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15,100 |
MR Brain wo+w contrast HISTORY: Evaluation for memory loss TECHNIQUE: Multiplanar, multisequence MRI of the brain was performed without and after intravenous contrast. COMPARISON: MRI of 12/15/2021 FINDINGS: INTRACRANIAL FINDINGS: There are patchy foci of FLAIR hyper signal intensity in deep white matter of the bilateral centrum semiovale with extension to the right basal ganglia most likely 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. The visualized paranasal sinuses and mastoid air cells are well aerated. On the T1 gradient echo MP-RAGE series, on a reconstructed image oriented perpendicular to the AC-PC line and passing through the mamillary bodies, the patient has grade 1 right hippocampal atrophy and grade 1 left hippocampal atrophy using the visual grading system of Duara et al. IMPRESSION: No acute intracranial lesion. Mild microvascular angiopathy. Grade one hippocampi volume loss.
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FINDINGS: INTRACRANIAL FINDINGS: There are patchy foci of FLAIR hyper signal intensity in deep white matter of the bilateral centrum semiovale with extension to the right basal ganglia most likely 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. The visualized paranasal sinuses and mastoid air cells are well aerated. On the T1 gradient echo MP-RAGE series, on a reconstructed image oriented perpendicular to the AC-PC line and passing through the mamillary bodies, the patient has grade 1 right hippocampal atrophy and grade 1 left hippocampal atrophy using the visual grading system of Duara et al.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Mild diffuse parenchymal volume loss. EXTRA-AXIAL SPACES: Mild asymmetric prominence of the left extra-axial spaces secondary to parenchymal volume loss. No extra-axial collections SKULL AND SKULL BASE: Bilateral mastoid air cells are clear. No acute fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Paranasal sinuses are clear. VESSELS: Normal noncontrast appearance of the vessels.
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15,101 |
MR Femur Left wo+w contrast TECHNIQUE: Multiplanar and multisequence MRI of the left femur was obtained without and with intravenous contrast. CLINICAL INFORMATION: Sarcoma left posterior thigh, sp resection COMPARISON: 10/12/2021 FINDINGS: Postoperative changes of the posterolateral distal thigh are again noted. No new mass or nodular postcontrast enhancement is seen. There is an unchanged area of fat signal at the surgical bed, (image 17, series 11). No abnormal bone marrow signal to suggest acute fracture or aggressive osseous lesion. The visualized muscles and tendons are unremarkable. CONCLUSION: Stable postoperative changes without new 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.
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FINDINGS: Postoperative changes of the posterolateral distal thigh are again noted. No new mass or nodular postcontrast enhancement is seen. There is an unchanged area of fat signal at the surgical bed, (image 17, series 11). No abnormal bone marrow signal to suggest acute fracture or aggressive osseous lesion. The visualized muscles and tendons are unremarkable.
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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 (
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15,102 |
MRI brain without Indication: Meningioma, monitor, D32.9 Benign neoplasm of meninges, unspecified, F41.9 Anxiety disorder, unspecified, M19.90 Unspecified osteoarthritis, unspecified site, F33.1 Major depressive disorder, recurrent, moderate, K21.9 Gastro-esophageal reflux disease without esophagitis, I10 Essential (primary) hypertension, E78.5 Hyperlipidemia, unspecified, R73.01 Impaired fasting glucose, G47.00 Insom Comparison: Head CT 12/19/2021 and brain MRI 8/31/2020 Technique: Multiple T1 and T2-weighted MR sequence images of the brain were obtained in the sagittal axial and coronal planes without the use of intravenous contrast per departmental protocol. Findings: The large right sphenoid wing meningioma measures 4.1 x 4.3 cm in the maximum axial dimensions compared to, essentially similar to the prior exam within limitations of a noncontrast exam. Extensive adjacent vasogenic edema is again noted with associated mass effect including partial effacement of the right lateral ventricle and 6 mm leftward midline shift. There is some cystic change in the right inferior frontal operculum, which is nonspecific, could represent cystic encephalomalacia. The smaller right anterior superior parafalcine meningioma measures 1.2 x 0.9 cm, also unchanged. There are underlying extensive chronic Fazekas grade 3 microangiopathic changes. There is underlying diffuse cerebral volume loss with ventricular prominence. There are partial mastoid effusions, the visualized paranasal sinuses are clear. Impression: 1. Similar appearance of the large right sphenoid wing meningioma, within limitations of noncontrast exam. Extensive adjacent right hemispheric edema and associated mass effect with leftward midline shift are similar. 2. Stable small right superior parafalcine meningioma.
