing. C4-C5: There is a posterior disc/osteophyte complex again seen which abuts the ventral aspect of the cervical spinal cord with resultant and effacement and mild spinal canal narrowing. There is peripheral no central narrowing of the right lateral recess with moderate to severe right and moderate left neural foraminal narrowing at this level. C5-C6: There is a posterior disc osteophyte complex which is result in significant spinal canal stenosis. No significant neural foraminal narrowing bilaterally. C6-C7: Unremarkable. C7-T1: Unremarkable. No abnormal enhancement is seen on postcontrast images. The paraspinal soft tissues are within normal limits. Appropriate flow voids are identified as visualized.
FINDINGS: CT of the head with and without contrast: There is no acute infarction, hemorrhage, or cerebral edema. The gray-white matter differentiation is maintained. Periventricular white matter hypoattenuation consistent with chronic microangiopathic changes. Mild age-appropriate diffuse parenchymal volume loss with ex vacuo dilatation of ventricles. There is no space occupying intracranial lesion. No enhancing intracranial abnormality. There is no acute osseous or orbital abnormality. The paranasal sinuses and mastoid air cells are clear. CT angiogram of the brain: RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Unremarkable. Hypoplastic right ACA. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: Atherosclerotic calcification of the proximal ICA with approximately 68% stenosis by Nascet criteria. There is no evidence of occlusion or aneurysmal dilation. LEFT CAROTID: Mild atherosclerosis of the proximal ICA without flow-limiting stenosis. There is no evidence of occlusion or aneurysmal dilation. RIGHT VERTEBRAL ARTERY: Mild atherosclerosis at the origin without flow-limiting stenosis. There is no evidence of occlusion or aneurysmal dilation. LEFT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. Right ACA is hypoplastic. SOFT TISSUES: No soft tissue abnormality within the neck. CERVICAL SPINE: Normal cervical spine alignment. Mild multilevel discogenic degenerative change. No aggressive osseous lesions.
15,054
MR Brain wo contrast 1/20/2022 5:18 PM CLINICAL INFORMATION: concern for va, gait changes, G31.84 Mild cognitive impairment, so stated Spec Inst: Memory Disorders Protocol COMPARISON: Prior CT head 8/4/2020 and MR brain 4/17/2018. TECHNIQUE: Multiplanar, multisequence MR images of the brain were obtained without the administration of intravenous contrast. FINDINGS: There is no restricted diffusion. There is mild periventricular white matter T2/FLAIR increased signal likely related to microangiopathic change, Fazekas grade 1. There is mild diffuse cerebral atrophy, age appropriate. The ventricles are normal in size for age and there is no midline shift. Appropriate flow-voids are seen, though the known small right MCA aneurysm is not identified due to technique. There are no significant chronic microhemorrhages. On the MP-RAGE coronal series, on an image oriented perpendicular to the AC-PC line and passing through the mamillary bodies, the patient has grade 1 bilateral hippocampal atrophy using the visual grading system of Duara et al. The bilateral orbits are within normal limits. The paranasal sinuses and the mastoid air cells are clear. CONCLUSION: 1. No acute intracranial abnormality. 2. Bilateral grade 1 hippocampal atrophy, in proportion to the mild generalized cerebral volume loss. No significant chronic microhemorrhages. Mild chronic microangiopathic changes. 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: There is no restricted diffusion. There is mild periventricular white matter T2/FLAIR increased signal likely related to microangiopathic change, Fazekas grade 1. There is mild diffuse cerebral atrophy, age appropriate. The ventricles are normal in size for age and there is no midline shift. Appropriate flow-voids are seen, though the known small right MCA aneurysm is not identified due to technique. There are no significant chronic microhemorrhages. On the MP-RAGE coronal series, on an image oriented perpendicular to the AC-PC line and passing through the mamillary bodies, the patient has grade 1 bilateral hippocampal atrophy using the visual grading system of Duara et al. The bilateral orbits are within normal limits. The paranasal sinuses and the mastoid air cells are clear.
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 (
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EXAM: MR Neck Soft Tissue wo+w contrast HISTORY: Left orbital squamous cell carcinoma status post resection on 3/13/2021 with adjuvant radiation therapy completed 8/4/2021. Evaluate right mandibular angle and fidgety on PET/CT. Technique: Multiplanar, multisequence MR images of the neck soft tissues was obtained before and after the administration of intravenous contrast. Patient weight: 92 lbs. IV contrast: ProHance, 9 ml, per protocol. COMPARISON: PET/CT 1/20/2022 and CT neck 2/19/2021. FINDINGS: Evaluation is limited by technique and lack of fat suppression on the postcontrast images. PARTIALLY VISUALIZED INTRACRANIAL STRUCTURES: Again seen is an enhancing left paraclinoid lesion which measures 2.2 x 1.8 cm on the current examination (series 901 image 19), previously 2.0 x 1.9 cm. The remaining intracranial structures are unremarkable. ORBITS: Normal. PARANASAL SINUSES AND MASTOID AIR CELLS: Extensive postsurgical changes are noted with extensive left maxillary sinus resection, especially the medial wall, with the left maxillary sinus communicating with the floor of the oral cavity. There is a left mastoid air cell effusion. PAROTID GLANDS: Normal. SUBMANDIBULAR GLANDS: The right submandibular gland is unremarkable. The left submandibular gland is not well seen, possibly excised. THYROID GLAND: Normal. SOFT TISSUES: There is ill-defined enhancement of the left nasopharyngeal soft tissues with an asymmetric left retropharyngeal lymph node measuring 7 mm in diameter (axial T2 series 901, image 20). There is edema and enhancement along the left palatine tonsil and oral pharyngeal soft tissues, without discrete enhancing lesion, likely postradiation change. There is mild asymmetric edema and enhancement in the left masticator space. There is clearly defined enhancing lesion along the right mandible. LYMPH NODES: No other pathologic adenopathy by imaging size criteria. AERODIGESTIVE STRUCTURES: There is mild rightward deviation of the oropharynx. Additional findings as above VASCULAR STRUCTURES: Not adequately evaluated by MR technique. Atherosclerotic plaque is noted at bilateral carotid bifurcations.. OSSEOUS STRUCTURES: No fracture, dislocation, or destructive lesion. LUNG APICES: Normal. CONCLUSION: 1. Asymmetric left retropharyngeal lymph node measuring 6 mm in diameter, nonspecific. Surrounding ill-defined enhancement of the left nasopharyngeal soft tissues, masticator space and oropharyngeal soft tissues without a discrete enhancing lesion. Findings may represent posttreatment/postradiation changes and follow-up would be recommended. Recommend correlation with contrast-enhanced neck CT, unless otherwise contraindicated. 2. Stable enhancing left paraclinoid lesion consistent with a meningioma. 3. Stable postsurgical changes including partial left maxillary sinus resection with an oral nasal/maxillary fistula. 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: Evaluation is limited by technique and lack of fat suppression on the postcontrast images. PARTIALLY VISUALIZED INTRACRANIAL STRUCTURES: Again seen is an enhancing left paraclinoid lesion which measures 2.2 x 1.8 cm on the current examination (series 901 image 19), previously 2.0 x 1.9 cm. The remaining intracranial structures are unremarkable. ORBITS: Normal. PARANASAL SINUSES AND MASTOID AIR CELLS: Extensive postsurgical changes are noted with extensive left maxillary sinus resection, especially the medial wall, with the left maxillary sinus communicating with the floor of the oral cavity. There is a left mastoid air cell effusion. PAROTID GLANDS: Normal. SUBMANDIBULAR GLANDS: The right submandibular gland is unremarkable. The left submandibular gland is not well seen, possibly excised. THYROID GLAND: Normal. SOFT TISSUES: There is ill-defined enhancement of the left nasopharyngeal soft tissues with an asymmetric left retropharyngeal lymph node measuring 7 mm in diameter (axial T2 series 901, image 20). There is edema and enhancement along the left palatine tonsil and oral pharyngeal soft tissues, without discrete enhancing lesion, likely postradiation change. There is mild asymmetric edema and enhancement in the left masticator space. There is clearly defined enhancing lesion along the right mandible. LYMPH NODES: No other pathologic adenopathy by imaging size criteria. AERODIGESTIVE STRUCTURES: There is mild rightward deviation of the oropharynx. Additional findings as above VASCULAR STRUCTURES: Not adequately evaluated by MR technique. Atherosclerotic plaque is noted at bilateral carotid bifurcations.. OSSEOUS STRUCTURES: No fracture, dislocation, or destructive lesion. LUNG APICES: Normal.
Findings: Suboccipital craniectomy and cerebellar mass resection changes with residual nodular hyperdense lesions within the resection cavity measuring up to 9 mm (series 2, image 12) also seen on coronal image 61. Fluid collection superficial to the craniectomy is unchanged measuring up to 39 x 12 mm (series 2, image 5), previously 39 x 12 mm. Right frontal approach ventriculostomy catheter tip terminates near the septum pellucidum. Interval decrease in pneumocephalus and pneumoventricle. Stable mild ventriculomegaly. No convincing intraventricular hemorrhage. Interval decrease in subcutaneous gas of the right frontal and suboccipital scalp.
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EXAM: MR Brain wo+w contrast, MR Angio Head wo contrast 1/20/2022 5:50 PM CLINICAL INFORMATION: Headache, new or worsening, post exertion or sex, G44.82 Headache associated with sexual activity. COMPARISON: None available. TECHNIQUE: Axial diffusion, axial FLAIR, sagittal T1, axial T2 and SWI. MRA of the head was performed without intravenous contrast utilizing 3-D time-of-flight technique. Multiple MIP images were generated. Patient weight: 215 lbs. IV contrast: ProHance, 20 ml, per protocol. FINDINGS: MRI Brain: Cerebral volume is normal. Punctate focus of susceptibility artifact in the left frontal lobe, parietal lobe and in the medial cerebellar hemisphere, likely chronic microhemorrhages. There is no acute infarction, hemorrhage or hydrocephalus. There is no vasogenic edema or mass effect. No abnormal postcontrast enhancement. The ventricular system is normal in caliber and configuration. The basal cisterns are clear. The visualized proximal cerebrovascular flow voids appear normal. The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Trace bilateral maxillary sinus floor and anterior ethmoid sinus mucosal thickening. Visualized paranasal sinuses and mastoid air cells are otherwise clear. Both orbits are unremarkable. MRA Brain: INTERNAL CAROTID ARTERIES: Normal in course, caliber, and contour. CEREBRAL ARTERIES: Normal in course, caliber, and contour. VERTEBROBASILAR SYSTEM: Normal in course, caliber, and contour. There is no evidence of saccular aneurysm, vascular malformation, or large vessel occlusion. There is no diffusion abnormality to suggest acute infarction. _________________________ CONCLUSION: 1. No acute intracranial abnormality. 2. Punctate few foci of susceptibility, likely early chronic microhemorrhages. 3. Normal MRA. No evidence of saccular aneurysm, vascular lesion, or large vessel occlusion. 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: MRI Brain: Cerebral volume is normal. Punctate focus of susceptibility artifact in the left frontal lobe, parietal lobe and in the medial cerebellar hemisphere, likely chronic microhemorrhages. There is no acute infarction, hemorrhage or hydrocephalus. There is no vasogenic edema or mass effect. No abnormal postcontrast enhancement. The ventricular system is normal in caliber and configuration. The basal cisterns are clear. The visualized proximal cerebrovascular flow voids appear normal. The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Trace bilateral maxillary sinus floor and anterior ethmoid sinus mucosal thickening. Visualized paranasal sinuses and mastoid air cells are otherwise clear. Both orbits are unremarkable. MRA Brain: INTERNAL CAROTID ARTERIES: Normal in course, caliber, and contour. CEREBRAL ARTERIES: Normal in course, caliber, and contour. VERTEBROBASILAR SYSTEM: Normal in course, caliber, and contour. There is no evidence of saccular aneurysm, vascular malformation, or large vessel occlusion. There is no diffusion abnormality to suggest acute infarction. _________________________
Findings: CTA Neck: No significant stenosis at the origin of great vessels from the arch of aorta. Scattered atherosclerotic calcifications along the aortic arch and bilateral carotid bifurcations. Carotid and vertebral arteries show no flow-limiting stenosis. CTA Head: Bilateral intradural cranial ICAs show atherosclerotic calcification without flow limitation. Mild narrowing of the proximal M1 segment of right MCA. No flow-limiting stenosis. There is irregular narrowing and decreased flow in the cortical branches of right MCA for example image #72, series 4 and sagittal image #87, 96 series 410. No evidence of aneurysm or AV malformation. Intradural vertebral arteries and basilar artery are hypoplastic with fetal origin of both PCAs. There is irregular narrowing of the distal branches of right PCA without complete occlusion.
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EXAM: MR Brain wo+w contrast, MR Angio Head wo contrast 1/20/2022 5:50 PM CLINICAL INFORMATION: Headache, new or worsening, post exertion or sex, G44.82 Headache associated with sexual activity. COMPARISON: None available. TECHNIQUE: Axial diffusion, axial FLAIR, sagittal T1, axial T2 and SWI. MRA of the head was performed without intravenous contrast utilizing 3-D time-of-flight technique. Multiple MIP images were generated. Patient weight: 215 lbs. IV contrast: ProHance, 20 ml, per protocol. FINDINGS: MRI Brain: Cerebral volume is normal. Punctate focus of susceptibility artifact in the left frontal lobe, parietal lobe and in the medial cerebellar hemisphere, likely chronic microhemorrhages. There is no acute infarction, hemorrhage or hydrocephalus. There is no vasogenic edema or mass effect. No abnormal postcontrast enhancement. The ventricular system is normal in caliber and configuration. The basal cisterns are clear. The visualized proximal cerebrovascular flow voids appear normal. The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Trace bilateral maxillary sinus floor and anterior ethmoid sinus mucosal thickening. Visualized paranasal sinuses and mastoid air cells are otherwise clear. Both orbits are unremarkable. MRA Brain: INTERNAL CAROTID ARTERIES: Normal in course, caliber, and contour. CEREBRAL ARTERIES: Normal in course, caliber, and contour. VERTEBROBASILAR SYSTEM: Normal in course, caliber, and contour. There is no evidence of saccular aneurysm, vascular malformation, or large vessel occlusion. There is no diffusion abnormality to suggest acute infarction. _________________________ CONCLUSION: 1. No acute intracranial abnormality. 2. Punctate few foci of susceptibility, likely early chronic microhemorrhages. 3. Normal MRA. No evidence of saccular aneurysm, vascular lesion, or large vessel occlusion. 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: MRI Brain: Cerebral volume is normal. Punctate focus of susceptibility artifact in the left frontal lobe, parietal lobe and in the medial cerebellar hemisphere, likely chronic microhemorrhages. There is no acute infarction, hemorrhage or hydrocephalus. There is no vasogenic edema or mass effect. No abnormal postcontrast enhancement. The ventricular system is normal in caliber and configuration. The basal cisterns are clear. The visualized proximal cerebrovascular flow voids appear normal. The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Trace bilateral maxillary sinus floor and anterior ethmoid sinus mucosal thickening. Visualized paranasal sinuses and mastoid air cells are otherwise clear. Both orbits are unremarkable. MRA Brain: INTERNAL CAROTID ARTERIES: Normal in course, caliber, and contour. CEREBRAL ARTERIES: Normal in course, caliber, and contour. VERTEBROBASILAR SYSTEM: Normal in course, caliber, and contour. There is no evidence of saccular aneurysm, vascular malformation, or large vessel occlusion. There is no diffusion abnormality to suggest acute infarction. _________________________
Findings: CTA Neck: No significant stenosis at the origin of great vessels from the arch of aorta. Scattered atherosclerotic calcifications along the aortic arch and bilateral carotid bifurcations. Carotid and vertebral arteries show no flow-limiting stenosis. CTA Head: Bilateral intradural cranial ICAs show atherosclerotic calcification without flow limitation. Mild narrowing of the proximal M1 segment of right MCA. No flow-limiting stenosis. There is irregular narrowing and decreased flow in the cortical branches of right MCA for example image #72, series 4 and sagittal image #87, 96 series 410. No evidence of aneurysm or AV malformation. Intradural vertebral arteries and basilar artery are hypoplastic with fetal origin of both PCAs. There is irregular narrowing of the distal branches of right PCA without complete occlusion.
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EXAM:MR Hand Right wo contrast CLINICAL INFORMATION:Right thumb injury with concern for UCL injury COMPARISON:12/8/2021 TECHNIQUE: Multiplanar and multisequence MRI of the right thumb was obtained without intravenous contrast. FINDINGS: No abnormal bone marrow signal to suggest acute fracture or aggressive osseous lesion. The ulnar collateral ligament of the thumb is intact. There is a tear of the dorsal radial capsule at the thumb MCP joint, extending into the radial collateral ligament with surrounding soft tissue edema. Small amount of edema is noted within the abductor pollicis brevis. The remaining visualized muscles and tendons are intact and unremarkable. No ganglion cyst is seen. CONCLUSION: 1. Dorsal radial capsular tear at the thumb MCP, extending into the radial collateral edema. 2. Strain of the abductor pollicis brevis muscle. 3. Intact thumb ulnar collateral ligament. 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: No abnormal bone marrow signal to suggest acute fracture or aggressive osseous lesion. The ulnar collateral ligament of the thumb is intact. There is a tear of the dorsal radial capsule at the thumb MCP joint, extending into the radial collateral ligament with surrounding soft tissue edema. Small amount of edema is noted within the abductor pollicis brevis. The remaining visualized muscles and tendons are intact and unremarkable. No ganglion cyst is seen.
Findings: There is encephalomalacia in the right parietal lobe likely from prior infarction. Nonspecific hyperattenuation is seen in the right sylvian fissure along the right MCA. No intracranial hemorrhage.
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MR Lumbar Spine wo+w contrast 1/20/2022 5:41 PM CLINICAL INFORMATION: Lumbar radiculopathy, cancer or infection suspected, R20.2 Paresthesia of skin, L40.9 Psoriasis, unspecified, L93.0 Discoid lupus erythematosus, C61 Malignant neoplasm of prostate Spec Inst: right thigh posterior-lateral paresthesia numbness COMPARISON: Prior MR lumbar spine 12/6/2013. TECHNIQUE: Multiplanar, multisequence MR images of the lumbar spine were obtained before and after the administration of intravenous contrast. Patient weight: 300 lbs. IV contrast: ProHance, 10 ml, per protocol. FINDINGS: The lumbar spine demonstrate normal alignment. There are mild Modic type I degenerative endplate changes anteriorly and inferiorly at L3. Otherwise no abnormal marrow signal change is identified. The conus is unremarkable terminating at the level of L1. Additional findings are given on a segmental basis as below: T12-L1: Bilateral facet arthropathy without spinal canal stenosis or neural foraminal narrowing at this level. L1-L2: There is no spinal canal stenosis. Mild facet arthropathy is noted bilaterally with mild left neural foraminal narrowing. L2-L3: There is moderate facet arthropathy with minimal disc bulge without significant spinal canal or foraminal narrowing. L3-L4: There is a posterior disc bulge with facet DJD and ligamentum flavum thickening and resultant mild spinal canal stenosis which is similar to the prior examination. Bilateral facet arthropathy is seen which results in moderate bilateral neural foraminal narrowing. L4-L5: There is a broad-based posterior disc bulge with facet DJD and ligament flavum thickening with mild spinal canal stenosis, which is not significantly changed from the prior examination. Bilateral facet arthropathy results in moderate bilateral neural foraminal narrowing. L5-S1: There is a broad-based posterior disc bulge that does not contribute to spinal canal stenosis. Bilateral facet arthropathy is noted, and there is moderate bilateral bilateral neuroforaminal narrowing which is similar. No abnormal enhancing lesion is seen on postcontrast images. Limited evaluation of the intra-abdominal structures shows no relevant abnormality. The paraspinal musculature is within normal limits. CONCLUSION: Mild-to-moderate degenerative changes with mild-to-moderate neural foraminal narrowing as above. These findings are not significantly changed from the prior examination. No evidence of abnormal enhancement noted. 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: The lumbar spine demonstrate normal alignment. There are mild Modic type I degenerative endplate changes anteriorly and inferiorly at L3. Otherwise no abnormal marrow signal change is identified. The conus is unremarkable terminating at the level of L1. Additional findings are given on a segmental basis as below: T12-L1: Bilateral facet arthropathy without spinal canal stenosis or neural foraminal narrowing at this level. L1-L2: There is no spinal canal stenosis. Mild facet arthropathy is noted bilaterally with mild left neural foraminal narrowing. L2-L3: There is moderate facet arthropathy with minimal disc bulge without significant spinal canal or foraminal narrowing. L3-L4: There is a posterior disc bulge with facet DJD and ligamentum flavum thickening and resultant mild spinal canal stenosis which is similar to the prior examination. Bilateral facet arthropathy is seen which results in moderate bilateral neural foraminal narrowing. L4-L5: There is a broad-based posterior disc bulge with facet DJD and ligament flavum thickening with mild spinal canal stenosis, which is not significantly changed from the prior examination. Bilateral facet arthropathy results in moderate bilateral neural foraminal narrowing. L5-S1: There is a broad-based posterior disc bulge that does not contribute to spinal canal stenosis. Bilateral facet arthropathy is noted, and there is moderate bilateral bilateral neuroforaminal narrowing which is similar. No abnormal enhancing lesion is seen on postcontrast images. Limited evaluation of the intra-abdominal structures shows no relevant abnormality. The paraspinal musculature is within normal limits.