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Findings: The large right sphenoid wing meningioma measures 4.1 x 4.3 cm in the maximum axial dimensions compared to, essentially similar to the prior exam within limitations of a noncontrast exam. Extensive adjacent vasogenic edema is again noted with associated mass effect including partial effacement of the right lateral ventricle and 6 mm leftward midline shift. There is some cystic change in the right inferior frontal operculum, which is nonspecific, could represent cystic encephalomalacia. The smaller right anterior superior parafalcine meningioma measures 1.2 x 0.9 cm, also unchanged. There are underlying extensive chronic Fazekas grade 3 microangiopathic changes. There is underlying diffuse cerebral volume loss with ventricular prominence. There are partial mastoid effusions, the visualized paranasal sinuses are clear.
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FINDINGS: VERTEBRA: Acute anterior compression fracture of the superior endplates of L1 and L4 with less than 25% vertebral body height loss. No bony retropulsion. Mildly displaced comminuted fractures of the right L1-L5 transverse processes. Mildly displaced fractures of the left L3-L5 transverse processes. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative change with multilevel facet hypertrophy. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Degenerative grade 1 anterolisthesis of L4 on L5 and L5 on S1, unchanged from prior MRI. SOFT TISSUES: No significant abnormality of the visualized abdomen and pelvis.
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15,103 |
EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: HCC surveillance, hepatitis C. Status post TACE on 11/30/2018 and 1/31/2019. Status post microwave ablation on 4/18/2019 in the right hepatic lobe. COMPARISON: MRI 1/9/2019. TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 160 lbs. IV contrast: ProHance, 15 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. TREATED LIVER LESIONS: - Lesion Number: 1 - Location: Segment(s) 8 - Size of largest enhancing portion of the mass: 1.6 cm (Image 246, Series 703). - Enhancement: Nodular, masslike, or thick irregular tissue in or along the treated lesion - Additional features: - Arterial phase hyperenhancement: Present. - Washout: Present. - Enhancement similar to pretreatment: Present. - Vascular invasion: No - LI-RADS: LR-TR Viable UNTREATED OR NEW LIVER LESION(S): - Lesion Number: 1 - Location: Segment(s) 2 (Image 282, Series 703). - Size: 1.7 cm. - Enhancement: Nonrim arterial phase hyperenhancement - Vascular invasion: No - Additional major features present: 2 - Enhancing "capsule": Present. - Nonperipheral "washout": Present. - Threshold growth (>= 50% in = 50% in <= 6 months): Not present. - Other features: None. - LI-RADS: LR-4 Additionally, there are two, T2 hyperintense small lesions in the inferior right hepatic lobe which are stable or decreased compared to the prior examination (series 501 image 501 image 24) and an additional one on image 501-28. LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: None. - Other varices or collaterals: None. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: No abnormality. LYMPH NODES: None enlarged. SPLEEN: Normal size and appearance. PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Small left renal cyst. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Residual nodular enhancement adjacent to the previously treated right hepatic lobe lesion consistent with viable tumor (LR-TR viable). 2. New enhancing lesion in the left hepatic lobe consistent with HCC (LR-5) as well as additional new lesion in the inferior right hepatic lobe (LR-4. 3. Multiple additional probable hemangiomas in the right hepatic lobe which are similar or slightly decreased from prior. 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.
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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. TREATED LIVER LESIONS: - Lesion Number: 1 - Location: Segment(s) 8 - Size of largest enhancing portion of the mass: 1.6 cm (Image 246, Series 703). - Enhancement: Nodular, masslike, or thick irregular tissue in or along the treated lesion - Additional features: - Arterial phase hyperenhancement: Present. - Washout: Present. - Enhancement similar to pretreatment: Present. - Vascular invasion: No - LI-RADS: LR-TR Viable UNTREATED OR NEW LIVER LESION(S): - Lesion Number: 1 - Location: Segment(s) 2 (Image 282, Series 703). - Size: 1.7 cm. - Enhancement: Nonrim arterial phase hyperenhancement - Vascular invasion: No - Additional major features present: 2 - Enhancing "capsule": Present. - Nonperipheral "washout": Present. - Threshold growth (>= 50% in = 50% in <= 6 months): Not present. - Other features: None. - LI-RADS: LR-4 Additionally, there are two, T2 hyperintense small lesions in the inferior right hepatic lobe which are stable or decreased compared to the prior examination (series 501 image 501 image 24) and an additional one on image 501-28. LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: None. - Other varices or collaterals: None. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: No abnormality. LYMPH NODES: None enlarged. SPLEEN: Normal size and appearance. PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Small left renal cyst. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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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. Small accessory spleen along the anterior inferior aspect. ADRENALS: Normal. KIDNEYS: There is an exophytic, heterogenous enhancing, solid mass of the lower pole of the right kidney measuring approximately 4.7 x 3.8 x 4.6 cm (series 201 image 101, series 203 image 73). The ureters are prominent bilaterally, possibly secondary to pelvic inflammation. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: There is circumferential small bowel thickening and submucosal edema in the right lower quadrant, adjacent to area of inflamed sigmoid colon discussed below. The remainder of the small bowel appears normal in caliber and enhancement throughout. COLON / APPENDIX: Likely perforated sigmoid diverticulitis with prominent peridiverticular abscess measuring approximately 5.2 x 4.5 x 7.0 cm (series 15 image 181 and series 103 image 38). The adjacent sigmoid colon is markedly thickened with pericolonic fat stranding. Additional area of colonic thickening and pericolonic stranding is seen at the ascending colon/cecum. There are numerous additional noninflamed descending and sigmoid diverticula. PERITONEUM / MESENTERY: Trace free fluid in the pelvis. No free intraperitoneal air. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerotic calcifications of the infrarenal abdominal aorta and iliac vessels without aneurysmal dilatation. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Calcified fibroid uterus. Bilateral adnexa appear unremarkable. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous lesion or acute fracture. Osteoporosis. T12 vertebral body hemangioma.
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15,104 |
MR Brain wo+w contrast HISTORY: Essential tremor, partial seizure TECHNIQUE: Multiplanar, multisequence MRI of the brain was performed without and after intravenous contrast. COMPARISON: None available. FINDINGS: INTRACRANIAL FINDINGS: There is minimal volume loss. A faint patchy FLAIR signal intensity of pons may represent 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. The visualized paranasal sinuses and mastoid air cells are well aerated. IMPRESSION: No acute intracranial lesion.
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FINDINGS: INTRACRANIAL FINDINGS: There is minimal volume loss. A faint patchy FLAIR signal intensity of pons may represent 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. The visualized paranasal sinuses and mastoid air cells are well aerated.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Normal cerebral cortical volume. Prominent perivascular space in the bilateral basal ganglia, right greater than left EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: Bilateral mastoid air cells are clear. No fracture. Benign-appearing peripherally sclerotic lesion in the left frontal calvarium measuring 6 mm (image 47, series #202), likely osteoma. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Mild mucosal thickening of the bilateral maxillary sinuses. VESSELS: Normal noncontrast appearance of the vessels.
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15,105 |
MR Brain wo+w contrast HISTORY: Evaluation for Parkinson disease TECHNIQUE: Multiplanar, multisequence MRI of the brain was performed without and after intravenous contrast. COMPARISON: None available. 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. An 8 mm pineal cyst is most consistent with an incidental finding. EXTRACRANIAL FINDINGS: The orbital contents are unremarkable. Mucosal thickening of left maxillary sinus suggestive for sinusitis. IMPRESSION: No acute intracranial lesion.
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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. An 8 mm pineal cyst is most consistent with an incidental finding. EXTRACRANIAL FINDINGS: The orbital contents are unremarkable. Mucosal thickening of left maxillary sinus suggestive for sinusitis.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: No focal consolidation, pleural effusion, or pneumothorax. Mild dependent atelectasis. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Increased attenuation and stranding involving the anterior mediastinum. No evidence of active extravasation. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Contusion overlying the anterior sternum. Stranding in the right 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: No abnormality. COLON / APPENDIX: The appendix and colon are normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered vascular calcifications. Two right renal arteries. URINARY BLADDER: Mildly distended with contrast. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: Obliquely oriented mildly comminuted minimally displaced mid sternal fracture. Multiple right-sided rib fractures involving the fourth through eighth ribs. Asymmetric widening of the right clavicular manubrial joint when compared to the left.
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15,106 |
MRI brain without Indication: Headache, chronic, new features or increased frequency, R51.9 Headache, unspecified 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 without the use of intravenous contrast per departmental protocol. Findings: Echoplanar diffusion-weighted imaging demonstrates no evidence of restrained diffusion at this time. Whole brain T2 and FLAIR imaging demonstrate no midline shift, mass effect, or other space-occupying lesion. There is no significant white matter hyperintensities. The ventricular system is of normal morphology. The basal cisterns are clear. The visualized vascular flow voids appear normal. There is a mucous retention cyst in the right maxillary sinus. The remaining visualized paranasal sinuses and mastoid air cells are clear. The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Impression: No acute intracranial process.