FINDINGS: Examination is limited due to motion artifacts. RAPID images demonstrate CBF less than 30% volume: 9 mL and T. Max greater than 6seconds volume: 57 mL. Mismatch volume is 48 mL. There are small areas of reduced cerebral blood flow in the right parietal lobe in the region of encephalomalacia with corresponding reduced cerebral blood volume and surrounding areas of elevated Tmax. There is diffusely increased Tmax in both cerebral hemispheres which can suggest hypoperfusion or may be artifactual.
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MR Cervical Spine wo contrast 1/20/2022 5:25 PM CLINICAL INFORMATION: CERVICAL RADICULOPATHY, M54.12 Radiculopathy, cervical region COMPARISON: MR cervical spine 2/19/2014. TECHNIQUE: Multiplanar, multisequence MR images of the cervical spine were obtained without the administration of intravenous contrast. FINDINGS: The diagnostic quality/utility of this examination is degraded by patient motion. There is absence of the normal lordotic curvature of the cervical spine. There is no abnormal marrow signal change. The visualized posterior fossa structures are within normal limits. There is no increased T2 signal within the cervical spinal cord. Additional findings given on a segmental basis as below: C2-C3: No spinal canal stenosis or neuroforaminal narrowing. C3-C4: Unremarkable. C4-C5: There is a mild disc bulge which does not result in severe spinal canal stenosis. There is mild right uncovertebral degenerative change with mild right neural foraminal narrowing C5-C6: There is a mild disc bulge with minimal spinal canal stenosis at this level. There is minimal bilateral neural foraminal narrowing. C6-C7: A small mild disc bulge with left asymmetric uncovertebral DJD resulting in mild left foraminal narrowing. C7-T1: Unremarkable. The paraspinal soft tissues are within normal limits. CONCLUSION: Mild degenerative changes with mild foraminal narrowing at C4-5 and C6-7, as detailed 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: The diagnostic quality/utility of this examination is degraded by patient motion. There is absence of the normal lordotic curvature of the cervical spine. There is no abnormal marrow signal change. The visualized posterior fossa structures are within normal limits. There is no increased T2 signal within the cervical spinal cord. Additional findings given on a segmental basis as below: C2-C3: No spinal canal stenosis or neuroforaminal narrowing. C3-C4: Unremarkable. C4-C5: There is a mild disc bulge which does not result in severe spinal canal stenosis. There is mild right uncovertebral degenerative change with mild right neural foraminal narrowing C5-C6: There is a mild disc bulge with minimal spinal canal stenosis at this level. There is minimal bilateral neural foraminal narrowing. C6-C7: A small mild disc bulge with left asymmetric uncovertebral DJD resulting in mild left foraminal narrowing. C7-T1: Unremarkable. The paraspinal soft tissues are within normal limits.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Dependent atelectasis, bilaterally. DISTAL ESOPHAGUS: Large hiatal hernia. HEART / VESSELS: No significant abnormality. 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: The appendix is normal. Scattered sigmoid diverticula. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered vascular calcifications. The common hepatic artery arises directly from the aorta as does the splenic artery. Two left renal arteries. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is absent. No adnexal mass. BODY WALL: Small right fat-containing femoral hernia. MUSCULOSKELETAL: Advanced discogenic degenerative change with lower lumbar spine facet arthropathy. Grade 1 anterolisthesis of L4 on L5. Congenital block vertebra at T9-T10.
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MR Cervical Spine wo contrast 1/20/2022 5:17 PM CLINICAL INFORMATION: Neck pain, M54.2 Cervicalgia Spec Inst: MRI CSpine without contrast .br neck pain COMPARISON: None. TECHNIQUE: Multiplanar, multisequence MR images of the cervical spine were obtained without the administration of intravenous contrast. FINDINGS: There is trace anterolisthesis of C2 over C3 with slight decrease of the normal lordotic curvature of the cervical spine. There is no abnormal marrow signal change. The visualized posterior fossa structures are within normal limits. There is no definite increased T2 signal within the cervical spinal cord. Additional findings are given on a segmental basis as below: C2-C3: Trace anterolisthesis of C2 over C3 which does not result in significant spinal canal stenosis or neural foraminal narrowing. C3-C4: There is a small posterior disc/osteophyte complex without spinal cord stenosis. Bilateral uncovertebral degenerative change results in mild bilateral neural foraminal narrowing. C4-C5: There is a posterior disc/osteophyte complex which does not result in significant spinal canal stenosis. Bilateral uncovertebral degenerative changes worse in the left with mild left neural foraminal narrowing. C5-C6: There is a posterior disc/osteophyte complex which results in mild spinal canal stenosis at this level. There is advanced facet arthropathy and uncovertebral degenerative change with resultant severe right and moderate left neural foraminal narrowing. There is minimal cord compression. C6-C7: A posterior disc/osteophyte complex is present which results in mild spinal canal stenosis. There is advanced facet arthropathy and uncovertebral degenerative change with resultant moderate bilateral neural foraminal narrowing. C7-T1: No spinal canal stenosis or appreciable neural foraminal narrowing. The paraspinal soft tissues are within normal limits. Appropriate flow voids are identified. The prespinal soft tissues are unremarkable. CONCLUSION: 1. Multilevel degenerative changes with mild spinal canal stenosis at C5-C6 and C6-C7. 2. Neural foraminal narrowing at multiple levels 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: There is trace anterolisthesis of C2 over C3 with slight decrease of the normal lordotic curvature of the cervical spine. There is no abnormal marrow signal change. The visualized posterior fossa structures are within normal limits. There is no definite increased T2 signal within the cervical spinal cord. Additional findings are given on a segmental basis as below: C2-C3: Trace anterolisthesis of C2 over C3 which does not result in significant spinal canal stenosis or neural foraminal narrowing. C3-C4: There is a small posterior disc/osteophyte complex without spinal cord stenosis. Bilateral uncovertebral degenerative change results in mild bilateral neural foraminal narrowing. C4-C5: There is a posterior disc/osteophyte complex which does not result in significant spinal canal stenosis. Bilateral uncovertebral degenerative changes worse in the left with mild left neural foraminal narrowing. C5-C6: There is a posterior disc/osteophyte complex which results in mild spinal canal stenosis at this level. There is advanced facet arthropathy and uncovertebral degenerative change with resultant severe right and moderate left neural foraminal narrowing. There is minimal cord compression. C6-C7: A posterior disc/osteophyte complex is present which results in mild spinal canal stenosis. There is advanced facet arthropathy and uncovertebral degenerative change with resultant moderate bilateral neural foraminal narrowing. C7-T1: No spinal canal stenosis or appreciable neural foraminal narrowing. The paraspinal soft tissues are within normal limits. Appropriate flow voids are identified. The prespinal soft tissues are unremarkable.
Findings: Bilateral intracranial ICAs, ACAs, MCAs, PCAs and their proximal branches show no flow-limiting stenosis there is however moderate narrowing of the right cavernous ICA secondary to atherosclerotic calcification. There is active extravasation of contrast in the left temporal lobe as well as in the subdural hemorrhage on images 635-658, series 402.
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EXAM: MULTIPARAMETRIC MRI OF THE PROSTATE W AND WO IV CONTRAST CLINICAL INDICATION: History of infertility and reported history of ejaculatory duct cyst TECHNIQUE: Multiplanar T1-, T2-, and diffusion-weighted imaging of the pelvis were performed on a 3 Tesla scanner. Axial T1-weighted images were obtained before, during, and after administration of intravenous contrast. Patient weight: 185 lbs. IV contrast: ProHance, 17 ml, per protocol. IV contrast injection rate: 2.50 ml per sec. COMPARISON: None. FINDINGS: STRUCTURED REPORT: MRI Prostate PROSTATE: Measurement: 2.9 x 3.5 x 2.8 cm; estimated volume: 15 cc Focal lesion(s): No lesions suspicious for prostate cancer. In the base of the prostate gland there is a T2 hyperintense cystic lesion that appears to communicate with the prostatic urethra. This lesion is midline and projects posteriorly in the central gland. Lesion measures 9.0 x 8.4 x 12.9 mm in AP by transverse by craniocaudal dimensions. Diffuse prostate abnormalities: None Other prostate findings: Imaged portions of the seminal vesicles and vas deferens are normal. VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. BLADDER: Within normal limits. OTHER PELVIC FINDINGS: None. Both testicles are present within the scrotum. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. Note: For more details about the Prostate Imaging-Reporting and Data System (PI-RADS) version 2.1, please visit: http://www.acr.org/Quality-Safety/Resources/PIRADS CONCLUSION: Posteriorly projecting cyst in the base of the prostate gland that appears to communicate with the prostatic urethra, likely prostatic utricle cyst. No evidence of inflammation or infection. 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: MRI Prostate PROSTATE: Measurement: 2.9 x 3.5 x 2.8 cm; estimated volume: 15 cc Focal lesion(s): No lesions suspicious for prostate cancer. In the base of the prostate gland there is a T2 hyperintense cystic lesion that appears to communicate with the prostatic urethra. This lesion is midline and projects posteriorly in the central gland. Lesion measures 9.0 x 8.4 x 12.9 mm in AP by transverse by craniocaudal dimensions. Diffuse prostate abnormalities: None Other prostate findings: Imaged portions of the seminal vesicles and vas deferens are normal. VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. BLADDER: Within normal limits. OTHER PELVIC FINDINGS: None. Both testicles are present within the scrotum. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. Note: For more details about the Prostate Imaging-Reporting and Data System (PI-RADS) version 2.1, please visit: http://www.acr.org/Quality-Safety/Resources/PIRADS
FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Scattered atelectasis. A few air cysts are noted. No consolidation or suspicious nodularity. HEART / VESSELS: Coronary calcification. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Patchy hypoattenuation in the liver on the arterial phase, not confidently seen on the venous phase. BILIARY TRACT: Diffuse moderate intrahepatic and extrahepatic biliary dilation. There is an abrupt change of the distal portion of the common bile duct. GALLBLADDER: Absent. PANCREAS: Pancreatic duct is dilated throughout its course measuring up to 8 mm. Mild pancreatic atrophy throughout the majority of the pancreas. There is a possible hypoattenuating focus in the head/uncinate process region measuring 1.4 x 0.9 cm on series 401 image 147. There is no contact with any of the major vessels in this area. The wall of the duodenum is indistinct in this region. Mild stranding in this area. SPLEEN: Normal. ADRENALS: Small left adrenal nodules. Slight nodular change along the right adrenal as well. KIDNEYS: There is a 1.1 cm partially calcified left renal artery aneurysm near the hilum on series 401 image 132. Small hypoattenuating foci in the kidneys are too small to characterize. LYMPH NODES: Prominent periportal and peripancreatic nodes as well as gastrohepatic nodes. STOMACH / SMALL BOWEL: Indistinct duodenum with adjacent stranding as described above. The remainder of the stomach and small bowel are unremarkable. COLON / APPENDIX: Colonic diverticulosis. PERITONEUM / MESENTERY: Trace infiltration. RETROPERITONEUM: Normal. VESSELS: Diffuse atherosclerosis. Left renal artery aneurysm as above. Portal vein is patent. Moderate narrowing of the celiac artery origin. URINARY BLADDER: Underdistended with mild thickening. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Minute umbilical hernia. MUSCULOSKELETAL: No destructive lesions. Degenerative changes in the spine. There is prior surgical hardware involving the spinous processes of L4 and L5.
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MR Cervical Spine wo contrast, MR Lumbar Spine wo contrast, MR Thoracic Spine wo contrast 1/20/2022 6:45 PM Clinical information: COVID Confirmed acute neurologic symptoms Spec Inst: unable to move BLEs and BUEs .br unable to feel BLEs and parts of BUEs Comparison: CT C-spine from earlier today and 1/16/2021 Technique: Unenhanced axial CT of the spine with coronal and sagittal reformats. Findings: MR cervical spine: There is a fluid collection in the anterior epidural space extending from C3 to the inferior endplate of C5. This results in severe spinal canal stenosis and compression of the cervical spinal cord at C3-C4. No cord signal abnormality is appreciated. This collection is new since the CT C-spine from 1/16/2022. Additionally there is prevertebral fluid collection extending from the clivus, inferiorly up to the level of lower endplate of C4. There is increased STIR signal within the C3, C4 and C5 vertebral bodies suggestive of marrow contusion. There is questionable discontinuity of the anterior longitudinal ligament at the level of C5 as seen on STIR image #5, series 601. Posterior longitudinal ligament and ligamentum flavum appear grossly intact. Alar ligament appears intact. MR thoracic spine: No bone marrow edema, fracture, spinal canal or neural from narrowing. MR lumbar spine: Lumbar intervertebral alignment is maintained. No acute fracture or bone marrow contusion. There is mild dextroscoliosis of the dorsal spine. Conus terminates at the level of L1. At L1-L2, there are disc desiccation changes in a symmetric disc bulge along with moderate left-sided facet hypertrophy resulting in narrowing of the left lateral recess, contacting the transiting L2 nerve root. There is mild left neural from narrowing without exiting nerve root compression. Mild to moderate facet arthropathy is seen from L3 to S1. Impression: 1. Bone marrow contusion involving C3, C4 and C5 vertebral bodies without visible fracture. There is anterior epidural fluid collection at C3-C5 resulting in severe spinal canal stenosis and compression of the cord at the level of C3-C4 without definite cord signal changes. 2. Prevertebral collection extending from the clivus to the lower endplate of C4. 3. No acute abnormality of the thoracic or lumbar spine. These results were discussed with Sarah Rayborn NP by Dr. Atif Haneef at 7:31 PM on 1/20/2022. Increased T2/STIR signal abnormality in the left greater than right paraspinal muscles of the cervical spine, suggestive of muscle strain. There is also increased signal in the region of interspinous ligament at the level of and C3-C5.
Findings: MR cervical spine: There is a fluid collection in the anterior epidural space extending from C3 to the inferior endplate of C5. This results in severe spinal canal stenosis and compression of the cervical spinal cord at C3-C4. No cord signal abnormality is appreciated. This collection is new since the CT C-spine from 1/16/2022. Additionally there is prevertebral fluid collection extending from the clivus, inferiorly up to the level of lower endplate of C4. There is increased STIR signal within the C3, C4 and C5 vertebral bodies suggestive of marrow contusion. There is questionable discontinuity of the anterior longitudinal ligament at the level of C5 as seen on STIR image #5, series 601. Posterior longitudinal ligament and ligamentum flavum appear grossly intact. Alar ligament appears intact. MR thoracic spine: No bone marrow edema, fracture, spinal canal or neural from narrowing. MR lumbar spine: Lumbar intervertebral alignment is maintained. No acute fracture or bone marrow contusion. There is mild dextroscoliosis of the dorsal spine. Conus terminates at the level of L1. At L1-L2, there are disc desiccation changes in a symmetric disc bulge along with moderate left-sided facet hypertrophy resulting in narrowing of the left lateral recess, contacting the transiting L2 nerve root. There is mild left neural from narrowing without exiting nerve root compression. Mild to moderate facet arthropathy is seen from L3 to S1.
FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Scattered atelectasis. A few air cysts are noted. No consolidation or suspicious nodularity. HEART / VESSELS: Coronary calcification. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Patchy hypoattenuation in the liver on the arterial phase, not confidently seen on the venous phase. BILIARY TRACT: Diffuse moderate intrahepatic and extrahepatic biliary dilation. There is an abrupt change of the distal portion of the common bile duct. GALLBLADDER: Absent. PANCREAS: Pancreatic duct is dilated throughout its course measuring up to 8 mm. Mild pancreatic atrophy throughout the majority of the pancreas. There is a possible hypoattenuating focus in the head/uncinate process region measuring 1.4 x 0.9 cm on series 401 image 147. There is no contact with any of the major vessels in this area. The wall of the duodenum is indistinct in this region. Mild stranding in this area. SPLEEN: Normal. ADRENALS: Small left adrenal nodules. Slight nodular change along the right adrenal as well. KIDNEYS: There is a 1.1 cm partially calcified left renal artery aneurysm near the hilum on series 401 image 132. Small hypoattenuating foci in the kidneys are too small to characterize. LYMPH NODES: Prominent periportal and peripancreatic nodes as well as gastrohepatic nodes. STOMACH / SMALL BOWEL: Indistinct duodenum with adjacent stranding as described above. The remainder of the stomach and small bowel are unremarkable. COLON / APPENDIX: Colonic diverticulosis. PERITONEUM / MESENTERY: Trace infiltration. RETROPERITONEUM: Normal. VESSELS: Diffuse atherosclerosis. Left renal artery aneurysm as above. Portal vein is patent. Moderate narrowing of the celiac artery origin. URINARY BLADDER: Underdistended with mild thickening. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Minute umbilical hernia. MUSCULOSKELETAL: No destructive lesions. Degenerative changes in the spine. There is prior surgical hardware involving the spinous processes of L4 and L5.
15,064
MR Cervical Spine wo contrast, MR Lumbar Spine wo contrast, MR Thoracic Spine wo contrast 1/20/2022 6:45 PM Clinical information: COVID Confirmed acute neurologic symptoms Spec Inst: unable to move BLEs and BUEs .br unable to feel BLEs and parts of BUEs Comparison: CT C-spine from earlier today and 1/16/2021 Technique: Unenhanced axial CT of the spine with coronal and sagittal reformats. Findings: MR cervical spine: There is a fluid collection in the anterior epidural space extending from C3 to the inferior endplate of C5. This results in severe spinal canal stenosis and compression of the cervical spinal cord at C3-C4. No cord signal abnormality is appreciated. This collection is new since the CT C-spine from 1/16/2022. Additionally there is prevertebral fluid collection extending from the clivus, inferiorly up to the level of lower endplate of C4. There is increased STIR signal within the C3, C4 and C5 vertebral bodies suggestive of marrow contusion. There is questionable discontinuity of the anterior longitudinal ligament at the level of C5 as seen on STIR image #5, series 601. Posterior longitudinal ligament and ligamentum flavum appear grossly intact. Alar ligament appears intact. MR thoracic spine: No bone marrow edema, fracture, spinal canal or neural from narrowing. MR lumbar spine: Lumbar intervertebral alignment is maintained. No acute fracture or bone marrow contusion. There is mild dextroscoliosis of the dorsal spine. Conus terminates at the level of L1. At L1-L2, there are disc desiccation changes in a symmetric disc bulge along with moderate left-sided facet hypertrophy resulting in narrowing of the left lateral recess, contacting the transiting L2 nerve root. There is mild left neural from narrowing without exiting nerve root compression. Mild to moderate facet arthropathy is seen from L3 to S1. Impression: 1. Bone marrow contusion involving C3, C4 and C5 vertebral bodies without visible fracture. There is anterior epidural fluid collection at C3-C5 resulting in severe spinal canal stenosis and compression of the cord at the level of C3-C4 without definite cord signal changes. 2. Prevertebral collection extending from the clivus to the lower endplate of C4. 3. No acute abnormality of the thoracic or lumbar spine. These results were discussed with Sarah Rayborn NP by Dr. Atif Haneef at 7:31 PM on 1/20/2022. Increased T2/STIR signal abnormality in the left greater than right paraspinal muscles of the cervical spine, suggestive of muscle strain. There is also increased signal in the region of interspinous ligament at the level of and C3-C5.