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Findings: Echoplanar diffusion-weighted imaging demonstrates no evidence of restrained diffusion at this time. Whole brain T2 and FLAIR imaging demonstrate no midline shift, mass effect, or other space-occupying lesion. There is no significant white matter hyperintensities. The ventricular system is of normal morphology. The basal cisterns are clear. The visualized vascular flow voids appear normal. There is a mucous retention cyst in the right maxillary sinus. The remaining visualized paranasal sinuses and mastoid air cells are clear. The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: No focal consolidation, pleural effusion, or pneumothorax. Mild dependent atelectasis. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Increased attenuation and stranding involving the anterior mediastinum. No evidence of active extravasation. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Contusion overlying the anterior sternum. Stranding in the right 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: No abnormality. COLON / APPENDIX: The appendix and colon are normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered vascular calcifications. Two right renal arteries. URINARY BLADDER: Mildly distended with contrast. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: Obliquely oriented mildly comminuted minimally displaced mid sternal fracture. Multiple right-sided rib fractures involving the fourth through eighth ribs. Asymmetric widening of the right clavicular manubrial joint when compared to the left.
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15,107 |
MRI brain with and without contrast Clinical Information: Female aged 60 years. Hearing loss (left) Comparison: CT 11/5/2021 Technique: Multiplanar, multisequence MRI of the brain were obtained in multiple planes pre-and post administration of intravenous contrast per departmental protocol. Patient weight: 124 lbs. IV contrast: ProHance, 5 ml, per protocol. Findings: No space-occupying lesion in the cerebellopontine angle. The cranial nerves VII and VIII are intact with normal pattern of enhancement in the internal auditory canal. Normal structures of the otic capsules. No mastoid air cell or middle ear effusions. No acute infarct or intracranial hemorrhage. No midline shift, hydrocephalus, mass effect, or other space-occupying lesion. There is a small focus of FLAIR hyperintensity in the left corona radiata, which is nonspecific, likely chronic microangiopathic change or a chronic infarct. No abnormal parenchymal or leptomeningeal enhancement. No significant abnormality of the extracranial osseous and soft tissue structures. Conclusion: 1. No acute intracranial or significant IAC abnormality. 2. Chronic microangiopathic change versus a chronic lacunar infarct in the left corona radiata. No abnormal 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.
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Findings: No space-occupying lesion in the cerebellopontine angle. The cranial nerves VII and VIII are intact with normal pattern of enhancement in the internal auditory canal. Normal structures of the otic capsules. No mastoid air cell or middle ear effusions. No acute infarct or intracranial hemorrhage. No midline shift, hydrocephalus, mass effect, or other space-occupying lesion. There is a small focus of FLAIR hyperintensity in the left corona radiata, which is nonspecific, likely chronic microangiopathic change or a chronic infarct. No abnormal parenchymal or leptomeningeal enhancement. No significant abnormality of the extracranial osseous and soft tissue structures.
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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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15,108 |
EXAM: CV MR Cardiac w contrast PATIENT DATA Date of Study: 1/21/2022 11:29 AM Referring MD: Efstathia Andrikopoulou Height: 182 cm. Patient weight: 104 kg. BSA: 2.29298 Blood Pressure: 138/68 Heart Rate: 68 bpm. EGFR 60. The patient's creatinine was 1 on 01/21/22. The patient received 20 cc's of gadavist at a rate of 2 ml per second without immediate complication. CLINICAL INFORMATION: Patient studied for evaluation of: Cardiomyopathy, undefined, further testing, R55 Syncope and collapse Spec Inst: syncope History: 61 year old woman with past medical history of nonobstructive CAD, fibromyalgia, chronic pancreatitis, pectus excavatum with surgical repair with syncope and chest pain presenting for cardiac MRI. 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 T2 Sequences: FSE 2IR FSE 3IR SSFP FGRE ET perfusion Additional views: delayed contrast enhancement General: ECG gated: yes MEASUREMENTS: in millimeters Left Atrium: 31 LV End Diastolic Dimension: 44 LV End Systolic Dimension: 28 LV Posterior Wall: 8 Right Atrium 46 RV End Diastolic Dimension: 42 Interventricular Septum: 9 Left Ventricle (short axis): Volumes in mL, Index volumes in mL per square meter End Diastolic Volume: 125 ED index: 55 End Systolic Volume: 48 ES index: 21 Stroke Volume: 77 SV index: 34 Ejection Fraction: 61.6% Morphology: There is normal size and systolic function of the left ventricle. There is no increased signal intensity on T2 weighted images. There is normal first pass gadolinium perfusion. There is no late gadolinium enhancement noted. Right Ventricle (short axis): Volumes in mL, Index volumes in mL per square meter End Diastolic Volume: 135 ED index: 60 End Systolic Volume: 50 ES index: 22 Stroke Volume: 85 SV index: 38 Ejection Fraction: 63.0% Morphology: There is normal size and systolic function of the right ventricle with normal systolic motion. There is no fatty infiltration noted on triple IR fat suppresion images. Pericardium: Thickness: 2mm (1-3 mm) Effusion: none Epicardial fat noted anterior and apically. VALVULAR MORPHOLOGY No significant valvular stenosis or regurgitation noted. Vessel dimensions: (In mm normal range dimensions mm) Main Pulmonary Artery 30 Aortic Root 35 Aortic Arch 25 [18-37] Right Pulmonary Artery 46 Ascending Aorta 30 [19-37] Left Pulmonary Artery 15 Inferior Vena Cava 22 Descending Aorta 22 [16-29] INCIDENTAL FINDINGS: Fixation plate of pectus excavatum present. CONCLUSION: 1. Normal cardiac MRI with normal left and right systolic size and function. 2. No sign of cardiac inflammation or scaring. 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.
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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 T2 Sequences: FSE 2IR FSE 3IR SSFP FGRE ET perfusion Additional views: delayed contrast enhancement General: ECG gated: yes MEASUREMENTS: in millimeters Left Atrium: 31 LV End Diastolic Dimension: 44 LV End Systolic Dimension: 28 LV Posterior Wall: 8 Right Atrium 46 RV End Diastolic Dimension: 42 Interventricular Septum: 9 Left Ventricle (short axis): Volumes in mL, Index volumes in mL per square meter End Diastolic Volume: 125 ED index: 55 End Systolic Volume: 48 ES index: 21 Stroke Volume: 77 SV index: 34 Ejection Fraction: 61.6% Morphology: There is normal size and systolic function of the left ventricle. There is no increased signal intensity on T2 weighted images. There is normal first pass gadolinium perfusion. There is no late gadolinium enhancement noted. Right Ventricle (short axis): Volumes in mL, Index volumes in mL per square meter End Diastolic Volume: 135 ED index: 60 End Systolic Volume: 50 ES index: 22 Stroke Volume: 85 SV index: 38 Ejection Fraction: 63.0% Morphology: There is normal size and systolic function of the right ventricle with normal systolic motion. There is no fatty infiltration noted on triple IR fat suppresion images. Pericardium: Thickness: 2mm (1-3 mm) Effusion: none Epicardial fat noted anterior and apically. VALVULAR MORPHOLOGY No significant valvular stenosis or regurgitation noted. Vessel dimensions: (In mm normal range dimensions mm) Main Pulmonary Artery 30 Aortic Root 35 Aortic Arch 25 [18-37] Right Pulmonary Artery 46 Ascending Aorta 30 [19-37] Left Pulmonary Artery 15 Inferior Vena Cava 22 Descending Aorta 22 [16-29] INCIDENTAL FINDINGS: Fixation plate of pectus excavatum present.
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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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15,109 |
MR Breast Diagnostic Bil wo+w contrast CLINICAL INFORMATION: hx breast ca
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MR Breast Diagnostic Bil wo+w contrast CLINICAL INFORMATION: hx breast ca
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FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Moderately suboptimal quality with incomplete evaluation of segmental and subsegmental pulmonary arteries. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: No central or proximal/lobar pulmonary thromboembolism. Suboptimal contrast bolus timing limits evaluation of the segmental and subsegmental pulmonary arteries. Main pulmonary artery is normal in diameter. LUNGS / AIRWAYS / PLEURA: Subtle mosaic attenuation within the upper lobes may be secondary to air trapping. No focal consolidation. No pleural effusion or pneumothorax. No suspicious pulmonary nodules. HEART / OTHER VESSELS: Stable mild cardiomegaly and trace pericardial effusion. Thoracic aorta is normal in course and caliber. MEDIASTINUM / ESOPHAGUS: No mediastinal abnormality. Small hiatal hernia. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Multiple hypodense lesions are again seen within the liver, the majority of which appear compatible with simple cysts. A few smaller lesions are indeterminate and incompletely characterized on this exam but appear grossly stable as visualized. Several probable small nonobstructing intrarenal calculi bilaterally. MUSCULOSKELETAL: Mild multilevel discogenic degenerative changes of the thoracic spine. No destructive osseous lesions.