Findings: MR cervical spine: There is a fluid collection in the anterior epidural space extending from C3 to the inferior endplate of C5. This results in severe spinal canal stenosis and compression of the cervical spinal cord at C3-C4. No cord signal abnormality is appreciated. This collection is new since the CT C-spine from 1/16/2022. Additionally there is prevertebral fluid collection extending from the clivus, inferiorly up to the level of lower endplate of C4. There is increased STIR signal within the C3, C4 and C5 vertebral bodies suggestive of marrow contusion. There is questionable discontinuity of the anterior longitudinal ligament at the level of C5 as seen on STIR image #5, series 601. Posterior longitudinal ligament and ligamentum flavum appear grossly intact. Alar ligament appears intact. MR thoracic spine: No bone marrow edema, fracture, spinal canal or neural from narrowing. MR lumbar spine: Lumbar intervertebral alignment is maintained. No acute fracture or bone marrow contusion. There is mild dextroscoliosis of the dorsal spine. Conus terminates at the level of L1. At L1-L2, there are disc desiccation changes in a symmetric disc bulge along with moderate left-sided facet hypertrophy resulting in narrowing of the left lateral recess, contacting the transiting L2 nerve root. There is mild left neural from narrowing without exiting nerve root compression. Mild to moderate facet arthropathy is seen from L3 to S1.
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Normal cerebral cortical volume for patient's age. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Mild mucosal thickening of the left frontal sinus and left anterior ethmoid air cells. VESSELS: Normal noncontrast appearance of the vessels.
15,065
MR Cervical Spine wo contrast, MR Lumbar Spine wo contrast, MR Thoracic Spine wo contrast 1/20/2022 6:45 PM Clinical information: COVID Confirmed acute neurologic symptoms Spec Inst: unable to move BLEs and BUEs .br unable to feel BLEs and parts of BUEs Comparison: CT C-spine from earlier today and 1/16/2021 Technique: Unenhanced axial CT of the spine with coronal and sagittal reformats. Findings: MR cervical spine: There is a fluid collection in the anterior epidural space extending from C3 to the inferior endplate of C5. This results in severe spinal canal stenosis and compression of the cervical spinal cord at C3-C4. No cord signal abnormality is appreciated. This collection is new since the CT C-spine from 1/16/2022. Additionally there is prevertebral fluid collection extending from the clivus, inferiorly up to the level of lower endplate of C4. There is increased STIR signal within the C3, C4 and C5 vertebral bodies suggestive of marrow contusion. There is questionable discontinuity of the anterior longitudinal ligament at the level of C5 as seen on STIR image #5, series 601. Posterior longitudinal ligament and ligamentum flavum appear grossly intact. Alar ligament appears intact. MR thoracic spine: No bone marrow edema, fracture, spinal canal or neural from narrowing. MR lumbar spine: Lumbar intervertebral alignment is maintained. No acute fracture or bone marrow contusion. There is mild dextroscoliosis of the dorsal spine. Conus terminates at the level of L1. At L1-L2, there are disc desiccation changes in a symmetric disc bulge along with moderate left-sided facet hypertrophy resulting in narrowing of the left lateral recess, contacting the transiting L2 nerve root. There is mild left neural from narrowing without exiting nerve root compression. Mild to moderate facet arthropathy is seen from L3 to S1. Impression: 1. Bone marrow contusion involving C3, C4 and C5 vertebral bodies without visible fracture. There is anterior epidural fluid collection at C3-C5 resulting in severe spinal canal stenosis and compression of the cord at the level of C3-C4 without definite cord signal changes. 2. Prevertebral collection extending from the clivus to the lower endplate of C4. 3. No acute abnormality of the thoracic or lumbar spine. These results were discussed with Sarah Rayborn NP by Dr. Atif Haneef at 7:31 PM on 1/20/2022. Increased T2/STIR signal abnormality in the left greater than right paraspinal muscles of the cervical spine, suggestive of muscle strain. There is also increased signal in the region of interspinous ligament at the level of and C3-C5.
Findings: MR cervical spine: There is a fluid collection in the anterior epidural space extending from C3 to the inferior endplate of C5. This results in severe spinal canal stenosis and compression of the cervical spinal cord at C3-C4. No cord signal abnormality is appreciated. This collection is new since the CT C-spine from 1/16/2022. Additionally there is prevertebral fluid collection extending from the clivus, inferiorly up to the level of lower endplate of C4. There is increased STIR signal within the C3, C4 and C5 vertebral bodies suggestive of marrow contusion. There is questionable discontinuity of the anterior longitudinal ligament at the level of C5 as seen on STIR image #5, series 601. Posterior longitudinal ligament and ligamentum flavum appear grossly intact. Alar ligament appears intact. MR thoracic spine: No bone marrow edema, fracture, spinal canal or neural from narrowing. MR lumbar spine: Lumbar intervertebral alignment is maintained. No acute fracture or bone marrow contusion. There is mild dextroscoliosis of the dorsal spine. Conus terminates at the level of L1. At L1-L2, there are disc desiccation changes in a symmetric disc bulge along with moderate left-sided facet hypertrophy resulting in narrowing of the left lateral recess, contacting the transiting L2 nerve root. There is mild left neural from narrowing without exiting nerve root compression. Mild to moderate facet arthropathy is seen from L3 to S1.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Bilateral dependent atelectasis and subsegmental atelectasis in the right lower lobe. No pneumothorax or pleural effusion. Central airways are patent. HEART / VESSELS: Normal heart size. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Focal fatty infiltration along the falciform ligament. Otherwise normal appearance of the liver. 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 acute abnormality. Appendix is not visualized PERITONEUM / MESENTERY: No free intraperitoneal fluid or air. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: No acute fracture. Chronic deformity of the right L4 transverse process. Mild retrolisthesis of L5 on S1. Mild multilevel discogenic degenerative change of the thoracic and lumbar spine. Please separately reported same day CT thoracic and lumbar spine.
15,066
EXAM:MR Shoulder Right wo contrast CLINICAL INFORMATION:72-year-old female with right shoulder pain. COMPARISON:Right shoulder radiograph 10/8/2021. TECHNIQUE:MR Shoulder Right wo contrast STRUCTURED REPORT: MRI SHOULDERv5/23//2019 FINDINGS: BONES:No fracture, marrow replacement or suspicious focal lesion. ROTATOR CUFF: Supraspinatus:Intact. Small amount of intermediate signal within the proximal supraspinatus near its attachment (series 6 image 11), consistent with tendinosis. Infraspinatus:Normal. Subscapularis:Normal. Teres minor:Normal. LONG HEAD BICEPS TENDON: Mild tendinosis without tear. GLENOHUMERAL JOINT: Position: Normal. Articular cartilage:Mild thinning of the articular cartilage. Ligaments/Capsule:Normal. Labrum:Normal given limitations of non-arthrographic technique. BURSAE:No fluid. ACROMIAL CLAVICULAR JOINT:Osteophytes are present with capsular hypertrophy. No os acromiale. SUBACROMIAL ENCROACHMENT:None. MUSCLES:No atrophy. CONCLUSION: 1. Supraspinatus and biceps tendinopathy without tear. 2. Mild degenerative changes of the glenohumeral and acromioclavicular joints. 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: BONES:No fracture, marrow replacement or suspicious focal lesion. ROTATOR CUFF: Supraspinatus:Intact. Small amount of intermediate signal within the proximal supraspinatus near its attachment (series 6 image 11), consistent with tendinosis. Infraspinatus:Normal. Subscapularis:Normal. Teres minor:Normal. LONG HEAD BICEPS TENDON: Mild tendinosis without tear. GLENOHUMERAL JOINT: Position: Normal. Articular cartilage:Mild thinning of the articular cartilage. Ligaments/Capsule:Normal. Labrum:Normal given limitations of non-arthrographic technique. BURSAE:No fluid. ACROMIAL CLAVICULAR JOINT:Osteophytes are present with capsular hypertrophy. No os acromiale. SUBACROMIAL ENCROACHMENT:None. MUSCLES:No atrophy.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Bilateral dependent atelectasis and subsegmental atelectasis in the right lower lobe. No pneumothorax or pleural effusion. Central airways are patent. HEART / VESSELS: Normal heart size. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Focal fatty infiltration along the falciform ligament. Otherwise normal appearance of the liver. 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 acute abnormality. Appendix is not visualized PERITONEUM / MESENTERY: No free intraperitoneal fluid or air. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: No acute fracture. Chronic deformity of the right L4 transverse process. Mild retrolisthesis of L5 on S1. Mild multilevel discogenic degenerative change of the thoracic and lumbar spine. Please separately reported same day CT thoracic and lumbar spine.
15,067
MRI brain with and without Indication: Left temporal tumor resection Spec Inst: Stealth protocol Comparison: No previous similar studies are available for comparison at this time. Technique: Multiple T1 and T2-weighted MR sequence images of the brain were obtained in the sagittal axial and coronal planes pre-and post administration of intravenous contrast per departmental protocol. Patient weight: 183 lbs. IV contrast: ProHance, 18 ml, per protocol. Findings: Patient status post left-sided craniotomy for resection of left temporal mass. Expected postsurgical changes with trace extra-axial subdural convexity collection. Bifrontal pneumocephalus. Intrinsic T1 hyperintense signal and increased DWI signal suggestive of evolving blood products in the operative bed. No definite residual enhancing lesion is identified. Surrounding mild T2/FLAIR hyperintense signal is again noted overall similar in extent to the preoperative study. Impression: Expected post surgical changes from left temporal mass resection with with no evidence of residual enhancing lesion. Stable extent of surrounding nonenhancing T2/FLAIR hyperintense signal.
Findings: Patient status post left-sided craniotomy for resection of left temporal mass. Expected postsurgical changes with trace extra-axial subdural convexity collection. Bifrontal pneumocephalus. Intrinsic T1 hyperintense signal and increased DWI signal suggestive of evolving blood products in the operative bed. No definite residual enhancing lesion is identified. Surrounding mild T2/FLAIR hyperintense signal is again noted overall similar in extent to the preoperative study.
Findings: CTA neck: The visualized aortic arch appears normal. There is no evidence of traumatic aortic arch injury. There are no great vessel origin stenoses. There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. Left vertebral artery is hypoplastic in its entire course. The included major intracranial arteries appear normal. C-spine: There is reversal of normal cervical lordosis Craniocervical junction is maintained. There are no fractures. There is no prevertebral edema or other soft tissue abnormality. Multilevel discogenic, facet and uncovertebral changes, most significant at C6-C7.
15,068
MR 3D Neuro Requiring Indep Wkst, MR Diffusion Tract Imaging 1/20/2022 2:11 PM Clinical Information: Brain met, C79.31 Secondary malignant neoplasm of brain Spec Inst: DTI, tractography for visual pathways Technique: Diffusion tensor MRI scan was acquired with 60 diffusion sensitizing gradient orientations (b=0 and 1000) on 3T Siemens Prisma scanner. Fractional anisotropy and directionally encoded colormap were generated. DT tractography for the right optic radiation was produced using DynaSuite software, and results were exported to Stealth workstation. Findings/ Impression: Streamline diffusion tensor tractography mapping of the right optic radiation is provided for presurgical planning purpose.
Findings/
FINDINGS: CT THORACIC SPINE: VERTEBRA: No fracture. Moderate neural foramen narrowing at T9-T10 and T10-T11 worse on the left secondary to uncovertebral DJD. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. CT LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Facet arthropathy at L5-S1. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
15,069
MR Brain wo+w contrast HISTORY: Evaluation for encephalopathy with hypertension TECHNIQUE: Multiplanar, multisequence MRI of the brain was performed without and after intravenous contrast. Patient weight: 126 lbs. IV contrast: ProHance, 6 ml, per protocol. COMPARISON: CT of 1/20/2022 FINDINGS: INTRACRANIAL FINDINGS: There is minimal cortical based FLAIR hyper signal intensity involving the anteromedial portion of the temporal lobes and insular cortex bilaterally which can be sequela of seizure. There is a patchy FLAIR hyper signal intensity in left aspect of pons slightly more prominent since prior MRI dated 11/27/2021. There is a tiny patchy subcortical FLAIR signal intensity in the lateral portion of the right temporal lobe (series 301 image 12) The brain parenchyma appears normal without evidence for acute ischemia, hemorrhage, or mass lesion. The ventricles are normal in size. There is no abnormal extra-axial collection. The flow voids at the skull base are normal. The cerebellar tonsils are normal in position. EXTRACRANIAL FINDINGS: The orbital contents are unremarkable. The visualized paranasal sinuses and mastoid air cells are well aerated. IMPRESSION: Minimal cortical based FLAIR hyper signal intensity of the temporal lobes and insular likely sequela of seizure. Interval slight worsening of patchy FLAIR hyper signal intensity in left aspect of pons which is nonspecific finding but can be secondary to brainstem variant of PRES. A tiny focus of cortical based FLAIR hyper signal intensity of the right temporal lobe also concerning for PRES versus small subacute infarction secondary to substance abuse and vasculopathy.
FINDINGS: INTRACRANIAL FINDINGS: There is minimal cortical based FLAIR hyper signal intensity involving the anteromedial portion of the temporal lobes and insular cortex bilaterally which can be sequela of seizure. There is a patchy FLAIR hyper signal intensity in left aspect of pons slightly more prominent since prior MRI dated 11/27/2021. There is a tiny patchy subcortical FLAIR signal intensity in the lateral portion of the right temporal lobe (series 301 image 12) The brain parenchyma appears normal without evidence for acute ischemia, hemorrhage, or mass lesion. The ventricles are normal in size. There is no abnormal extra-axial collection. The flow voids at the skull base are normal. The cerebellar tonsils are normal in position. EXTRACRANIAL FINDINGS: The orbital contents are unremarkable. The visualized paranasal sinuses and mastoid air cells are well aerated.
FINDINGS: CT THORACIC SPINE: VERTEBRA: No fracture. Moderate neural foramen narrowing at T9-T10 and T10-T11 worse on the left secondary to uncovertebral DJD. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. CT LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Facet arthropathy at L5-S1. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
15,070
MR Cervical Spine wo contrast HISTORY: Cervical pain TECHNIQUE: Multiplanar, multisequence MRI of the cervical spine was performed without intravenous contrast. COMPARISON: None available. FINDINGS: ALIGNMENT: Straightening of the normal cervical lordosis. VERTEBRAE: No vertebral body compression fracture or aggressive marrow lesion. Status post anterior fusion from C5 to C7. SPINAL CORD/POSTERIOR FOSSA: Atrophic changes and T2 hyper signal intensity in cord is noted at C4-C5 in favor of myelomalacia. PARASPINAL SOFT TISSUES: Unremarkable. At C2-3, there is a small central disc osteophyte without obvious spinal canal stenosis or cord compression. Mild bilateral facet arthropathy without neural foraminal narrowing. At C3-4, mild bilateral uncovertebral joint arthropathy with a small posterior disc osteophyte with mild spinal canal stenosis. No significant neural foraminal narrowing. At C4-5, there is a large posterior disc osteophyte with moderate spinal canal stenosis and moderate cord compression as well as left lateral recess narrowing. There is moderate bilateral facet arthropathy. There is severe bilateral neural foraminal narrowing. At C5-6, small residual disc osteophyte with mild residual spinal canal stenosis and mild neural foraminal narrowing. At C6-7, small residual disc osteophyte with mild spinal canal stenosis and minimal cord indentation and mild bilateral neural foraminal narrowing. At C7-T1, there is no spinal canal or foraminal stenosis. IMPRESSION: Status post anterior fusion at C5-C7. Large posterior disc osteophyte at C4-C5 with moderate bilateral facet arthropathy are causing moderate spinal canal stenosis, moderate cord compression and severe bilateral neural foraminal stenosis at this level. Myelomalacia at this level.
FINDINGS: ALIGNMENT: Straightening of the normal cervical lordosis. VERTEBRAE: No vertebral body compression fracture or aggressive marrow lesion. Status post anterior fusion from C5 to C7. SPINAL CORD/POSTERIOR FOSSA: Atrophic changes and T2 hyper signal intensity in cord is noted at C4-C5 in favor of myelomalacia. PARASPINAL SOFT TISSUES: Unremarkable. At C2-3, there is a small central disc osteophyte without obvious spinal canal stenosis or cord compression. Mild bilateral facet arthropathy without neural foraminal narrowing. At C3-4, mild bilateral uncovertebral joint arthropathy with a small posterior disc osteophyte with mild spinal canal stenosis. No significant neural foraminal narrowing. At C4-5, there is a large posterior disc osteophyte with moderate spinal canal stenosis and moderate cord compression as well as left lateral recess narrowing. There is moderate bilateral facet arthropathy. There is severe bilateral neural foraminal narrowing. At C5-6, small residual disc osteophyte with mild residual spinal canal stenosis and mild neural foraminal narrowing. At C6-7, small residual disc osteophyte with mild spinal canal stenosis and minimal cord indentation and mild bilateral neural foraminal narrowing. At C7-T1, there is no spinal canal or foraminal stenosis.
Findings: CTA neck: The visualized aortic arch appears normal. There is no evidence of traumatic aortic arch injury. There are no great vessel origin stenoses. There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. Left vertebral artery is hypoplastic in its entire course. The included major intracranial arteries appear normal. C-spine: There is reversal of normal cervical lordosis Craniocervical junction is maintained. There are no fractures. There is no prevertebral edema or other soft tissue abnormality. Multilevel discogenic, facet and uncovertebral changes, most significant at C6-C7.
15,071
MR Thoracic Spine wo contrast HISTORY: TECHNIQUE: Multiplanar, multisequence MRI of the thoracic spine was performed without intravenous contrast. COMPARISON: None available. FINDINGS: ALIGNMENT: Normal. VERTEBRAE: There is no vertebral body compression fracture or aggressive marrow lesion. There are hemangiomas at T1, T7 and T12 vertebral bodies. SPINAL CORD: Normal in morphology and signal intensity. LEVELS: No significant degenerative changes of thoracic spine is seen. IMPRESSION: No acute pathology in thoracic spine.
FINDINGS: ALIGNMENT: Normal. VERTEBRAE: There is no vertebral body compression fracture or aggressive marrow lesion. There are hemangiomas at T1, T7 and T12 vertebral bodies. SPINAL CORD: Normal in morphology and signal intensity. LEVELS: No significant degenerative changes of thoracic spine is seen.
Findings: CT head: BRAIN PARENCHYMA: Interval enlargement of left greater than right temporal parenchymal hemorrhages with similar inferior frontal lobe parenchymal hemorrhages. For example the 5.6 x 4.2 x 4.4 cm multiloculated left temporal hematoma previously measured 1.1 cm. EXTRA-AXIAL SPACES: Interval increase in subarachnoid hemorrhage throughout the cerebrum, predominantly the frontotemporal regions. Bilateral cerebral convexity mixed density extra-axial hemorrhage is noted. The left subdural hemorrhage has increased near the vertex and along the left parietal convexity (coronal image 60). SKULL AND SKULL BASE: No acute fracture. Left posterior scalp hematoma with overlying staples. VENTRICULAR SYSTEM: Unchanged layering hemorrhage in the occipital horns. No hydrocephalus. Focal hemorrhage in the genu of the corpus callosum protruding into left lateral ventricle frontal horn is unchanged. There is no midline shift. ORBITS: Bilateral pseudophakia. SINUSES: Normal.
15,072
EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: 46-year-old female undergoing pretransplant evaluation. COMPARISON: MR abdomen with MRCP 1/17/2022 TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 264 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: Small right pleural effusion with redemonstration of a peripheral wedge-shaped signal abnormality in the right lower lobe, better appreciated on recent chest CT. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhosis. No suspicious lesion identified, though evaluation is markedly limited secondary to patient motion. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Enlarged, stable. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Conventional hepatic arterial anatomy noted, though evaluation is limited given motion artifact. Gastroesophageal varices. Splenorenal varices also noted. Normal caliber abdominal aorta. BODY WALL: Diffuse anasarca. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Markedly limited examination secondary to patient motion. Liver is cirrhotic without definite suspicious lesion. If clinically indicated, consider further evaluation with liver CT protocol. 2. Splenomegaly with portosystemic collateralization including gastroesophageal varices. 3. Right pleural effusion with partial visualization of abnormal wedge-shaped region in the posterior right lower lobe, better seen on recently obtained chest CT.
FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: Small right pleural effusion with redemonstration of a peripheral wedge-shaped signal abnormality in the right lower lobe, better appreciated on recent chest CT. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhosis. No suspicious lesion identified, though evaluation is markedly limited secondary to patient motion. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Enlarged, stable. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Conventional hepatic arterial anatomy noted, though evaluation is limited given motion artifact. Gastroesophageal varices. Splenorenal varices also noted. Normal caliber abdominal aorta. BODY WALL: Diffuse anasarca. MUSCULOSKELETAL: No significant abnormality.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Patchy groundglass opacities at the left base. DISTAL ESOPHAGUS: Mild distal esophageal wall thickening which can be seen with reflux. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Mild intrahepatic and extrahepatic biliary ductal dilatation likely related to cholecystectomy. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Multiple bilateral simple renal cysts. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Mural lipoma involving the cecum. The appendix is not definitively identified. Mild colonic wall thickening involving the proximal transverse colon which may be related to underdistention. No significant associated stranding PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Large left iliac vein DVT. Thrombus is also noted within the bilateral femoral veins. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is absent. No adnexal mass. BODY WALL: Moderate stranding and soft tissue gas is noted extensively throughout the tissues overlying the left gluteal region. No significant associated walled off fluid collection is no significant extension to involve the proximal lower extremities. Multifocal regions of soft tissue gas to extend to closely abut the posterior aspect of the left iliac bone with questionable subtle cortical irregularity at this region. There is also inferior extension nearing the superior aspect of the gluteal cleft. No significant intramuscular component is identified. MUSCULOSKELETAL: Subtle cortical irregularity at the posterior aspect of the left iliac bone closely abutting the previously described regions of soft tissue gas. Advanced lower lumbar spine discogenic degenerative change with lower lumbar spine facet arthropathy. Grade 1 anterolisthesis of L4 on L5.
15,073
MRI brain with and without Indication: Sp brain mass excision Comparison: Preoperative MRI 1/19/2022 Technique: Multiple T1 and T2-weighted MR sequence images of the brain were obtained in the sagittal axial and coronal planes pre-and post administration of intravenous contrast per departmental protocol. Patient weight: 240 lbs. IV contrast: ProHance, 20 ml, per protocol. Findings: Postsurgical changes are seen with right parietal craniotomy and resection of the right parietal mass. Expected postsurgical changes with hemorrhage in the resection cavity. A small 4 mm nodular focus of enhancement is seen anterior-inferior margin of the resection cavity (series 901 image 130. Similar appearance of the surrounding nonenhancing T2/FLAIR hyperintense signal in the subcortical and deep parietal white matter with extension across the corpus callosum. The regular enhancing focus in the right medial temporal lobe with necrosis measures 10 x 9 mm in axial plane, unchanged. Additional nodular focus of enhancement measuring about 4 mm seen more medially. A 2 mm nodular focus of enhancement in the anterior limb of internal capsule and right side (series 901 image 112. Additional nodular focus of enhancement in the right posterior temporal lobe white matter (series 901 image 96). Nonenhancing T2/FLAIR hyperintense signal is again seen in the right posterior limb of internal capsule and extends into the brain stem. There is no evidence of acute infarct. Remaining findings are unchanged. Impression: 1. Expected postsurgical changes from right parietal lobe mass resection. 2. Multiple enhancing lesions and non enhancing T2/ FLAIR white matter signal abnormality as described. 3. This scan can serve as a baseline for future comparisons.
Findings: Postsurgical changes are seen with right parietal craniotomy and resection of the right parietal mass. Expected postsurgical changes with hemorrhage in the resection cavity. A small 4 mm nodular focus of enhancement is seen anterior-inferior margin of the resection cavity (series 901 image 130. Similar appearance of the surrounding nonenhancing T2/FLAIR hyperintense signal in the subcortical and deep parietal white matter with extension across the corpus callosum. The regular enhancing focus in the right medial temporal lobe with necrosis measures 10 x 9 mm in axial plane, unchanged. Additional nodular focus of enhancement measuring about 4 mm seen more medially. A 2 mm nodular focus of enhancement in the anterior limb of internal capsule and right side (series 901 image 112. Additional nodular focus of enhancement in the right posterior temporal lobe white matter (series 901 image 96). Nonenhancing T2/FLAIR hyperintense signal is again seen in the right posterior limb of internal capsule and extends into the brain stem. There is no evidence of acute infarct. Remaining findings are unchanged.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Postsurgical changes of bilateral lung transplant. Stent is noted within the right middle lobe bronchus. Right lower lobe peribronchial wall thickening and atelectasis. There is also mild septal thickening and increased attenuation at the left base. The small bilateral left greater than right pleural effusions. The right hemidiaphragm is asymmetrically elevated. HEART / VESSELS: Right approach central venous catheter distal tip terminates in the right atrium. Atherosclerotic disease of the coronary arteries. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. Hyperdense mediastinal lymph nodes are again seen. CHEST WALL: Postsurgical changes of clamshell sternotomy and anterior chest wall. 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: Appropriately positioned gastrojejunostomy tube with the distal tip terminating in the proximal jejunum. Stomach and small bowel are unremarkable. COLON / APPENDIX: Colonic diverticulosis. The appendix and colon are otherwise unremarkable. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered vascular calcifications. Otherwise unremarkable for noncontrast technique. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Unremarkable. MUSCULOSKELETAL: No significant abnormality.
15,074
MR Brain wo+w contrast HISTORY: Covid infection evaluation for stroke TECHNIQUE: Multiplanar, multisequence MRI of the brain was performed without and after intravenous contrast. Patient weight: 235 lbs. IV contrast: ProHance, 20 ml, per protocol. COMPARISON: CT of 1/19/2022 FINDINGS: INTRACRANIAL FINDINGS: There are multiple congested, tortuous and prominent vasculature within the left temporal lobe. It appears that these vessels are partially feeding by branches of the left MCA with venous drainage to the cortical veins and prominent left-sided vein of Rosenthal. Also, the left middle meningeal artery is prominent and appears to participate to the abnormal vasculature. This finding would be in favor of an AV fistula involving the left temporal lobe. There are scattered foci of microhemorrhages within the left temporal lobe as well. These pathology should be better evaluated by DSA angiogram. There are tiny linear signal void intensity within the left sigmoid sinus as well which can be a small component of AV fistula at this location. There is significant cortical swelling with T2 and FLAIR hyper signal intensity involving the entire left temporal lobe with involvement of the entire left hippocampus also with diffusion restriction. T2 and FLAIR hyper signal intensity with diffusion restriction is noted involving the dorsomedial portion of the left thalamus. There is a small parenchymal hemorrhage with moderate associated edema in the anterior inferior portion of the right frontal lobe (Orbital gyrus). The ventricles are normal in size. There is no abnormal extra-axial collection. The flow voids at the skull base are normal. The cerebellar tonsils are normal in position. EXTRACRANIAL FINDINGS: The orbital contents are unremarkable. Mild mucosal thickening of ethmoidal sinuses is in favor of inflammation. IMPRESSION: Multiple congested tortuous vascularity within the left temporal lobe which are likely partially fed by a prominent left middle meningeal artery. This finding would be in favor of the vascular pathology of the left temporal lobe including dural AV fistula. Abnormal signal intensity and swelling involving the left temporal lobe, left hippocampus and left dorsomedial thalamus likely secondary to recent seizure. Given the fact that the left temporal lobe is the location of the vascular pathology encephalitis is considered to be less likely however COVID encephalitis and HSV encephalitis should be excluded clinically. The other possibility would be venous congestion of the left temporal lobe however given the acute onset symptoms sequela of seizure would be the most likely possibility. A small focus of parenchymal hemorrhage in the anterior inferior portion of the right frontal lobe with mild associated edema in favor of recent small hematoma likely secondary to Covid infection.
FINDINGS: INTRACRANIAL FINDINGS: There are multiple congested, tortuous and prominent vasculature within the left temporal lobe. It appears that these vessels are partially feeding by branches of the left MCA with venous drainage to the cortical veins and prominent left-sided vein of Rosenthal. Also, the left middle meningeal artery is prominent and appears to participate to the abnormal vasculature. This finding would be in favor of an AV fistula involving the left temporal lobe. There are scattered foci of microhemorrhages within the left temporal lobe as well. These pathology should be better evaluated by DSA angiogram. There are tiny linear signal void intensity within the left sigmoid sinus as well which can be a small component of AV fistula at this location. There is significant cortical swelling with T2 and FLAIR hyper signal intensity involving the entire left temporal lobe with involvement of the entire left hippocampus also with diffusion restriction. T2 and FLAIR hyper signal intensity with diffusion restriction is noted involving the dorsomedial portion of the left thalamus. There is a small parenchymal hemorrhage with moderate associated edema in the anterior inferior portion of the right frontal lobe (Orbital gyrus). The ventricles are normal in size. There is no abnormal extra-axial collection. The flow voids at the skull base are normal. The cerebellar tonsils are normal in position. EXTRACRANIAL FINDINGS: The orbital contents are unremarkable. Mild mucosal thickening of ethmoidal sinuses is in favor of inflammation.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Postsurgical changes of bilateral lung transplant. Stent is noted within the right middle lobe bronchus. Right lower lobe peribronchial wall thickening and atelectasis. There is also mild septal thickening and increased attenuation at the left base. The small bilateral left greater than right pleural effusions. The right hemidiaphragm is asymmetrically elevated. HEART / VESSELS: Right approach central venous catheter distal tip terminates in the right atrium. Atherosclerotic disease of the coronary arteries. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. Hyperdense mediastinal lymph nodes are again seen. CHEST WALL: Postsurgical changes of clamshell sternotomy and anterior chest wall. 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: Appropriately positioned gastrojejunostomy tube with the distal tip terminating in the proximal jejunum. Stomach and small bowel are unremarkable. COLON / APPENDIX: Colonic diverticulosis. The appendix and colon are otherwise unremarkable. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered vascular calcifications. Otherwise unremarkable for noncontrast technique. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Unremarkable. MUSCULOSKELETAL: No significant abnormality.
15,075
MR Cervical Spine wo contrast HISTORY: Evaluation for cord injury TECHNIQUE: Multiplanar, multisequence MRI of the cervical spine was performed without intravenous contrast. COMPARISON: CT of yesterday FINDINGS: ALIGNMENT: Straightening of the normal cervical lordosis. VERTEBRAE: No vertebral body compression fracture or aggressive marrow lesion. SPINAL CORD/POSTERIOR FOSSA: Normal in morphology and signal intensity. PARASPINAL SOFT TISSUES: Unremarkable. T2 hyper signal intensity is noted within the right-sided transverse and alar ligaments in the right C1-C2 articulation in association with mild soft tissue edema at this location but without definite evidence of tearing in favor of partial injury. At C2-3, there is no spinal canal or foraminal stenosis. At C3-4, there is no spinal canal or foraminal stenosis. At C4-5, there is no spinal canal or foraminal stenosis. At C5-6, there is no spinal canal or foraminal stenosis. At C6-7, there is no spinal canal or foraminal stenosis. At C7-T1, there is no spinal canal or foraminal stenosis. IMPRESSION: Partial injury of the right alar and right transverse ligaments in the right C1-C2 articulation. Otherwise unremarkable study.
FINDINGS: ALIGNMENT: Straightening of the normal cervical lordosis. VERTEBRAE: No vertebral body compression fracture or aggressive marrow lesion. SPINAL CORD/POSTERIOR FOSSA: Normal in morphology and signal intensity. PARASPINAL SOFT TISSUES: Unremarkable. T2 hyper signal intensity is noted within the right-sided transverse and alar ligaments in the right C1-C2 articulation in association with mild soft tissue edema at this location but without definite evidence of tearing in favor of partial injury. At C2-3, there is no spinal canal or foraminal stenosis. At C3-4, there is no spinal canal or foraminal stenosis. At C4-5, there is no spinal canal or foraminal stenosis. At C5-6, there is no spinal canal or foraminal stenosis. At C6-7, there is no spinal canal or foraminal stenosis. At C7-T1, there is no spinal canal or foraminal stenosis.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Unchanged right basilar nodule measuring up to 5 mm. Other smaller right lower lobe are noted. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Coronary artery calcifications. ABDOMEN and PELVIS: LIVER: Borderline cirrhotic morphology of the liver. BILIARY TRACT: Central predominant intrahepatic and extrahepatic biliary ductal dilatation, likely related to cholecystectomy. GALLBLADDER: No abnormality. PANCREAS: Redemonstrated small calcification in the pancreatic head. Interdigitated fat is noted within the pancreatic body. SPLEEN: Normal. ADRENALS: Left adrenal cyst is unchanged measuring 4.8 x 4.3 cm, previously 4.6 x 4.4 cm. Normal right adrenal gland. KIDNEYS: Scattered simple renal cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis. The appendix is not visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is absent. The ovaries are present. No adnexal mass. BODY WALL: Fat-containing umbilical hernia. MUSCULOSKELETAL: Chronic deformity of the left inferior pubic ramus. Mild multilevel discogenic degenerative change with lower lumbar spine facet arthropathy.
15,076
MR Brain wo+w contrast 1/21/2022 10:08 PM CLINICAL INFORMATION: 49 years Male concern for septic emboli Spec Inst: better characterization of right frontal lobe lesion noted on CTA, cf septic emboli, would guide consideration of future surgical management COMPARISON: CT head 1/19/2021 TECHNIQUE: Multiplanar multisequence MR images of the brain were obtained before and after the administration of intravenous contrast. Patient weight: 195 lbs. IV contrast: ProHance, 9 ml, per protocol. FINDINGS: Focal diffusion restriction in the right cerebellar hemisphere suggesting acute infarct. No other regions of diffusion restriction. There is focal blooming artifact on SWI in the right frontal lobe, corresponding to focal enhancement seen on CTA head 1/19/2022. There is mild adjacent surrounding T2/FLAIR signal hyperintensity and peripheral enhancement on postcontrast images. There is also a tiny remote left frontal microhemorrhage No other regions of parenchymal signal abnormality or abnormal intracranial enhancement. No intracranial mass. Extra-axial spaces are preserved. Septum pellucidum cavum with otherwise normal configuration of the ventricles and basal cisterns. The bilateral orbits and globes have a normal appearance. The paranasal sinuses, mastoid air cells and middle ears are clear. The soft tissues of the scalp, face and visualized skull base have a normal appearance without suspicious enhancement. CONCLUSION: 1. Right frontal lobe microhemorrhage with adjacent parenchymal enhancement, corresponding to the focal enhancement seen on the recent CTA head. Given clinical history, findings are suggestive of septic embolism. 2. Focal acute infarct in the right cerebellar hemisphere, also possibly related to embolic phenomenon. However, No associated hemorrhage or enhancement. 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: Focal diffusion restriction in the right cerebellar hemisphere suggesting acute infarct. No other regions of diffusion restriction. There is focal blooming artifact on SWI in the right frontal lobe, corresponding to focal enhancement seen on CTA head 1/19/2022. There is mild adjacent surrounding T2/FLAIR signal hyperintensity and peripheral enhancement on postcontrast images. There is also a tiny remote left frontal microhemorrhage No other regions of parenchymal signal abnormality or abnormal intracranial enhancement. No intracranial mass. Extra-axial spaces are preserved. Septum pellucidum cavum with otherwise normal configuration of the ventricles and basal cisterns. The bilateral orbits and globes have a normal appearance. The paranasal sinuses, mastoid air cells and middle ears are clear. The soft tissues of the scalp, face and visualized skull base have a normal appearance without suspicious enhancement.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Multifocal right middle lobe and bilateral lower lobe groundglass opacities. Bibasilar subsegmental atelectasis/scarring. No pleural effusion or pneumothorax. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Enlarged. Diffuse steatosis without cirrhotic morphology. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Severely enlarged and edematous. Focal area of hypoenhancement at the neck and proximal body with approximately 6.0 cm in greatest transverse width. SPLEEN: Normal. ADRENALS: Stable indeterminate 2.5 cm right adrenal nodule (series 301, image 101). The left adrenal gland is normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The colon is normal. Normal appendix. RETROPERITONEUM/PERITONEUM / MESENTERY: Extensive peripancreatic edema and small-volume mesenteric ascites. No organized peripancreatic fluid collection. VESSELS: Filling defects at the SMV/splenic vein confluence. Main portal vein is patent. No other significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus and bilateral adnexa are is surgically absent. No focal enhancing mass. BODY WALL: Tiny fat-containing periumbilical hernia. Midline ventral abdominal wall postsurgical incisional scarring. MUSCULOSKELETAL: Multilevel lower lumbar spine degenerative changes. No aggressive osseous lesion.
15,077
MR Brain wo contrast 1/22/2022 11:12 AM Clinical Information: stroke Comparison: CT head dated 1/20/2020. Technique: Sagittal T1, axial T2, FLAIR, DWI with ADC map and SWI, postcontrast axial, coronal and sagittal T1. Findings: The left MCA acute infarction involves left frontal operculum, insula cortex, and anterior and superior temporal regions. Mild mass effect exerts on the left lateral ventricle. The midline is normally preserved. There is no hemorrhagic transformation. The M1 segment of the left MCA demonstrates an intra-arterial thrombus. The left ICA appears occluded. Impression: Left MCA territory acute infarction with mild mass effect without hemorrhagic transformation.
Findings: The left MCA acute infarction involves left frontal operculum, insula cortex, and anterior and superior temporal regions. Mild mass effect exerts on the left lateral ventricle. The midline is normally preserved. There is no hemorrhagic transformation. The M1 segment of the left MCA demonstrates an intra-arterial thrombus. The left ICA appears occluded.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Mild patchy opacity at the posterior right base likely at least in part related to atelectasis as well as a likely component of secondary inflammatory change from hemoperitoneum adjacent to the right hemidiaphragm. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Compared to CT from 8/31/2021, significant interval enlargement of the previously noted heterogeneously enhancing mass arising from the inferior aspect of the right hepatic lobe now measuring 7.1 x 5.2 cm on axial series 201 image 86 (previously this lesion measured approximately 3.7 cm). Its peripheral capsule is less well-defined anteriorly and is likely ruptured with adjacent hematoma and moderate volume hemoperitoneum. Hyperdense linear focus in the center of this lesion may likely represent focus of active extravasation. Redemonstrated right lateral hepatic hemangioma. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Unchanged exophytic foci within the anterior aspect of the left kidney. Otherwise the kidneys are unremarkable. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No acute abnormality. Small amount of fluid/hemoperitoneum is noted adjacent to multiple jejunal loops. COLON / APPENDIX: The appendix is not identified. Scattered sigmoid diverticulosis. PERITONEUM / MESENTERY: Moderate volume hemoperitoneum in the deep pelvis and adjacent to the liver. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is present. BODY WALL: Fat-containing umbilical hernia. MUSCULOSKELETAL: Advanced discogenic degenerative change of the lower lumbar spine with associated lower lumbar spine facet arthropathy. Grade 1 anterolisthesis of L4 on L5 and grade 1 retrolisthesis of L2 on L3.
15,078
MR Diffusion Tract Imaging, MR 3D Neuro Requiring Indep Wkst, MR Brain wo+w contrast 1/21/2022 7:28 AM Clinical Information: Diffuse left temporal edema Spec Inst: Stealth Comparison: Outside MRI brain dated 1/20/2022. Technique: Axial T1, T2, FLAIR, SWI, DWI, sagittal T1, and dynamic susceptibility contrast PWI followed by postcontrast sagittal 3-D MPRAGE T1 fat-sat with axial and coronal reformats. Perfusion parametric mapping was provided. Diffusion tensor MRI scan was acquired with 30 diffusion sensitizing gradient orientations (b=0 and 1000) on 3T Philips Ingenia scanner. Fractional anisotropy and directionally encoded colormap were generated. DT tractography for the right corticospinal tract, cingulum and optic radiation were produced using DynaSuite software, and results were exported to Stealth workstation. Patient weight: 176 lbs. IV contrast: ProHance, 8 ml, per protocol. IV contrast injection rate: 2 ml per sec. Findings: There is an intra-axial infiltrative tumor involving the left temporal lobe, hippocampal formation and insula. Mass effects include severe effacement of the left lateral ventricle, 7 mm rightward midline shift, and uncal herniation with midbrain compression. CSF trapping in the temporal horn of the left lateral ventricle is present. The posterior inferior aspect of the peritrigonal region to the hippocampal tail show poorly demarcated contrast enhancement and microhemorrhages/microthrombi. CBV is mildly elevated in this area. The left paraspinal tract is medially displaced and the left arcuate fasciculus is superiorly displaced. Impression: 1. Left temporal/insular bulky infiltrative neoplasm with rightward midline shift, uncal herniation and left temporal horn CSF trapping. 2. Mild contrast enhancement with microhemorrhages/microthrombi and mildly elevated CBV in the posterior inferior aspect of the peritrigonal region to the hippocampal tail, concerning for IDHm astrocytoma with GBM transformation. This area may serve as the best biopsy target to yield the highest grade tissue.