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15,110 |
EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: Indeterminate liver lesion seen on CT COMPARISON: None. TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 160 lbs. IV contrast: Eovist, 10 ml, per protocol. IV contrast injection rate: 1 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 morphology. No steatosis. Nonenhancing cysts in hepatic segments VI and VII. No other liver lesions. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. 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: Benign cysts in the right lobe of the liver. No suspicious liver lesions. 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.
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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 morphology. No steatosis. Nonenhancing cysts in hepatic segments VI and VII. No other liver lesions. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. 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.
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Findings: Head CT: There is no intraparenchymal hemorrhage in the right basal ganglia measuring 18 x 13 mm on image 36 series 201. There is mild surrounding vasogenic edema. There is no significant mass effect or midline shift. There is questionable trace right paramedian frontal lobe subarachnoid hemorrhage. There is no other acute intracranial hemorrhage. There is no evidence of acute infarction, intracranial mass or hydrocephalus. There is no acute calvarial fracture. There is a moderate size right parietal occipital scalp subgaleal hematoma. Maxillofacial CT: There is left periorbital and left anterior cheek soft tissue swelling. There is no other evidence of orbital soft tissue injury. There is a chronic fracture of the right posterior lamina papyracea. There are no acute maxillofacial or mandibular fractures or traumatic TMJ dislocation. There is no mucosal thickening in the ethmoid, sphenoid and maxillary sinuses. The middle ears, mastoid antra, and mastoid air cells are clear.
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EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: HCC, status post TACE COMPARISON: MRI 10/22/2021 TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 205 lbs. IV contrast: ProHance, 10 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: Trace right pleural fluid. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. No steatosis. TREATED LIVER LESIONS: - Lesion Number: 1 - Description: Right hepatic lobe ablation defect - Location: Segment(s) 8 - Size of largest enhancing portion of the mass: No masslike enhancement - Enhancement: No lesional enhancement - Additional features: - Arterial phase hyperenhancement: Not present. - Washout: Not present. - Enhancement similar to pretreatment: Not present. - Vascular invasion: No - LI-RADS: LR-TR Nonviable Interval decrease in previously observed small subcapsular fluid collection along the superior aspect of the hepatic dome, now 1.5 x 1.1cm. UNTREATED OR NEW LIVER LESION(S): None LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent. Right hepatic artery arises from the SMA - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: None. - Other varices or collaterals: None. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: Intrinsic T1 hyperintense fluid in the gallbladder likely reflecting sludge. LYMPH NODES: None enlarged. SPLEEN: Normal size and appearance. PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Small, subcentimeter fluid signal intensity cysts in the kidneys, unchanged. Kidneys otherwise unremarkable STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Hepatic cirrhosis with stable previously treated right hepatic lobe lesion (LR-TR nonviable). No new suspicious hepatic lesion. 2. Interval resolution in previously observed small pericapsular fluid collection adjacent to the hepatic dome. 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.