Findings: There is an intra-axial infiltrative tumor involving the left temporal lobe, hippocampal formation and insula. Mass effects include severe effacement of the left lateral ventricle, 7 mm rightward midline shift, and uncal herniation with midbrain compression. CSF trapping in the temporal horn of the left lateral ventricle is present. The posterior inferior aspect of the peritrigonal region to the hippocampal tail show poorly demarcated contrast enhancement and microhemorrhages/microthrombi. CBV is mildly elevated in this area. The left paraspinal tract is medially displaced and the left arcuate fasciculus is superiorly displaced.
Findings: CT head: BRAIN PARENCHYMA: Unchanged position of left frontal approach electrode terminating in the left subthalamic nucleus. Increased edema along the electrode tract causing mild local mass effect. ` EXTRA-AXIAL SPACES: Trace subarachnoid hemorrhage posterior to the electrode. Interval decrease in pneumocephalus. SKULL AND SKULL BASE: No acute fracture. Left frontal burr hole. VENTRICULAR SYSTEM: Stable ORBITS: Bilateral pseudophakia. SINUSES: Normal.
15,079
MR Diffusion Tract Imaging, MR 3D Neuro Requiring Indep Wkst, MR Brain wo+w contrast 1/21/2022 7:28 AM Clinical Information: Diffuse left temporal edema Spec Inst: Stealth Comparison: Outside MRI brain dated 1/20/2022. Technique: Axial T1, T2, FLAIR, SWI, DWI, sagittal T1, and dynamic susceptibility contrast PWI followed by postcontrast sagittal 3-D MPRAGE T1 fat-sat with axial and coronal reformats. Perfusion parametric mapping was provided. Diffusion tensor MRI scan was acquired with 30 diffusion sensitizing gradient orientations (b=0 and 1000) on 3T Philips Ingenia scanner. Fractional anisotropy and directionally encoded colormap were generated. DT tractography for the right corticospinal tract, cingulum and optic radiation were produced using DynaSuite software, and results were exported to Stealth workstation. Patient weight: 176 lbs. IV contrast: ProHance, 8 ml, per protocol. IV contrast injection rate: 2 ml per sec. Findings: There is an intra-axial infiltrative tumor involving the left temporal lobe, hippocampal formation and insula. Mass effects include severe effacement of the left lateral ventricle, 7 mm rightward midline shift, and uncal herniation with midbrain compression. CSF trapping in the temporal horn of the left lateral ventricle is present. The posterior inferior aspect of the peritrigonal region to the hippocampal tail show poorly demarcated contrast enhancement and microhemorrhages/microthrombi. CBV is mildly elevated in this area. The left paraspinal tract is medially displaced and the left arcuate fasciculus is superiorly displaced. Impression: 1. Left temporal/insular bulky infiltrative neoplasm with rightward midline shift, uncal herniation and left temporal horn CSF trapping. 2. Mild contrast enhancement with microhemorrhages/microthrombi and mildly elevated CBV in the posterior inferior aspect of the peritrigonal region to the hippocampal tail, concerning for IDHm astrocytoma with GBM transformation. This area may serve as the best biopsy target to yield the highest grade tissue.
Findings: There is an intra-axial infiltrative tumor involving the left temporal lobe, hippocampal formation and insula. Mass effects include severe effacement of the left lateral ventricle, 7 mm rightward midline shift, and uncal herniation with midbrain compression. CSF trapping in the temporal horn of the left lateral ventricle is present. The posterior inferior aspect of the peritrigonal region to the hippocampal tail show poorly demarcated contrast enhancement and microhemorrhages/microthrombi. CBV is mildly elevated in this area. The left paraspinal tract is medially displaced and the left arcuate fasciculus is superiorly displaced.
FINDINGS: STRUCTURED REPORT: CTA CAP VASCULATURE: CORONARY ARTERIES: There are no atherosclerotic calcifications of the native coronary arteries. PULMONARY ARTERIES: No central pulmonary embolus. Normal size. ASCENDING THORACIC AORTA: No significant abnormality. AORTIC ARCH: No significant abnormality. ARCH VESSELS: No significant abnormality. 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 NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Mild inspissated secretions within the trachea. Groundglass opacity at the left base. Bilateral dependent atelectasis. Trace right pleural effusion. HEART / OTHER VESSELS: Trace pericardial effusion. MEDIASTINUM / ESOPHAGUS: Esophagus is fluid-filled. LYMPH NODES: None enlarged. CHEST WALL: Soft tissue nodule in the left anterior chest wall on axial series 501 image 36. ABDOMEN and PELVIS: LIVER: Nodular/masslike regions of hypoattenuation with innumerable foci of arterial hyperenhancement in a distribution that appears peripheral, nodular, and discontinuous, most pronounced within the anterior liver. The largest most distinct of these nodular masses measures approximately 9.0 x 7.3 cm on axial series 501 image 200. The liver is enlarged. BILIARY TRACT: Normal. GALLBLADDER: Collapsed. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix and colon are unremarkable. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: Unremarkable for technique. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Fat-containing umbilical hernia. MUSCULOSKELETAL: Advanced multilevel discogenic degenerative change most pronounced in the lower lumbar spine with associated lower lumbar spine facet arthropathy. Subtle irregularity at the anterior aspect of the superior endplate of the T12 vertebral body is age-indeterminate. Similar-appearing superior endplate irregularities involving the sixth, seventh, and eighth thoracic vertebral bodies.
15,080
MR Diffusion Tract Imaging, MR 3D Neuro Requiring Indep Wkst, MR Brain wo+w contrast 1/21/2022 7:28 AM Clinical Information: Diffuse left temporal edema Spec Inst: Stealth Comparison: Outside MRI brain dated 1/20/2022. Technique: Axial T1, T2, FLAIR, SWI, DWI, sagittal T1, and dynamic susceptibility contrast PWI followed by postcontrast sagittal 3-D MPRAGE T1 fat-sat with axial and coronal reformats. Perfusion parametric mapping was provided. Diffusion tensor MRI scan was acquired with 30 diffusion sensitizing gradient orientations (b=0 and 1000) on 3T Philips Ingenia scanner. Fractional anisotropy and directionally encoded colormap were generated. DT tractography for the right corticospinal tract, cingulum and optic radiation were produced using DynaSuite software, and results were exported to Stealth workstation. Patient weight: 176 lbs. IV contrast: ProHance, 8 ml, per protocol. IV contrast injection rate: 2 ml per sec. Findings: There is an intra-axial infiltrative tumor involving the left temporal lobe, hippocampal formation and insula. Mass effects include severe effacement of the left lateral ventricle, 7 mm rightward midline shift, and uncal herniation with midbrain compression. CSF trapping in the temporal horn of the left lateral ventricle is present. The posterior inferior aspect of the peritrigonal region to the hippocampal tail show poorly demarcated contrast enhancement and microhemorrhages/microthrombi. CBV is mildly elevated in this area. The left paraspinal tract is medially displaced and the left arcuate fasciculus is superiorly displaced. Impression: 1. Left temporal/insular bulky infiltrative neoplasm with rightward midline shift, uncal herniation and left temporal horn CSF trapping. 2. Mild contrast enhancement with microhemorrhages/microthrombi and mildly elevated CBV in the posterior inferior aspect of the peritrigonal region to the hippocampal tail, concerning for IDHm astrocytoma with GBM transformation. This area may serve as the best biopsy target to yield the highest grade tissue.
Findings: There is an intra-axial infiltrative tumor involving the left temporal lobe, hippocampal formation and insula. Mass effects include severe effacement of the left lateral ventricle, 7 mm rightward midline shift, and uncal herniation with midbrain compression. CSF trapping in the temporal horn of the left lateral ventricle is present. The posterior inferior aspect of the peritrigonal region to the hippocampal tail show poorly demarcated contrast enhancement and microhemorrhages/microthrombi. CBV is mildly elevated in this area. The left paraspinal tract is medially displaced and the left arcuate fasciculus is superiorly displaced.
FINDINGS: STRUCTURED REPORT: CTA CAP VASCULATURE: CORONARY ARTERIES: There are no atherosclerotic calcifications of the native coronary arteries. PULMONARY ARTERIES: No central pulmonary embolus. Normal size. ASCENDING THORACIC AORTA: No significant abnormality. AORTIC ARCH: No significant abnormality. ARCH VESSELS: No significant abnormality. 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 NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Mild inspissated secretions within the trachea. Groundglass opacity at the left base. Bilateral dependent atelectasis. Trace right pleural effusion. HEART / OTHER VESSELS: Trace pericardial effusion. MEDIASTINUM / ESOPHAGUS: Esophagus is fluid-filled. LYMPH NODES: None enlarged. CHEST WALL: Soft tissue nodule in the left anterior chest wall on axial series 501 image 36. ABDOMEN and PELVIS: LIVER: Nodular/masslike regions of hypoattenuation with innumerable foci of arterial hyperenhancement in a distribution that appears peripheral, nodular, and discontinuous, most pronounced within the anterior liver. The largest most distinct of these nodular masses measures approximately 9.0 x 7.3 cm on axial series 501 image 200. The liver is enlarged. BILIARY TRACT: Normal. GALLBLADDER: Collapsed. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix and colon are unremarkable. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: Unremarkable for technique. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Fat-containing umbilical hernia. MUSCULOSKELETAL: Advanced multilevel discogenic degenerative change most pronounced in the lower lumbar spine with associated lower lumbar spine facet arthropathy. Subtle irregularity at the anterior aspect of the superior endplate of the T12 vertebral body is age-indeterminate. Similar-appearing superior endplate irregularities involving the sixth, seventh, and eighth thoracic vertebral bodies.
15,081
MR Brain wo+w contrast, MR Cervical Spine wo+w contrast 1/21/2022 5:26 PM CLINICAL INFORMATION: 43 years Male Horner s syndrome COMPARISON: CTA head and neck from same day TECHNIQUE: Multiplanar multisequence MR images of the brain and cervical spine were obtained before and after the administration of intravenous contrast. Patient weight: 200 lbs. IV contrast: ProHance, 20 ml, per protocol. FINDINGS: MRI BRAIN: There is no acute infarction, intracranial hemorrhage, brain edema or mass effect. Scattered nonspecific subcortical white matter T2/FLAIR signal hyperintense foci. No abnormal intracranial enhancement seen on postcontrast images. The ventricular system has a normal configuration. There is no abnormal extra-axial collection. The bilateral orbits and globes have a normal appearance. Mild mucosal thickening in the right maxillary sinus. The remaining paranasal sinuses, mastoid air cells and middle ears are clear. The soft tissues of the scalp, face and visualized skull base have a normal appearance. MRI C-S{INE: ALIGNMENT: Reversal of the cervical lordosis is noted centered at C5-6, without subluxations. VERTEBRAE: Vertebral body marrow signal is normal, without evidence of abnormal enhancement. There is no vertebral body compression fracture. INTERVERTEBRAL DISC SPACES: Diffuse disc desiccation is noted from decreased T2-weighted signal, with associated mild C5-C6 disc height loss. There is mild diffuse circumferential disc bulge at C5-C6, with right subarticular protrusion, resulting in effacement of the right lateral recess and minimal right neural foraminal narrowing. Otherwise, there is no significant spinal canal or neural foraminal narrowing in the cervical spine. SPINAL CORD: Cord demonstrates normal signal intensity without suspicious enhancement. PARASPINAL AND CERVICAL SOFT TISSUES: No significant abnormality or pathologic enhancement. IMPRESSION: 1. No acute intracranial process or abnormal enhancement identified. 2. Scattered nonspecific subcortical white matter long TR hyperintense signal foci, may represent sequela of chronic migraine headaches, demyelination or vasculitis, given patient's demographics. 3. No evidence of acute findings, pathologic enhancement or abnormal spinal cord signal in the cervical spine. 4. Chronic degenerative disc disease centered at C5-C6, resulting in effacement of the right lateral recess and minimal right neuroforaminal 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: MRI BRAIN: There is no acute infarction, intracranial hemorrhage, brain edema or mass effect. Scattered nonspecific subcortical white matter T2/FLAIR signal hyperintense foci. No abnormal intracranial enhancement seen on postcontrast images. The ventricular system has a normal configuration. There is no abnormal extra-axial collection. The bilateral orbits and globes have a normal appearance. Mild mucosal thickening in the right maxillary sinus. The remaining paranasal sinuses, mastoid air cells and middle ears are clear. The soft tissues of the scalp, face and visualized skull base have a normal appearance. MRI C-S{INE: ALIGNMENT: Reversal of the cervical lordosis is noted centered at C5-6, without subluxations. VERTEBRAE: Vertebral body marrow signal is normal, without evidence of abnormal enhancement. There is no vertebral body compression fracture. INTERVERTEBRAL DISC SPACES: Diffuse disc desiccation is noted from decreased T2-weighted signal, with associated mild C5-C6 disc height loss. There is mild diffuse circumferential disc bulge at C5-C6, with right subarticular protrusion, resulting in effacement of the right lateral recess and minimal right neural foraminal narrowing. Otherwise, there is no significant spinal canal or neural foraminal narrowing in the cervical spine. SPINAL CORD: Cord demonstrates normal signal intensity without suspicious enhancement. PARASPINAL AND CERVICAL SOFT TISSUES: No significant abnormality or pathologic enhancement.
FINDINGS: FACIAL BONES: Acute, comminuted and displaced fractures of the right lamina papyracea with displaced fracture fragments in the right ethmoid air cells. Pterygoid plates are intact. MANDIBLE: No fracture. Bilateral temporomandibular joints are intact. REMAINING VISUALIZED BONES: Normal. SINONASAL CAVITIES: Small amount of intrasinus hemorrhage in the right ethmoid air cells. Mild mucosal thickening of the right maxillary, bilateral sphenoid, and left frontal sinuses. VISUALIZED INTRACRANIAL STRUCTURES: Normal. ORBITAL CONTENTS: Right lamina papyracea fractures as above. Herniation of extraocular fat through the fracture site. Minimal herniation of the medial rectus muscle without muscle thickening. Globes are intact. Right infraorbital contusion.
15,082
MR Brain wo+w contrast, MR Cervical Spine wo+w contrast 1/21/2022 5:26 PM CLINICAL INFORMATION: 43 years Male Horner s syndrome COMPARISON: CTA head and neck from same day TECHNIQUE: Multiplanar multisequence MR images of the brain and cervical spine were obtained before and after the administration of intravenous contrast. Patient weight: 200 lbs. IV contrast: ProHance, 20 ml, per protocol. FINDINGS: MRI BRAIN: There is no acute infarction, intracranial hemorrhage, brain edema or mass effect. Scattered nonspecific subcortical white matter T2/FLAIR signal hyperintense foci. No abnormal intracranial enhancement seen on postcontrast images. The ventricular system has a normal configuration. There is no abnormal extra-axial collection. The bilateral orbits and globes have a normal appearance. Mild mucosal thickening in the right maxillary sinus. The remaining paranasal sinuses, mastoid air cells and middle ears are clear. The soft tissues of the scalp, face and visualized skull base have a normal appearance. MRI C-S{INE: ALIGNMENT: Reversal of the cervical lordosis is noted centered at C5-6, without subluxations. VERTEBRAE: Vertebral body marrow signal is normal, without evidence of abnormal enhancement. There is no vertebral body compression fracture. INTERVERTEBRAL DISC SPACES: Diffuse disc desiccation is noted from decreased T2-weighted signal, with associated mild C5-C6 disc height loss. There is mild diffuse circumferential disc bulge at C5-C6, with right subarticular protrusion, resulting in effacement of the right lateral recess and minimal right neural foraminal narrowing. Otherwise, there is no significant spinal canal or neural foraminal narrowing in the cervical spine. SPINAL CORD: Cord demonstrates normal signal intensity without suspicious enhancement. PARASPINAL AND CERVICAL SOFT TISSUES: No significant abnormality or pathologic enhancement. IMPRESSION: 1. No acute intracranial process or abnormal enhancement identified. 2. Scattered nonspecific subcortical white matter long TR hyperintense signal foci, may represent sequela of chronic migraine headaches, demyelination or vasculitis, given patient's demographics. 3. No evidence of acute findings, pathologic enhancement or abnormal spinal cord signal in the cervical spine. 4. Chronic degenerative disc disease centered at C5-C6, resulting in effacement of the right lateral recess and minimal right neuroforaminal 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: MRI BRAIN: There is no acute infarction, intracranial hemorrhage, brain edema or mass effect. Scattered nonspecific subcortical white matter T2/FLAIR signal hyperintense foci. No abnormal intracranial enhancement seen on postcontrast images. The ventricular system has a normal configuration. There is no abnormal extra-axial collection. The bilateral orbits and globes have a normal appearance. Mild mucosal thickening in the right maxillary sinus. The remaining paranasal sinuses, mastoid air cells and middle ears are clear. The soft tissues of the scalp, face and visualized skull base have a normal appearance. MRI C-S{INE: ALIGNMENT: Reversal of the cervical lordosis is noted centered at C5-6, without subluxations. VERTEBRAE: Vertebral body marrow signal is normal, without evidence of abnormal enhancement. There is no vertebral body compression fracture. INTERVERTEBRAL DISC SPACES: Diffuse disc desiccation is noted from decreased T2-weighted signal, with associated mild C5-C6 disc height loss. There is mild diffuse circumferential disc bulge at C5-C6, with right subarticular protrusion, resulting in effacement of the right lateral recess and minimal right neural foraminal narrowing. Otherwise, there is no significant spinal canal or neural foraminal narrowing in the cervical spine. SPINAL CORD: Cord demonstrates normal signal intensity without suspicious enhancement. PARASPINAL AND CERVICAL SOFT TISSUES: No significant abnormality or pathologic enhancement.
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: Stable appearance of the transplant liver. Normal in size and morphology. No focal lesions visualized although evaluation is limited on this unenhanced exam. BILIARY TRACT: Dilation of the common bile duct with tapering to normal caliber distally overall similar to the comparison MRI and likely related to prior cholecystectomy. GALLBLADDER: Surgically absent. PANCREAS: Normal unenhanced appearance. SPLEEN: Stable marked splenomegaly measuring approximately 19 cm in craniocaudal dimension. ADRENALS: Normal. KIDNEYS: Normal unenhanced appearance of the kidneys. No hydronephrosis or nephrolithiasis. Left ureteral stent in stable satisfactory position. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach is unremarkable. Oral contrast is present within nondilated small bowel loops. Stable appearance of right lower quadrant and ileostomy. No evidence of bowel obstruction. COLON / APPENDIX: Status post proctocolectomy. Irregular stranding in the presacral space is similar to prior with slight interval decrease in small hypoattenuating fluid collection now measuring approximately 2.5 x 1.9 cm, previously 3.2 x 2.2 cm. PERITONEUM / MESENTERY: No free intraperitoneal air or new fluid collection. Embolization coils again noted in the right lower quadrant mesentery. RETROPERITONEUM: Normal. VESSELS: Limited evaluation on this unenhanced exam. Dilation of the main portal vein measuring 1.8 cm similar to prior. URINARY BLADDER: Stable positioning of left ureteral stent entering near the dome of the bladder suggesting prior ureteral reimplantation. Focal irregularity at the posterior left bladder wall unchanged from prior. REPRODUCTIVE ORGANS: Uterus is unremarkable. No suspicious adnexal lesions. BODY WALL: Healed midline laparotomy incision. Stable appearance of right lower quadrant end ileostomy. MUSCULOSKELETAL: No significant abnormality.
15,083
MR Brain wo contrast 1/23/2022 4:55 AM CLINICAL iNFORMATION: 64 years Male stroke COMPARISON: CT head 1/22/2021 TECHNIQUE: Multiplanar multisequence MR images of the brain were obtained without administration of intravenous contrast. FINDINGS: Multiple sequences are degraded by motion. Multifocal diffusion restriction in the right frontal parietal and temporal lobes with involvement of both the insula and the operculum. Additional focus of diffusion restriction in the right thalamus, with corresponding T2/FLAIR signal hyperintensity. There are additional scattered foci of periventricular and subcortical white matter T2/flair signal hyperintensities involving the bilateral cerebral hemispheres, suggesting moderate chronic microangiopathic ischemic disease. No intracranial hemorrhage or mass effect. Ventricular system and basal cisterns have a normal configuration. Extra-axial spaces are preserved. The right ICA flow void within the skull base is abnormal Orbits and globes are unremarkable. Visualized paranasal sinuses, middle ears and mastoid air cells are clear. The visualized soft tissues of the scalp, face and skull base are unremarkable. CONCLUSION: 1. Mildly limited evaluation due to patient motion. Evolving right MCA infarction involving the right frontal and temporal lobes.. No intracranial hemorrhage or hydrocephalus. 2. Additional tiny acute infarctions within the right basal ganglia and thalamus also without hemorrhagic conversion. 3. Abnormal right ICA flow void within the skull base indicating either occlusion or slow flow. Flow is demonstrated within the proximal right MCA on basis of spin echo images. There is flow within the distal right ACA. Right A1 segment does not appear developed. 4. Periventricular and subcortical white matter hyperintensities are nonspecific, but suggestive of moderate chronic microangiopathic ischemic changes. 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: Multiple sequences are degraded by motion. Multifocal diffusion restriction in the right frontal parietal and temporal lobes with involvement of both the insula and the operculum. Additional focus of diffusion restriction in the right thalamus, with corresponding T2/FLAIR signal hyperintensity. There are additional scattered foci of periventricular and subcortical white matter T2/flair signal hyperintensities involving the bilateral cerebral hemispheres, suggesting moderate chronic microangiopathic ischemic disease. No intracranial hemorrhage or mass effect. Ventricular system and basal cisterns have a normal configuration. Extra-axial spaces are preserved. The right ICA flow void within the skull base is abnormal Orbits and globes are unremarkable. Visualized paranasal sinuses, middle ears and mastoid air cells are clear. The visualized soft tissues of the scalp, face and skull base are unremarkable.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Small bilateral pleural effusions, left greater than right. Bibasilar atelectasis. Tree-in-bud nodularity in the right lower lobe. Calcified granuloma in the lingula DISTAL ESOPHAGUS: Fluid-filled HEART / VESSELS: Coronary artery atherosclerosis. No other significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis PANCREAS: Extensive peripancreatic fat stranding, fluid and edema. Peripancreatic fluid collection extending caudally into the anterior and posterior pararenal spaces. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Tiny nonobstructing right renal calculus. Nonspecific perinephric stranding. LYMPH NODES: Retroperitoneal, mesenteric and bilateral iliac chain adenopathy. Presumed Calcified mesenteric lymph node the right hemiabdomen measuring 19 x 14 mm on axial image 187 STOMACH / SMALL BOWEL: Diffuse gastric and small bowel distention without transition point, overall similar in appearance compared to the prior exam. COLON / APPENDIX: Diverticulosis. Normal appendix. Significant pericolonic stranding of the proximal descending colon. PERITONEUM / MESENTERY: Small-volume ascites. No free intraperitoneal air. RETROPERITONEUM: Peripancreatic stranding as above VESSELS: Moderate to severe atherosclerotic vascular calcifications URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Subcutaneous gas in the anterior lateral abdominal wall likely secondary to injection. Mild anasarca. MUSCULOSKELETAL: No acute osseous abnormality or focal aggressive osseous lesion. Severe asymmetric degenerative changes in the right hip. Degenerative changes throughout the spine.
15,084
MR Brain wo+w contrast, MR Orbit wo+w contrast HISTORY: TECHNIQUE: Multiplanar, multisequence MRI of the brain and orbits was performed without and after intravenous contrast. COMPARISON: CT of 1/21/2022 FINDINGS: INTRACRANIAL FINDINGS: There are scattered foci of small periventricular and deep white matter FLAIR hyper signal intensity in the white matter of the bilateral cerebral hemispheres, a nonspecific finding but likely foci of mild microvascular angiopathy. The brain parenchyma appears normal without evidence for acute ischemia, hemorrhage, or mass lesion. The ventricles are normal in size. There is no abnormal extra-axial collection. The flow voids at the skull base are normal. The cerebellar tonsils are normal in position. EXTRACRANIAL FINDINGS: The orbital contents are unremarkable. Again noted the sphenoidal air cells are markedly expanded and completely opacified with T2 hyper signal secretion and mild T1 hyper signal intensity. The lateral margins of the sphenoidal air cells are also expanded. Erosion is noted involving the superior portion of the clivus and along the planum sphenoidal. Also bulging of the sphenoidal sinus opacification is noted superiorly abutting the pituitary gland. The pituitary gland itself cannot be seen separated from the expansile sinus disease. There is a focal expansion from the mentioned sphenoidal expansion toward the right cavernous sinuses with apparent mass effect over the nerves of the right cavernous sinuses. In addition there is mild compression over the right optic nerve in the right orbital apex. After contrast injection avid enhancement is noted around the mentioned expansile sphenoidal sinus which extends to the pituitary tissue. There is mild bone marrow edema and enhancement in the clivus. The pituitary stalk is deviated to the left side. The superior bulging of the expansile sphenoidal sinus is close to the chiasm but without obvious mass effect at this time. IMPRESSION: Expansile complete opacification of the sphenoidal air cells with superior extension, erosion of the planum sphenoidal, sella turcica and superior portion of clivus and close contact with the pituitary gland. A focal bulging from the expansile sphenoidal sinus to the right cavernous sinuses and right orbital apex with mass effect over the nerves of the right cavernous sinuses and the right optic nerve. Given the morphology of the lesion, findings are likely secondary to a large sphenoidal mucocele in association with peripheral osseous erosion. Mild edema and enhancement of the clivus is likely secondary to osteitis. The pituitary gland itself cannot be seen separated from the expansile sphenoidal lesion which can be secondary to inflammation of the pituitary gland. A large pituitary macroadenoma with apoplexy is considered to be less likely because the epicenter of the lesion is located in the sphenoidal sinus and also there is marked expansion of the sphenoidal sinus which would be in favor of long-lasting slowly enlarging sphenoidal lesion.
FINDINGS: INTRACRANIAL FINDINGS: There are scattered foci of small periventricular and deep white matter FLAIR hyper signal intensity in the white matter of the bilateral cerebral hemispheres, a nonspecific finding but likely foci of mild microvascular angiopathy. The brain parenchyma appears normal without evidence for acute ischemia, hemorrhage, or mass lesion. The ventricles are normal in size. There is no abnormal extra-axial collection. The flow voids at the skull base are normal. The cerebellar tonsils are normal in position. EXTRACRANIAL FINDINGS: The orbital contents are unremarkable. Again noted the sphenoidal air cells are markedly expanded and completely opacified with T2 hyper signal secretion and mild T1 hyper signal intensity. The lateral margins of the sphenoidal air cells are also expanded. Erosion is noted involving the superior portion of the clivus and along the planum sphenoidal. Also bulging of the sphenoidal sinus opacification is noted superiorly abutting the pituitary gland. The pituitary gland itself cannot be seen separated from the expansile sinus disease. There is a focal expansion from the mentioned sphenoidal expansion toward the right cavernous sinuses with apparent mass effect over the nerves of the right cavernous sinuses. In addition there is mild compression over the right optic nerve in the right orbital apex. After contrast injection avid enhancement is noted around the mentioned expansile sphenoidal sinus which extends to the pituitary tissue. There is mild bone marrow edema and enhancement in the clivus. The pituitary stalk is deviated to the left side. The superior bulging of the expansile sphenoidal sinus is close to the chiasm but without obvious mass effect at this time.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Moderate left and trace pleural effusion, increased in size from prior exam. Calcified granuloma in the right lower lobe. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Questionable filling defect in a right lower lobe subsegmental pulmonary artery branch ABDOMEN and PELVIS: LIVER: Cirrhotic morphology. No focal liver lesion. Scattered calcified granulomas. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Splenomegaly. Patchy hypoattenuation in the posterior lateral aspect of the spleen, more prominent than on prior exam ADRENALS: Normal. KIDNEYS: Kidneys are somewhat hyperdense on the noncontrast images. Punctate nonobstructing left renal calculus unchanged. No other significant abnormality. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: End ileostomy in the right lower quadrant. No convincing evidence of active GI bleed. Focally dilated loops of small bowel in the central abdomen. Mucosal hyperenhancement within the stomach. Radiopaque densities in the distal gastric body and pylorus/duodenal bulb. COLON / APPENDIX: Right hemicolectomy changes. PERITONEUM / MESENTERY: Moderate ascites thickening and enhancement of the peritoneum is again demonstrated. RETROPERITONEUM: Normal. VESSELS: Perisplenic and perigastric varices. Small splenorenal shunt. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is present. No adnexal mass. BODY WALL: Anasarca. Gynecomastia. Hyperattenuating fluid collection at the umbilicus is decrease in size in interval likely evolving hematoma.. Multiple presumed injection granuloma in the anterior abdominal wall. MUSCULOSKELETAL: No acute osseous abnormality or focal aggressive osseous lesion.
15,085
MR Brain wo+w contrast, MR Orbit wo+w contrast HISTORY: TECHNIQUE: Multiplanar, multisequence MRI of the brain and orbits was performed without and after intravenous contrast. COMPARISON: CT of 1/21/2022 FINDINGS: INTRACRANIAL FINDINGS: There are scattered foci of small periventricular and deep white matter FLAIR hyper signal intensity in the white matter of the bilateral cerebral hemispheres, a nonspecific finding but likely foci of mild microvascular angiopathy. The brain parenchyma appears normal without evidence for acute ischemia, hemorrhage, or mass lesion. The ventricles are normal in size. There is no abnormal extra-axial collection. The flow voids at the skull base are normal. The cerebellar tonsils are normal in position. EXTRACRANIAL FINDINGS: The orbital contents are unremarkable. Again noted the sphenoidal air cells are markedly expanded and completely opacified with T2 hyper signal secretion and mild T1 hyper signal intensity. The lateral margins of the sphenoidal air cells are also expanded. Erosion is noted involving the superior portion of the clivus and along the planum sphenoidal. Also bulging of the sphenoidal sinus opacification is noted superiorly abutting the pituitary gland. The pituitary gland itself cannot be seen separated from the expansile sinus disease. There is a focal expansion from the mentioned sphenoidal expansion toward the right cavernous sinuses with apparent mass effect over the nerves of the right cavernous sinuses. In addition there is mild compression over the right optic nerve in the right orbital apex. After contrast injection avid enhancement is noted around the mentioned expansile sphenoidal sinus which extends to the pituitary tissue. There is mild bone marrow edema and enhancement in the clivus. The pituitary stalk is deviated to the left side. The superior bulging of the expansile sphenoidal sinus is close to the chiasm but without obvious mass effect at this time. IMPRESSION: Expansile complete opacification of the sphenoidal air cells with superior extension, erosion of the planum sphenoidal, sella turcica and superior portion of clivus and close contact with the pituitary gland. A focal bulging from the expansile sphenoidal sinus to the right cavernous sinuses and right orbital apex with mass effect over the nerves of the right cavernous sinuses and the right optic nerve. Given the morphology of the lesion, findings are likely secondary to a large sphenoidal mucocele in association with peripheral osseous erosion. Mild edema and enhancement of the clivus is likely secondary to osteitis. The pituitary gland itself cannot be seen separated from the expansile sphenoidal lesion which can be secondary to inflammation of the pituitary gland. A large pituitary macroadenoma with apoplexy is considered to be less likely because the epicenter of the lesion is located in the sphenoidal sinus and also there is marked expansion of the sphenoidal sinus which would be in favor of long-lasting slowly enlarging sphenoidal lesion.
FINDINGS: INTRACRANIAL FINDINGS: There are scattered foci of small periventricular and deep white matter FLAIR hyper signal intensity in the white matter of the bilateral cerebral hemispheres, a nonspecific finding but likely foci of mild microvascular angiopathy. The brain parenchyma appears normal without evidence for acute ischemia, hemorrhage, or mass lesion. The ventricles are normal in size. There is no abnormal extra-axial collection. The flow voids at the skull base are normal. The cerebellar tonsils are normal in position. EXTRACRANIAL FINDINGS: The orbital contents are unremarkable. Again noted the sphenoidal air cells are markedly expanded and completely opacified with T2 hyper signal secretion and mild T1 hyper signal intensity. The lateral margins of the sphenoidal air cells are also expanded. Erosion is noted involving the superior portion of the clivus and along the planum sphenoidal. Also bulging of the sphenoidal sinus opacification is noted superiorly abutting the pituitary gland. The pituitary gland itself cannot be seen separated from the expansile sinus disease. There is a focal expansion from the mentioned sphenoidal expansion toward the right cavernous sinuses with apparent mass effect over the nerves of the right cavernous sinuses. In addition there is mild compression over the right optic nerve in the right orbital apex. After contrast injection avid enhancement is noted around the mentioned expansile sphenoidal sinus which extends to the pituitary tissue. There is mild bone marrow edema and enhancement in the clivus. The pituitary stalk is deviated to the left side. The superior bulging of the expansile sphenoidal sinus is close to the chiasm but without obvious mass effect at this time.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Scattered mild cystic change at the right base. Multiple tiny solid pulmonary nodules, bilaterally measuring up to 3 mm, unchanged from prior exam. DISTAL ESOPHAGUS: Small hiatal hernia HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. Prominent bilateral inguinal lymph nodes, unchanged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix and colon are normal aside from a scattered sigmoid diverticula. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic disease in the aorta and iliac arteries. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Redemonstrated fat-containing ventral body wall hernia with a similar-appearing internal stranding when compared to prior and small amount of stranding adjacent to the hernia sac. MUSCULOSKELETAL: No significant abnormality.
15,086
EXAM:MR Shoulder Left wo contrast CLINICAL INFORMATION:Shoulder pain COMPARISON:11/17/2021 TECHNIQUE: Multiplanar and multisequence MRI of the left shoulder was obtained without intravenous contrast. FINDINGS: BONES:No fracture, marrow replacement or suspicious focal lesion. ROTATOR CUFF: Supraspinatus:Minimal bursal surface fraying with mild tendinosis. No discrete tear. Infraspinatus:Normal. Subscapularis:Normal. Teres minor:Normal. LONG HEAD BICEPS TENDON:Normal. GLENOHUMERAL JOINT: Position:Normal. Articular cartilage:Normal. Ligaments/Capsule:Normal. Labrum:Normal given limitations of non-arthrographic technique. BURSAE:Fluid is seen within the subacromial and subdeltoid bursa. ACROMIAL CLAVICULAR JOINT:Mild capsular hypertrophy with surrounding edema. No os acromiale. SUBACROMIAL ENCROACHMENT:None. MUSCLES:No atrophy. CONCLUSION: 1. Bursal surface fraying of the supraspinatus tendon with associated tendinosis. 2. Fluid within the subacromial and subdeltoid bursa which can be seen with bursitis. 3. Inflammatory changes of the acromioclavicular joint. 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: BONES:No fracture, marrow replacement or suspicious focal lesion. ROTATOR CUFF: Supraspinatus:Minimal bursal surface fraying with mild tendinosis. No discrete tear. Infraspinatus:Normal. Subscapularis:Normal. Teres minor:Normal. LONG HEAD BICEPS TENDON:Normal. GLENOHUMERAL JOINT: Position:Normal. Articular cartilage:Normal. Ligaments/Capsule:Normal. Labrum:Normal given limitations of non-arthrographic technique. BURSAE:Fluid is seen within the subacromial and subdeltoid bursa. ACROMIAL CLAVICULAR JOINT:Mild capsular hypertrophy with surrounding edema. No os acromiale. SUBACROMIAL ENCROACHMENT:None. MUSCLES:No atrophy.
FINDINGS: CT of the head with and without contrast: Please see separately reported same day noncontrast CT head. No abnormal intracranial enhancement within limitations of arterial phase exam. CT angiogram of the brain: RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Mild focal narrowing of the proximal left P1 segment. Fetal predominant circulation of the left PCA. Unremarkable appearance of the bilateral ACAs, MCAs, and right PCA. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: 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: No soft tissue abnormality within the neck. Subtle irregular consolidation in the posterior left upper lobe most likely related atelectasis. CERVICAL SPINE: Reversal of normal cervical lordosis. Mild multilevel discogenic degenerative change. No aggressive osseous lesions. Ossification of posterior longitudinal ligament at C3-C4 with resultant mild spinal canal narrowing.
15,087
EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: Portal vein thrombus COMPARISON: MRI 7/29/2021 TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 215 lbs. IV contrast: ProHance, 10 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: STRUCTURED REPORT: MR HCC Screening IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. No steatosis. LIVER LESIONS: None LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Interval worsening in portal venous thrombus which now appears completely occlusive in the main portal vein. Interval development of occlusive thrombus within the superior mesenteric vein as well. The splenic vein is opacified with contrast in the hilum but there is thrombus in the splenic vein in the region of the confluence. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: Large (>5 mm diameter). - Other varices or collaterals: None. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: Possible small layering stones LYMPH NODES: Borderline enlarged periportal lymph nodes. SPLEEN: Enlarged with unchanged areas of infarction. There is a hematoma inferior to the spleen which has decreased in size compared to prior examination, today measuring 4.7 x 3.5 cm (previously 5.3 x 4.1 cm). PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Normal. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: T1 hyperintense focus in the superior endplate of T12 on 901 image 78. CONCLUSION: 1. Hepatic cirrhosis with sequela of portal venous hypertension. No suspicious hepatic lesion. 2. Interval worsening in portal thrombus with completely occlusive thrombus in the main portal vein. There is also interval development of occlusive thrombus in the superior mesenteric vein and splenic vein. 3. Interval decrease in hematoma inferior to the partially infarcted spleen. 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: MR HCC Screening IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. No steatosis. LIVER LESIONS: None LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Interval worsening in portal venous thrombus which now appears completely occlusive in the main portal vein. Interval development of occlusive thrombus within the superior mesenteric vein as well. The splenic vein is opacified with contrast in the hilum but there is thrombus in the splenic vein in the region of the confluence. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: Large (>5 mm diameter). - Other varices or collaterals: None. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: Possible small layering stones LYMPH NODES: Borderline enlarged periportal lymph nodes. SPLEEN: Enlarged with unchanged areas of infarction. There is a hematoma inferior to the spleen which has decreased in size compared to prior examination, today measuring 4.7 x 3.5 cm (previously 5.3 x 4.1 cm). PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Normal. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: T1 hyperintense focus in the superior endplate of T12 on 901 image 78.
FINDINGS: CT of the head with and without contrast: Please see separately reported same day noncontrast CT head. No abnormal intracranial enhancement within limitations of arterial phase exam. CT angiogram of the brain: RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Mild focal narrowing of the proximal left P1 segment. Fetal predominant circulation of the left PCA. Unremarkable appearance of the bilateral ACAs, MCAs, and right PCA. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: 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: No soft tissue abnormality within the neck. Subtle irregular consolidation in the posterior left upper lobe most likely related atelectasis. CERVICAL SPINE: Reversal of normal cervical lordosis. Mild multilevel discogenic degenerative change. No aggressive osseous lesions. Ossification of posterior longitudinal ligament at C3-C4 with resultant mild spinal canal narrowing.