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FINDINGS: STRUCTURED REPORT: MR HCC Follow-up IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: Trace right pleural fluid. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. No steatosis. TREATED LIVER LESIONS: - Lesion Number: 1 - Description: Right hepatic lobe ablation defect - Location: Segment(s) 8 - Size of largest enhancing portion of the mass: No masslike enhancement - Enhancement: No lesional enhancement - Additional features: - Arterial phase hyperenhancement: Not present. - Washout: Not present. - Enhancement similar to pretreatment: Not present. - Vascular invasion: No - LI-RADS: LR-TR Nonviable Interval decrease in previously observed small subcapsular fluid collection along the superior aspect of the hepatic dome, now 1.5 x 1.1cm. UNTREATED OR NEW LIVER LESION(S): None LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent. Right hepatic artery arises from the SMA - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: None. - Other varices or collaterals: None. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: Intrinsic T1 hyperintense fluid in the gallbladder likely reflecting sludge. LYMPH NODES: None enlarged. SPLEEN: Normal size and appearance. PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Small, subcentimeter fluid signal intensity cysts in the kidneys, unchanged. Kidneys otherwise unremarkable STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Dependent atelectasis, bilaterally. HEART / VESSELS: Coronary vascular calcifications. Heart is normal in size. Thoracic aorta is normal in course and caliber. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: 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 and colon are normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered vascular calcifications. Replaced left hepatic artery arising from the left gastric artery. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Large fat-containing right inguinal hernia. Small fat-containing left inguinal hernia. Fat-containing umbilical hernia. MUSCULOSKELETAL: No significant abnormality. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. Traditional lumbosacral anatomy. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. Mild-to-moderate multilevel discogenic and facet joint degenerative changes. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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MR Breast Diagnostic Bil wo+w contrast CLINICAL INFORMATION: Other, R92.8 Other abnormal and inconclusive findings on diagnostic imaging of breast Spec Inst: short interval follow up of focus of enhancement to anterior-superior of right lumpectomy cavity please use Dotarem contrast. 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: 215 lbs. IV contrast: Meglumine Dotarem, 20 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: Prior breast MRI 2/3/2021 MRI FINDINGS: The breasts are composed of scattered fibroglandular tissue. Following contrast administration, there is mild background enhancement. RIGHT BREAST: There are postlumpectomy changes in the 6:00 breast, posterior depth. There is no suspicious enhancement in the lumpectomy bed. The previously described focus of enhancement anterior and superior to the surgical bed is no longer present, benign. 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 of breast conservation therapy without MRI evidence of malignancy. The previously seen focus of enhancement is no longer present, benign. BI-RADS 2: Benign LEFT BREAST: No MRI evidence of malignancy. BI-RADS 1: Negative. OVERALL BI-RADS ASSESSMENT: BI-RADS 2: Benign
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FINDINGS: The breasts are composed of scattered fibroglandular tissue. Following contrast administration, there is mild background enhancement. RIGHT BREAST: There are postlumpectomy changes in the 6:00 breast, posterior depth. There is no suspicious enhancement in the lumpectomy bed. The previously described focus of enhancement anterior and superior to the surgical bed is no longer present, benign. LEFT BREAST: There is no suspicious enhancing mass or nonmass enhancement. LYMPH NODES: There is no axillary or internal mammary adenopathy.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Dependent atelectasis, bilaterally. HEART / VESSELS: Coronary vascular calcifications. Heart is normal in size. Thoracic aorta is normal in course and caliber. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: 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 and colon are normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered vascular calcifications. Replaced left hepatic artery arising from the left gastric artery. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Large fat-containing right inguinal hernia. Small fat-containing left inguinal hernia. Fat-containing umbilical hernia. MUSCULOSKELETAL: No significant abnormality. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. Traditional lumbosacral anatomy. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. Mild-to-moderate multilevel discogenic and facet joint degenerative changes. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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MR Brain wo+w contrast HISTORY: Hearing loss TECHNIQUE: Multiplanar, multisequence MRI of the brain was performed without and after intravenous contrast. COMPARISON: None available. FINDINGS: INTRACRANIAL FINDINGS: There is a tiny focus of FLAIR hyper signal intensity white matter of left centrum semiovale most consistent with minimal 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. The visualized paranasal sinuses and mastoid air cells are well aerated. Internal auditory canals are unremarkable. IMPRESSION: No acute intracranial lesion.
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FINDINGS: INTRACRANIAL FINDINGS: There is a tiny focus of FLAIR hyper signal intensity white matter of left centrum semiovale most consistent with minimal 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. The visualized paranasal sinuses and mastoid air cells are well aerated. Internal auditory canals are unremarkable.
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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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15,114 |
MR Brain wo+w contrast HISTORY: Bilateral sensorineural hearing loss and tinnitus TECHNIQUE: Multiplanar, multisequence MRI of the brain was performed without and after intravenous contrast. COMPARISON: None available. FINDINGS: INTRACRANIAL FINDINGS: There are scattered foci of periventricular and deep white matter FLAIR signal intensity is most consistent with mild microvascular angiopathy. Mild ventriculomegaly is likely excavatum dilation. 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. Internal auditory canals are unremarkable. IMPRESSION: No acute intracranial lesion. Mild microvascular angiopathy.