15,088
MR Breast Diagnostic Bil wo+w contrast CLINICAL INFORMATION: Bilateral breast cancer diagnosed in 2020. Patient declined conventional treatment at that time and pursued low-dose chemotherapy at outside institution. Has only had PET scans in the interim. TECHNIQUE: T1 axial, FSE T2 fat sat axial, pre and post contrast vibrant sequence with 3D reconstructions and time intensity curves. Delayed post contrast sagittals. A dedicated 8 channel breast imaging coil was utilized. Patient weight: 233 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: No prior breast MRI. Contrast mammogram 10/22/2020 MRI FINDINGS: Images are limited by motion artifact. The breasts are composed of scattered fibroglandular tissue. Following contrast administration, there is minimal background enhancement. RIGHT BREAST: There is a focus of susceptibility artifact in the lower outer breast, posterior depth. This is consistent with postbiopsy clip which migrated inferiorly from the biopsy site. There is subtle focal nonmass enhancement in the 9:00 breast, posterior depth measuring 6 x 5 x 6 mm (AP x TV x CC) which appears to be at the site of known malignancy (series 403, image 71 and series 601, image 262). There is 7 x 3 x 4 mm (AP x TV x CC) of focal nonmass enhancement in the upper outer breast, posterior depth (series 403, image 93 and series 601, image 239). This appears to be medial and superior to the known malignancy. LEFT BREAST: There is clumped nonmass enhancement in a segmental distribution predominantly in the lateral breast, middle to posterior depth, involving the upper and lower outer quadrants as well as the upper inner quadrant consistent with patient's known malignancy. This measures approximately 88 x 49 x 39 mm (AP x TV x CC) on maximum intensity projection images. The enhancement measures approximately 30 mm from the chest wall. There is abnormal enhancement in the upper inner quadrant directly under the skin (series 403, image 90) but there is no evidence of skin or nipple involvement. Overall, enhancement appears similar to prior contrast mammogram on 10/22/2020. There are several foci of susceptibility artifact throughout the breast consistent with biopsy clips at sites of known multicentric malignancy. LYMPH NODES: There is no axillary or internal mammary adenopathy. OTHER: Mediport noted in the upper inner right chest wall. IMPRESSION: RIGHT BREAST: 1. Focal nonmass enhancement in the 9:00 breast, posterior depth, measuring 6 mm likely corresponds to patient's site of known malignancy. Postbiopsy clip migrated inferiorly. BI-RADS 6: Biopsy proven malignancy. Recommend surgical excision when clinically appropriate. 2. Focal nonmass enhancement in the upper outer breast, posterior depth, measuring 7 mm. BI-RADS 4: Suspicious abnormality. If breast conservation therapy is being considered, MRI guided biopsy is recommended. LEFT BREAST: Findings consistent with known multicentric malignancy involving the upper outer, lower outer, and upper inner breast measuring up to 88 mm in AP dimension. No evidence of nipple involvement. BI-RADS 6: Biopsy proven malignancy. Recommend surgical excision when clinically appropriate. OVERALL BI-RADS ASSESSMENT: BI-RADS 4: Suspicious abnormality. Biopsy is recommended. Recommend bilateral mammogram.
FINDINGS: Images are limited by motion artifact. The breasts are composed of scattered fibroglandular tissue. Following contrast administration, there is minimal background enhancement. RIGHT BREAST: There is a focus of susceptibility artifact in the lower outer breast, posterior depth. This is consistent with postbiopsy clip which migrated inferiorly from the biopsy site. There is subtle focal nonmass enhancement in the 9:00 breast, posterior depth measuring 6 x 5 x 6 mm (AP x TV x CC) which appears to be at the site of known malignancy (series 403, image 71 and series 601, image 262). There is 7 x 3 x 4 mm (AP x TV x CC) of focal nonmass enhancement in the upper outer breast, posterior depth (series 403, image 93 and series 601, image 239). This appears to be medial and superior to the known malignancy. LEFT BREAST: There is clumped nonmass enhancement in a segmental distribution predominantly in the lateral breast, middle to posterior depth, involving the upper and lower outer quadrants as well as the upper inner quadrant consistent with patient's known malignancy. This measures approximately 88 x 49 x 39 mm (AP x TV x CC) on maximum intensity projection images. The enhancement measures approximately 30 mm from the chest wall. There is abnormal enhancement in the upper inner quadrant directly under the skin (series 403, image 90) but there is no evidence of skin or nipple involvement. Overall, enhancement appears similar to prior contrast mammogram on 10/22/2020. There are several foci of susceptibility artifact throughout the breast consistent with biopsy clips at sites of known multicentric malignancy. LYMPH NODES: There is no axillary or internal mammary adenopathy. OTHER: Mediport noted in the upper inner right chest wall.
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Mild diffuse age-appropriate parenchymal volume loss. EXTRA-AXIAL SPACES: No extra-axial collections. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Paranasal sinuses are clear. VESSELS: Normal noncontrast appearance of the vessels.
15,089
MR Brain wo+w contrast HISTORY: Headache, double vision and ophthalmoplegia TECHNIQUE: Multiplanar, multisequence MRI of the brain was performed without and after intravenous contrast. COMPARISON: CT of 1/6/2022 FINDINGS: INTRACRANIAL FINDINGS: The brain parenchyma appears normal without evidence for acute ischemia, hemorrhage, or mass lesion. The ventricles are normal in size. There is no abnormal extra-axial collection. The flow voids at the skull base are normal. The cerebellar tonsils are normal in position. EXTRACRANIAL FINDINGS: The orbital contents are unremarkable. Mucosal thickening in the maxillary and ethmoidal sinuses is suggestive for sinusitis. IMPRESSION: No acute intracranial lesion. Maxillary and ethmoidal sinusitis.
FINDINGS: INTRACRANIAL FINDINGS: The brain parenchyma appears normal without evidence for acute ischemia, hemorrhage, or mass lesion. The ventricles are normal in size. There is no abnormal extra-axial collection. The flow voids at the skull base are normal. The cerebellar tonsils are normal in position. EXTRACRANIAL FINDINGS: The orbital contents are unremarkable. Mucosal thickening in the maxillary and ethmoidal sinuses is suggestive for sinusitis.
Findings: Color parametric maps demonstrate no abnormal perfusion. Prognostic maps demonstrate no abnormal perfusion.
15,090
EXAM: MR Pelvis wo+w contrast CLINICAL INFORMATION: Suspected mullerian duct abnormality based on prior ultrasound findings. COMPARISON: Ultrasound 11/24/2021 TECHNIQUE: MR Pelvis wo+w contrast Patient weight: 177 lbs. IV contrast: ProHance, 8 ml, per protocol. FINDINGS: STRUCTURED REPORT: MRI Pelvis LOWER ABDOMEN: BOWEL: No abnormality. PERITONEUM: Trace pelvic free fluid, likely physiologic OTHER: No other abnormality. PELVIS: VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: There is a normal fundal contour of the uterus. Junctional zone measures up to approximately 12 mm on series 2 image 17. There are a few possible punctate T2 hyperintense foci seen. There is mild inferior protrusion of the endometrium at the uterine fundus. Endometrial thickness measures about 1.2 cm. There are two small uterine fibroids observed, the largest in the right body of uterus measuring 2.6 cm. Small ovarian follicles are observed bilaterally. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Uterine configuration favoring arcuate uterus over minute partial muscular septum. 2. Mild adenomyosis. 3. Uterine fibroids. 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: MRI Pelvis LOWER ABDOMEN: BOWEL: No abnormality. PERITONEUM: Trace pelvic free fluid, likely physiologic OTHER: No other abnormality. PELVIS: VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: There is a normal fundal contour of the uterus. Junctional zone measures up to approximately 12 mm on series 2 image 17. There are a few possible punctate T2 hyperintense foci seen. There is mild inferior protrusion of the endometrium at the uterine fundus. Endometrial thickness measures about 1.2 cm. There are two small uterine fibroids observed, the largest in the right body of uterus measuring 2.6 cm. Small ovarian follicles are observed bilaterally. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen LOWER CHEST: LUNG BASES / PLEURA: Linear consolidation in the right lower lobe, likely subsegmental atelectasis. Space consolidation in the medial aspect of the right lower lobe. Centrilobular groundglass nodularity in the imaged lower lungs DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. Resolution of trace pneumomediastinum. ABDOMEN: LIVER: Tiny focus of gas along the falciform ligament and in the hilum. Simple cyst in the posterior hepatic segment. BILIARY TRACT: Tiny focus of gas in the hilum as above, possibly pneumobilia versus free air. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: A catheter is present in the gastrostomy tract, terminating in the gastric fundus. Enteric contrast is present in the stomach and duodenum. No extraluminal contrast identified. COLON: No abnormality. PERITONEUM / MESENTERY: Trace free intraperitoneal air in the upper abdomen. No free intraperitoneal fluid. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. Open apophyses of the bilateral iliac crests.
15,091
EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: HCC sp ablation; is there residual tumor?, C22.0 Liver cell carcinoma COMPARISON: Liver MRI dated 11/1/2021, 7/15/2021 TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 137 lbs. IV contrast: ProHance, 7 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: STRUCTURED REPORT: MR HCC Follow-up IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. No steatosis. T2 hyperintense lesion measuring up to 1.2 cm within hepatic segment VII is redemonstrated, with postcontrast enhancement which follows blood flow, compatible with hemangioma. No new focal lesions. TREATED LIVER LESIONS: - Lesion Number: 1 - Description: Posttreatment changes which measure approximately 5.3 x 2.4 cm on precontrast T1 image 305, series 802, demonstrate mild T2 hyperintensity, T2 isointensity, and diffuse diffusion restriction. - Location: Segment(s) 8 - Size of largest enhancing portion of the mass: N/A - 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 Equivocal 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: Large (>5 mm diameter). - Other varices or collaterals: Left splenorenal shunt and prominent right upper quadrant collateral vessels are redemonstrated. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: Absent. LYMPH NODES: None enlarged. SPLEEN: Enlarged. PERITONEUM / ASCITES: Trace ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Normal. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. BODY WALL: Tiny periumbilical hernia containing ascitic fluid. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Post ablative changes to the hepatic segment VIII lesion without residual enhancement but diffuse diffusion restriction (larger than the lesion), presumably postprocedural changes though followup suggested (LR-TR-equivocal). 2. No new suspicious/enhancing hepatic lesions. Stable hemangioma. 3. Hepatic cirrhosis with portal hypertension as detailed 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: MR HCC Follow-up IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. No steatosis. T2 hyperintense lesion measuring up to 1.2 cm within hepatic segment VII is redemonstrated, with postcontrast enhancement which follows blood flow, compatible with hemangioma. No new focal lesions. TREATED LIVER LESIONS: - Lesion Number: 1 - Description: Posttreatment changes which measure approximately 5.3 x 2.4 cm on precontrast T1 image 305, series 802, demonstrate mild T2 hyperintensity, T2 isointensity, and diffuse diffusion restriction. - Location: Segment(s) 8 - Size of largest enhancing portion of the mass: N/A - 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 Equivocal 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: Large (>5 mm diameter). - Other varices or collaterals: Left splenorenal shunt and prominent right upper quadrant collateral vessels are redemonstrated. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: Absent. LYMPH NODES: None enlarged. SPLEEN: Enlarged. PERITONEUM / ASCITES: Trace ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Normal. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. BODY WALL: Tiny periumbilical hernia containing ascitic fluid. MUSCULOSKELETAL: No significant abnormality.
FINDINGS: CT of the head with and without contrast: New focal moderate edema in the right parietotemporal lobes with associated loss of gray-white matter differentiation concerning for subacute infarct. Minimal mass effect on the occipital horn of the right lateral ventricle. No midline shift. No evidence of hemorrhagic conversion or intracranial hemorrhage identified. Unchanged position of the right frontal approach VP shunt catheter with tip terminating in the frontal horn of the left lateral ventricle. Interval decreased size of ventricles. No hydrocephalus. No abnormal intracranial enhancement. Periventricular white matter hypoattenuation consistent with chronic microangiopathic changes. Basal cisterns are patent. Right pseudophakia. Mastoid air cells and paranasal sinuses are clear. CT angiogram of the brain: RIGHT CAROTID: Unchanged appearance of the supraclinoid ICA pipeline stent. Patency is difficult to evaluate due to extensive artifact from stent, however the distal supraclinoid ICA is opacified with contrast. Moderate atherosclerosis of the carotid siphon with associated moderate irregular narrowing without flow-limiting stenosis. No evidence of recurrent aneurysm. LEFT CAROTID: Unchanged moderate atherosclerosis of the carotid siphon with associated mild irregular narrowing without flow-limiting stenosis. No evidence of occlusion or aneurysm. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Unchanged moderate irregular narrowing of the right M1 segment. Interval worsening of moderate irregular narrowing of the left M1 and proximal M2 segments without flow-limiting stenosis. Unchanged small aneurysm measuring 3 mm originating from the M2 branches. P-comm aneurysm clip is unchanged without evidence of aneurysm recurrence. Unchanged mild irregular narrowing of the bilateral P1 segments, likely secondary to atherosclerosis. Decreased size and conspicuity of the vascular nidus versus tortuous irregular MCA branches in the left middle cranial fossa measuring 4 x 4 mm (image 146, series #507). VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: Moderate atherosclerosis of the proximal ICA without flow-limiting stenosis. No evidence of occlusion or aneurysmal dilation. LEFT CAROTID: 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: No soft tissue abnormality within the neck. Irregular nodularity in the right upper lobe measuring 5 mm (image 90, series #502). Additional tiny right upper lobe noncalcified nodule measuring 4 mm (image 73, series #502. Scattered calcified granulomas. Biapical centrilobular emphysematous change. CERVICAL SPINE: Advanced multilevel discogenic degenerative change of the cervical spine with straightening of normal cervical lordosis.
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MR Lumbar Spine wo contrast HISTORY: Low-back pain TECHNIQUE: Multiplanar, multisequence MRI of the lumbar spine was performed without intravenous contrast . COMPARISON: None available. FINDINGS: ALIGNMENT: There is grade 1 anterolisthesis of L4 on L5. There is trace with recesses of L5 on S1. VERTEBRAE: There is no vertebral body compression fracture or aggressive marrow lesion. Modic changes type I and II is noted at L4-L5 and L5-S1 levels. DISCS: Disc desiccation is present in all lumbar levels. Disc space narrowing from L4 to S1 is seen. CONUS MEDULLARIS: Normal in position and appearance and ends at L1 level. SOFT TISSUES: Unremarkable. At L1-2, minimal disc bulging. Mild bilateral facet arthropathy. No spinal canal stenosis or neural foraminal narrowing. At L2-3, there is disc bulging with moderate bilateral facet arthropathy and hypertrophic ligamentum flavum as well as dorsal epidural lipomatosis. Combination of mentioned pathology are causing moderate narrowing of the thecal sac and mild bilateral neural foraminal stenosis. At L3-4, disc bulging with mild bilateral facet arthropathy and effusion in the facet joints. There is mild to moderate thecal sac narrowing. There is moderate right and severe left neural foraminal narrowing with mild compression over the left L3 root within the neural foramen. At L4-5, there is posterior uncovering of disc space and disc bulging. The patient is status post posterior decompression. There is advanced bilateral facet arthropathy. There is moderate residual thecal sac narrowing with severe bilateral neural foraminal narrowing and mild compression over the L4 roots within the neural foramen. There is an 8 mm synovial cyst from the right facet which is located in the right lateral recess accentuating the thecal sac narrowing. At L5-S1, there is posterior uncovering of disc space with mild bilateral facet arthropathy. There is mild spinal canal stenosis with moderate bilateral neural foraminal narrowing. IMPRESSION: Disc bulging, facet arthropathy, hypertrophic ligamentum flavum and dorsal epidural lipomatosis at L2-L3 causing moderate narrowing of thecal sac at this level. Disc bulging and facet arthropathy at L3-L4 with mild to moderate thecal sac narrowing, moderate right and severe left neural foraminal stenosis. Grade 1 anterolisthesis and disc bulging at L4-L5 with moderate thecal sac narrowing and severe bilateral neural foraminal stenosis. There is compression over the intrathecal nerve roots at L4 level. A synovial cyst located in the right lateral recess of L4. Moderate bilateral neural foraminal stenosis at L5-S1.
FINDINGS: ALIGNMENT: There is grade 1 anterolisthesis of L4 on L5. There is trace with recesses of L5 on S1. VERTEBRAE: There is no vertebral body compression fracture or aggressive marrow lesion. Modic changes type I and II is noted at L4-L5 and L5-S1 levels. DISCS: Disc desiccation is present in all lumbar levels. Disc space narrowing from L4 to S1 is seen. CONUS MEDULLARIS: Normal in position and appearance and ends at L1 level. SOFT TISSUES: Unremarkable. At L1-2, minimal disc bulging. Mild bilateral facet arthropathy. No spinal canal stenosis or neural foraminal narrowing. At L2-3, there is disc bulging with moderate bilateral facet arthropathy and hypertrophic ligamentum flavum as well as dorsal epidural lipomatosis. Combination of mentioned pathology are causing moderate narrowing of the thecal sac and mild bilateral neural foraminal stenosis. At L3-4, disc bulging with mild bilateral facet arthropathy and effusion in the facet joints. There is mild to moderate thecal sac narrowing. There is moderate right and severe left neural foraminal narrowing with mild compression over the left L3 root within the neural foramen. At L4-5, there is posterior uncovering of disc space and disc bulging. The patient is status post posterior decompression. There is advanced bilateral facet arthropathy. There is moderate residual thecal sac narrowing with severe bilateral neural foraminal narrowing and mild compression over the L4 roots within the neural foramen. There is an 8 mm synovial cyst from the right facet which is located in the right lateral recess accentuating the thecal sac narrowing. At L5-S1, there is posterior uncovering of disc space with mild bilateral facet arthropathy. There is mild spinal canal stenosis with moderate bilateral neural foraminal narrowing.
FINDINGS: CT of the head with and without contrast: New focal moderate edema in the right parietotemporal lobes with associated loss of gray-white matter differentiation concerning for subacute infarct. Minimal mass effect on the occipital horn of the right lateral ventricle. No midline shift. No evidence of hemorrhagic conversion or intracranial hemorrhage identified. Unchanged position of the right frontal approach VP shunt catheter with tip terminating in the frontal horn of the left lateral ventricle. Interval decreased size of ventricles. No hydrocephalus. No abnormal intracranial enhancement. Periventricular white matter hypoattenuation consistent with chronic microangiopathic changes. Basal cisterns are patent. Right pseudophakia. Mastoid air cells and paranasal sinuses are clear. CT angiogram of the brain: RIGHT CAROTID: Unchanged appearance of the supraclinoid ICA pipeline stent. Patency is difficult to evaluate due to extensive artifact from stent, however the distal supraclinoid ICA is opacified with contrast. Moderate atherosclerosis of the carotid siphon with associated moderate irregular narrowing without flow-limiting stenosis. No evidence of recurrent aneurysm. LEFT CAROTID: Unchanged moderate atherosclerosis of the carotid siphon with associated mild irregular narrowing without flow-limiting stenosis. No evidence of occlusion or aneurysm. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Unchanged moderate irregular narrowing of the right M1 segment. Interval worsening of moderate irregular narrowing of the left M1 and proximal M2 segments without flow-limiting stenosis. Unchanged small aneurysm measuring 3 mm originating from the M2 branches. P-comm aneurysm clip is unchanged without evidence of aneurysm recurrence. Unchanged mild irregular narrowing of the bilateral P1 segments, likely secondary to atherosclerosis. Decreased size and conspicuity of the vascular nidus versus tortuous irregular MCA branches in the left middle cranial fossa measuring 4 x 4 mm (image 146, series #507). VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: Moderate atherosclerosis of the proximal ICA without flow-limiting stenosis. No evidence of occlusion or aneurysmal dilation. LEFT CAROTID: 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: No soft tissue abnormality within the neck. Irregular nodularity in the right upper lobe measuring 5 mm (image 90, series #502). Additional tiny right upper lobe noncalcified nodule measuring 4 mm (image 73, series #502. Scattered calcified granulomas. Biapical centrilobular emphysematous change. CERVICAL SPINE: Advanced multilevel discogenic degenerative change of the cervical spine with straightening of normal cervical lordosis.
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EXAM:MR Shoulder Right wo contrast CLINICAL INFORMATION:47-year-old male with right shoulder pain. COMPARISON:Right shoulder radiograph 12/20/2021. TECHNIQUE:MR Shoulder Right wo contrast STRUCTURED REPORT: MRI SHOULDERv5/23//2019 FINDINGS: BONES:No fracture, marrow replacement or suspicious focal lesion. ROTATOR CUFF: Supraspinatus:There is intermediate signal within the posterior supraspinatus tendon. Infraspinatus:Intermediate signal within the tendon near the insertion without a focal tear. Subscapularis:Normal. Teres minor:Normal. LONG HEAD BICEPS TENDON:Intermediate signal within the proximal biceps tendon. GLENOHUMERAL JOINT: Position:Normal. Articular cartilage:Mild articular cartilage thinning. Ligaments/Capsule:There is thickening of the inferior glenohumeral ligament. Labrum:Normal given limitations of non-arthrographic technique. BURSAE:No fluid. ACROMIAL CLAVICULAR JOINT:Osteophytes are present with capsular hypertrophy. No os acromiale. SUBACROMIAL ENCROACHMENT:None. MUSCLES:No atrophy. There is intermediate signal within the rotator interval. CONCLUSION: 1. Findings suggesting adhesive capsulitis. 2. Tendinosis of the supraspinatus and infraspinatus with partial intrasubstance biceps tendon tear. 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: BONES:No fracture, marrow replacement or suspicious focal lesion. ROTATOR CUFF: Supraspinatus:There is intermediate signal within the posterior supraspinatus tendon. Infraspinatus:Intermediate signal within the tendon near the insertion without a focal tear. Subscapularis:Normal. Teres minor:Normal. LONG HEAD BICEPS TENDON:Intermediate signal within the proximal biceps tendon. GLENOHUMERAL JOINT: Position:Normal. Articular cartilage:Mild articular cartilage thinning. Ligaments/Capsule:There is thickening of the inferior glenohumeral ligament. Labrum:Normal given limitations of non-arthrographic technique. BURSAE:No fluid. ACROMIAL CLAVICULAR JOINT:Osteophytes are present with capsular hypertrophy. No os acromiale. SUBACROMIAL ENCROACHMENT:None. MUSCLES:No atrophy. There is intermediate signal within the rotator interval.
Findings: CT head: BRAIN PARENCHYMA: No hemorrhage, intracranial mass, acute large territory infarct, or edema. Gray-white matter differentiation maintained. Unchanged right frontal lobe encephalomalacia. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No acute fracture. No aggressive osseous lesion. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal.
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EXAM: MR Pelvis wo+w contrast CLINICAL INFORMATION: PMB, N95.0 Postmenopausal bleeding Spec Inst: Recommend MRI for further evaluation of the endometrial stripe as indicated COMPARISON: Pelvic ultrasound dated 12/6/2021 TECHNIQUE: MR Pelvis wo+w contrast Patient weight: 163 lbs. IV contrast: ProHance, 7 ml, per protocol. FINDINGS: STRUCTURED REPORT: MRI Pelvis LOWER ABDOMEN: BOWEL: No abnormality. PERITONEUM: Normal. OTHER: No other abnormality. PELVIS: VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: T1/T2 isointense contents with irregular margins and adjacent fluid within the endometrial cavity measures roughly 2.3 x 0.6 cm on T2 sagittal image 15, series 201. This area appears to demonstrate postcontrast enhancement. Multiple uterine fibroids are present, including subserosal, intramural, and submucosal, with index lesions detail below. Trace fluid within the endometrial cavity. The largest fibroid is intramural within the anterior uterine wall measures 2.4 x 2.6 x 2.2 cm (AP, TV, CC) which is minimally T1 hyperintense and moderately T2 hypointense and largely hypoenhancing to adjacent myometrium. Submucosal fibroid within the right uterine fundus measures 1.0 x 0.9 x 1.2 cm (AP, TV, CC) and demonstrates T1 isointensity and moderate T2 hypointensity in is hypoenhancing on postcontrast images. Additional adjacent submucosal fibroid within the uterine fundus measures 1.6 x 1.4 x 1.6 cm (AP, TV, CC) with similar signal characteristics. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. T1/T2 isointense lesion within the endometrial cavity which appears to demonstrates postcontrast enhancement. While this may represent scar or other irregular tissue given patient's history of ablation, there is surrounding fluid and, further evaluation with hysteroscopy and/or tissue sampling is recommended. 2. No pathologically enlarged lymph nodes or additional evidence of malignancy within the pelvis. 3. Multiple uterine fibroids as detailed 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: MRI Pelvis LOWER ABDOMEN: BOWEL: No abnormality. PERITONEUM: Normal. OTHER: No other abnormality. PELVIS: VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: T1/T2 isointense contents with irregular margins and adjacent fluid within the endometrial cavity measures roughly 2.3 x 0.6 cm on T2 sagittal image 15, series 201. This area appears to demonstrate postcontrast enhancement. Multiple uterine fibroids are present, including subserosal, intramural, and submucosal, with index lesions detail below. Trace fluid within the endometrial cavity. The largest fibroid is intramural within the anterior uterine wall measures 2.4 x 2.6 x 2.2 cm (AP, TV, CC) which is minimally T1 hyperintense and moderately T2 hypointense and largely hypoenhancing to adjacent myometrium. Submucosal fibroid within the right uterine fundus measures 1.0 x 0.9 x 1.2 cm (AP, TV, CC) and demonstrates T1 isointensity and moderate T2 hypointensity in is hypoenhancing on postcontrast images. Additional adjacent submucosal fibroid within the uterine fundus measures 1.6 x 1.4 x 1.6 cm (AP, TV, CC) with similar signal characteristics. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
FINDINGS: No intraparenchymal hemorrhage, mass effect or edema. The gray white matter differentiation is maintained. Septum cavum et vergea noted. Physiologic calcifications in the bilateral basal ganglia. No extra axial collections. The ventricles are within normal size limits and there is no midline shift. No acute osseous abnormality. The paranasal sinuses, middle ears, and mastoid air cells are clear. The orbits are unremarkable. The visualized soft tissues are unremarkable.
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EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: Adrenal nodule COMPARISON: CT 12/29/2021 TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 154 lbs. IV contrast: ProHance, 14 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: There is loss of the normal T1 hyperintensity in the pancreatic body/tail. The pancreatic head and uncinate process demonstrate normal T1 hyperintensity. As well there is atrophy and mild ductal dilatation in the pancreatic body/tail measuring about 5 mm. There is transition to normal caliber of the pancreatic duct in the pancreatic head. There is a cystic lesion in the pancreatic body which measures about 7 mm (series 501 image 20), with no enhancement or nodularity similar to the prior exam. SPLEEN: Normal. ADRENALS: Redemonstration of a right adrenal nodule measuring approximately 1.1 x 1.0 cm on the current exam (series 901 image 52). The nodule is difficult to fully characterize on this exam due to its small size and motion artifact. It is not well seen on the in/opposed phase dual echo imaging though there may be some drop in the area. The adrenal glands are otherwise unremarkable. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Findings suggestive of chronic pancreatitis involving the pancreatic body/tail. There is a small cystic lesion in the pancreatic body which likely reflects a side branch type IPMN. One year follow-up MRI is recommended. 2. Right adrenal nodule is not fully characterized on the current exam due to its small size and motion artifact. In the absence of any history of known malignancy, this is likely benign and optional one year follow-up CT could be obtained per published guidelines. 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: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: There is loss of the normal T1 hyperintensity in the pancreatic body/tail. The pancreatic head and uncinate process demonstrate normal T1 hyperintensity. As well there is atrophy and mild ductal dilatation in the pancreatic body/tail measuring about 5 mm. There is transition to normal caliber of the pancreatic duct in the pancreatic head. There is a cystic lesion in the pancreatic body which measures about 7 mm (series 501 image 20), with no enhancement or nodularity similar to the prior exam. SPLEEN: Normal. ADRENALS: Redemonstration of a right adrenal nodule measuring approximately 1.1 x 1.0 cm on the current exam (series 901 image 52). The nodule is difficult to fully characterize on this exam due to its small size and motion artifact. It is not well seen on the in/opposed phase dual echo imaging though there may be some drop in the area. The adrenal glands are otherwise unremarkable. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Interval enlargement of a right renal simple cysts. Otherwise unremarkable. LYMPH NODES: Mildly prominent periaortic lymph nodes. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is normal. Diffuse colonic wall thickening with associated inflammatory stranding extending from the splenic flexure distally through the sigmoid colon to the level of the rectum. PERITONEUM / MESENTERY: Inflammatory stranding adjacent to the sigmoid colon. RETROPERITONEUM: Inflammatory stranding adjacent to the descending colon. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is present. No adnexal mass. BODY WALL: Fat-containing umbilical hernia. MUSCULOSKELETAL: No significant abnormality.
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EXAM: MR Brain wo+w contrast 1/21/2022 8:36 AM CLINICAL INFORMATION: History of metastatic GEJ adeno, metastatic to brain, sp SRS followed by resection x2 and re-peat SRS for recurrence 8/20/20. Thin slice MRI brain met protocol. COMPARISON: MRI brain dated 10/15/2021, 7/15/2021, 4/9/2021, 1/8/2021. TECHNIQUE: Multiple T1 and T2-weighted MR sequence images of the brain were obtained in the sagittal axial and coronal planes pre- and post administration of intravenous contrast per departmental protocol. Patient weight: 195 lbs. IV contrast: ProHance, 19 ml, per protocol. FINDINGS: Stable right suboccipital craniotomy postsurgical changes with chronic right lateral cerebellar hemisphere encephalomalacia/gliosis, chronic blood products in the resection bed, and small fluid collection in the defect. No significant interval change in size or appearance of nodular enhancement along the anteromedial margin of the resection bed, with nodular focus up to 6 x 8 mm in AP by CC on today's study (series 17, image 39), previously 6 x 8 mm (series 1003, image 20). No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, or extra-axial collection. Minimal periventricular and scattered punctate subcortical/deep white matter T2/FLAIR hyperintensities in the anterior frontal lobes bilaterally, unchanged and likely mild chronic microangiopathic changes. Punctate focus of susceptibility artifact in the right posterior centrum semiovale, unchanged and likely chronic microhemorrhage. The ventricular system is normal in caliber and configuration. The basal cisterns are clear. The visualized proximal cerebrovascular flow voids appear normal. The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Trace mucosal thickening of the bilateral anterior ethmoid and frontal sinuses. Trace right mastoid effusion, unchanged. The paranasal sinuses and left mastoid air cells are otherwise clear. Both orbits are unremarkable. _________________________ CONCLUSION: 1. No significant interval change in size or appearance of nodular enhancement along the medial margin of the resection bed. No new site of enhancement. Continued follow-up recommended. 2. Stable right suboccipital postsurgical changes. 3. Ancillary 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: Stable right suboccipital craniotomy postsurgical changes with chronic right lateral cerebellar hemisphere encephalomalacia/gliosis, chronic blood products in the resection bed, and small fluid collection in the defect. No significant interval change in size or appearance of nodular enhancement along the anteromedial margin of the resection bed, with nodular focus up to 6 x 8 mm in AP by CC on today's study (series 17, image 39), previously 6 x 8 mm (series 1003, image 20). No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, or extra-axial collection. Minimal periventricular and scattered punctate subcortical/deep white matter T2/FLAIR hyperintensities in the anterior frontal lobes bilaterally, unchanged and likely mild chronic microangiopathic changes. Punctate focus of susceptibility artifact in the right posterior centrum semiovale, unchanged and likely chronic microhemorrhage. The ventricular system is normal in caliber and configuration. The basal cisterns are clear. The visualized proximal cerebrovascular flow voids appear normal. The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Trace mucosal thickening of the bilateral anterior ethmoid and frontal sinuses. Trace right mastoid effusion, unchanged. The paranasal sinuses and left mastoid air cells are otherwise clear. Both orbits are unremarkable. _________________________
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Moderate diffuse parenchymal volume loss. Periventricular white matter hypoattenuation consistent with chronic microangiopathic changes. Empty sella. EXTRA-AXIAL SPACES: Prominent extra-axial spaces secondary to parenchymal volume loss, unchanged. No extra-axial collections. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. VENTRICULAR SYSTEM: Normal. ORBITS: Bilateral pseudophakia. SINUSES: Paranasal sinuses are clear. VESSELS: Mild calcified atherosclerosis of the carotid siphons.
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MR Breast Diagnostic Bil wo+w contrast CLINICAL INFORMATION: repeat non diagnostic exam 162022, Z80.3 Family history of malignant neoplasm of breast Spec Inst: Leeds, LT risk >40%. TECHNIQUE: T1 axial, FSE T2 fat sat axial, pre and post contrast vibrant sequence with 3D reconstructions and time intensity curves. Delayed post contrast sagittals. A dedicated 8 channel breast imaging coil was utilized. Patient weight: 320 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: Multiple prior breast MRIs, most recently 1/4/2021 MRI FINDINGS: The breasts are composed of scattered fibroglandular tissue. Following contrast administration, there is mild background enhancement. RIGHT BREAST: There is no suspicious enhancing mass or nonmass enhancement. LEFT BREAST: There is no suspicious enhancing mass or nonmass enhancement. LYMPH NODES: There is no axillary or internal mammary adenopathy. IMPRESSION: No MRI evidence of malignancy within either breast. BI-RADS 1: Negative. Recommend continued annual screening with mammogram and MRI.
FINDINGS: The breasts are composed of scattered fibroglandular tissue. Following contrast administration, there is mild background enhancement. RIGHT BREAST: There is no suspicious enhancing mass or nonmass enhancement. LEFT BREAST: There is no suspicious enhancing mass or nonmass enhancement. LYMPH NODES: There is no axillary or internal mammary adenopathy.
FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Mildly suboptimal quality with incomplete evaluation of subsegmental pulmonary arteries. Examination is also limited secondary to motion artifact. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Patchy groundglass densities in the bilateral lungs, grossly unchanged from prior exam. Bibasilar atelectasis. No pleural effusion or pneumothorax. The tracheobronchial tree is patent. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. Prominent mediastinal and right hilar lymph nodes, unchanged. CHEST WALL: Interval decrease in size of hematoma in the right axillary region although this was largely excluded from field-of-view. Bilateral gynecomastia. STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Hepatic steatosis. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Tiny hypodense renal lesions, too small to characterize. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis. Appendix is not visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild to moderate atherosclerosis in the aorta and its branches. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Presumed injection granuloma in the left anterior abdominal wall. Mild stranding along the right lateral abdominal wall. MUSCULOSKELETAL: Healed fracture of the left posterior 11th rib. No other acute osseous abnormality or focal aggressive osseous lesion.
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EXAM: MULTIPARAMETRIC MRI OF THE PROSTATE W AND WO IV CONTRAST CLINICAL INDICATION: elevated PSA, R97.20 Elevated prostate specific antigen [PSA] Spec Inst: elevated PSA; history of negative biopsies TECHNIQUE: Multiplanar T1-, T2-, and diffusion-weighted imaging of the pelvis were performed on a 3 Tesla scanner. Axial T1-weighted images were obtained before, during, and after administration of intravenous contrast. Patient weight: 140 lbs. IV contrast: ProHance, 13 ml, per protocol. IV contrast injection rate: 2.50 ml per sec. COMPARISON: Prostate MRI dated 1/21/2021 FINDINGS: STRUCTURED REPORT: MRI Prostate PROSTATE: Measurement: 3.8 x 4.3 x 6.0 cm; estimated volume: 51 cc Focal lesion(s): Lesion # 1 (index lesion): - Key image: image 19; series 5 - Size: 9 mm - Location: left; mid; posterolateral peripheral zone - T2WI: 2; DWI: 4; DCE (early and focal enhancement): negative - PI-RADS v2.1 score: 2 - Low (clinically significant cancer is unlikely to be present) - Likelihood of extraprostatic extension: 1 - Highly unlikely - Likelihood of seminal vesicle invasion: 1 - Highly unlikely Lesion # 2 (index lesion): - Key image: image 21; series 5 - Size: 12 mm - Location: left; base; anterior central gland - T2WI: 3 ; DWI: 4; DCE (early and focal enhancement): negative - PI-RADS v2.1 score: 3 - Intermediate (the presence of clinically significant cancer is equivocal) - Likelihood of extraprostatic extension: 1 - Highly unlikely - Likelihood of seminal vesicle invasion: 1 - Highly unlikely The previously described focus in the apical right peripheral zone is slightly less conspicuous today, though again present and unchanged. Diffuse prostate abnormalities: Diffusely striated appearance of the peripheral zone on T2WI may reflect prostatitis Other prostate findings: Diffuse BPH nodules many of which demonstrate cystic degeneration. VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. BLADDER: Bladder diverticulum, with protrusion of the median lobe into the bladder lumen. Otherwise within normal limits. OTHER PELVIC FINDINGS: Small right hydrocele. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. Note: For more details about the Prostate Imaging-Reporting and Data System (PI-RADS) version 2.1, please visit: http://www.acr.org/Quality-Safety/Resources/PIRADS CONCLUSION: 1. Stable lesion within the left peripheral zone as detailed above, PIRADS 2/3 borderline. 2. Stable lesion within the left mid gland as above, PIRADS 3. 3. Ill defined hypoattenuation right peripheral zone is unchanged from prior, previously scored as PIRADS 3 4. BPH with prominent median lobe impressing the bladder trabecula, compatible with bladder outlet obstruction. Bladder diverticulum. 5. Multiple additional BPH nodules, some which demonstrates cystic degeneration. 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: MRI Prostate PROSTATE: Measurement: 3.8 x 4.3 x 6.0 cm; estimated volume: 51 cc Focal lesion(s): Lesion # 1 (index lesion): - Key image: image 19; series 5 - Size: 9 mm - Location: left; mid; posterolateral peripheral zone - T2WI: 2; DWI: 4; DCE (early and focal enhancement): negative - PI-RADS v2.1 score: 2 - Low (clinically significant cancer is unlikely to be present) - Likelihood of extraprostatic extension: 1 - Highly unlikely - Likelihood of seminal vesicle invasion: 1 - Highly unlikely Lesion # 2 (index lesion): - Key image: image 21; series 5 - Size: 12 mm - Location: left; base; anterior central gland - T2WI: 3 ; DWI: 4; DCE (early and focal enhancement): negative - PI-RADS v2.1 score: 3 - Intermediate (the presence of clinically significant cancer is equivocal) - Likelihood of extraprostatic extension: 1 - Highly unlikely - Likelihood of seminal vesicle invasion: 1 - Highly unlikely The previously described focus in the apical right peripheral zone is slightly less conspicuous today, though again present and unchanged. Diffuse prostate abnormalities: Diffusely striated appearance of the peripheral zone on T2WI may reflect prostatitis Other prostate findings: Diffuse BPH nodules many of which demonstrate cystic degeneration. VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. BLADDER: Bladder diverticulum, with protrusion of the median lobe into the bladder lumen. Otherwise within normal limits. OTHER PELVIC FINDINGS: Small right hydrocele. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. Note: For more details about the Prostate Imaging-Reporting and Data System (PI-RADS) version 2.1, please visit: http://www.acr.org/Quality-Safety/Resources/PIRADS
FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Mildly suboptimal quality with incomplete evaluation of subsegmental pulmonary arteries. Examination is also limited secondary to motion artifact. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Patchy groundglass densities in the bilateral lungs, grossly unchanged from prior exam. Bibasilar atelectasis. No pleural effusion or pneumothorax. The tracheobronchial tree is patent. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. Prominent mediastinal and right hilar lymph nodes, unchanged. CHEST WALL: Interval decrease in size of hematoma in the right axillary region although this was largely excluded from field-of-view. Bilateral gynecomastia. STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Hepatic steatosis. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Tiny hypodense renal lesions, too small to characterize. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis. Appendix is not visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild to moderate atherosclerosis in the aorta and its branches. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Presumed injection granuloma in the left anterior abdominal wall. Mild stranding along the right lateral abdominal wall. MUSCULOSKELETAL: Healed fracture of the left posterior 11th rib. No other acute osseous abnormality or focal aggressive osseous lesion.
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MR Brain Shunt Function HISTORY: Evaluation for shunt function TECHNIQUE: Axial, coronal and sagittal T2 sequence. COMPARISON: MRI of 11/1/2012 FINDINGS: INTRACRANIAL FINDINGS: There is a persistent left frontal approached intraventricular catheter which ends at the location of the foramen of Monro. There is interval enlargement of the lateral ventricular systems. For reference the left atrium measures 14 mm previously 5 mm. Persistent atrophic changes/hypoplasia of the corpus callosum is again seen. The cerebellar tonsils are at the level of foramen of magnum without obvious crowding. Decreased white matter of the bilateral parieto-occipital lobes may represent sequela of periventricular leukoencephalomalacia. EXTRACRANIAL FINDINGS: The orbital contents are unremarkable. The visualized paranasal sinuses and mastoid air cells are well aerated. IMPRESSION: A stable left frontal approached intraventricular catheter. Interval enlargement of ventricular system in comparison to prior MRI of 2012.
FINDINGS: INTRACRANIAL FINDINGS: There is a persistent left frontal approached intraventricular catheter which ends at the location of the foramen of Monro. There is interval enlargement of the lateral ventricular systems. For reference the left atrium measures 14 mm previously 5 mm. Persistent atrophic changes/hypoplasia of the corpus callosum is again seen. The cerebellar tonsils are at the level of foramen of magnum without obvious crowding. Decreased white matter of the bilateral parieto-occipital lobes may represent sequela of periventricular leukoencephalomalacia. EXTRACRANIAL FINDINGS: The orbital contents are unremarkable. The visualized paranasal sinuses and mastoid air cells are well aerated.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Focal Tree-in-bud nodularity in the right lower lobe likely infectious/inflammatory 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: 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: Small fat-containing umbilical hernia. MUSCULOSKELETAL: No significant abnormality.