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FINDINGS: INTRACRANIAL FINDINGS: There are scattered foci of periventricular and deep white matter FLAIR signal intensity is most consistent with mild microvascular angiopathy. Mild ventriculomegaly is likely excavatum dilation. 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. Internal auditory canals are unremarkable.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Dependent atelectasis, bilaterally. HEART / VESSELS: Coronary vascular calcifications. Heart is normal in size. Thoracic aorta is normal in course and caliber. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: 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 and colon are normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered vascular calcifications. Replaced left hepatic artery arising from the left gastric artery. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Large fat-containing right inguinal hernia. Small fat-containing left inguinal hernia. Fat-containing umbilical hernia. MUSCULOSKELETAL: No significant abnormality. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. Traditional lumbosacral anatomy. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. Mild-to-moderate multilevel discogenic and facet joint degenerative changes. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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15,115 |
MR Brain without and with contrast Clinical Information: Parkinson's Disease, G20 Parkinson s disease, R25.1 Tremor, unspecified, F31.9 Bipolar disorder, unspecified Spec Inst: MRI Brain w Comparison: None available. Technique: Diffusion tensor imaging with trace, ADC, FA maps, FGATIR , FLAWS, QSM, 2D T2 FLAIR, DTI, Postgad sagittal 3D T1 SPACE FS sequences. Findings/Impression: The supra and infratentorial brain shows no focal signal abnormality. The mid brain is normal in size. Diffusion tensor imaging with fractional anisotropy maps show no focal white matter abnormality. No significant cerebral parenchymal volume loss is noted. There is no abnormal intracranial contrast enhancement. Provided high-resolution volumetric image quality is adequate for presurgical DBS target mapping.
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Findings/Impression: The supra and infratentorial brain shows no focal signal abnormality. The mid brain is normal in size. Diffusion tensor imaging with fractional anisotropy maps show no focal white matter abnormality. No significant cerebral parenchymal volume loss is noted. There is no abnormal intracranial contrast enhancement. Provided high-resolution volumetric image quality is adequate for presurgical DBS target mapping.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Dependent atelectasis, bilaterally. HEART / VESSELS: Coronary vascular calcifications. Heart is normal in size. Thoracic aorta is normal in course and caliber. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: 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 and colon are normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered vascular calcifications. Replaced left hepatic artery arising from the left gastric artery. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Large fat-containing right inguinal hernia. Small fat-containing left inguinal hernia. Fat-containing umbilical hernia. MUSCULOSKELETAL: No significant abnormality. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. Traditional lumbosacral anatomy. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. Mild-to-moderate multilevel discogenic and facet joint degenerative changes. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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Brain and neck MR angiogram without contrast HISTORY: Evaluation for carotid artery dissection Technique: MRA of the neck and brain was performed before and after the intravenous administration of contrast. 3-D and MIP images were reconstructed. COMPARISON: MR angiogram dated 6/19/2012 FINDINGS: Aortic arch: The visualized portion of the aortic arch is patent. The origin of the main arteries are also patent. Right carotid circulation: The right common carotid artery is patent. The cervical portion of the right internal carotid artery is diffusely small in size, unchanged since prior MR angiogram of 2012. Left carotid circulation: Normal in course, caliber, and contour. Vertebral arteries: Normal in course, caliber, and contour. Intracranial arterial circulation: The intracranial portion of the right internal carotid artery is diffusely small in size. The flow signal within the cavernosal and paraclinoid segment of right internal carotid artery cannot be visualized concerning for slow flow versus occlusion. Intracranial portion of left internal carotid artery is patent. A1 segments and ACAs are patent. There is severe narrowing at origin of right A1 segment. MCAs and their cortical branches are patent. The right MCA is within normal limit of size. V4 arteries, basilar artery and PCAs are patent. Bilateral P-comm's are patent. IMPRESSION: No obvious interval change since prior MR angiogram of 2012. Diffuse narrowing of entire cervical right internal carotid artery with significantly decreased flow signal versus occlusion of the intracranial portion of the right internal carotid artery. Findings are most consistent with sequela of previous dissection. Reconstitution of the right MCA and right A1 segment . Severe narrowing at origin of right A1 segment. Right MCA is within normal limit of size.
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FINDINGS: Aortic arch: The visualized portion of the aortic arch is patent. The origin of the main arteries are also patent. Right carotid circulation: The right common carotid artery is patent. The cervical portion of the right internal carotid artery is diffusely small in size, unchanged since prior MR angiogram of 2012. Left carotid circulation: Normal in course, caliber, and contour. Vertebral arteries: Normal in course, caliber, and contour. Intracranial arterial circulation: The intracranial portion of the right internal carotid artery is diffusely small in size. The flow signal within the cavernosal and paraclinoid segment of right internal carotid artery cannot be visualized concerning for slow flow versus occlusion. Intracranial portion of left internal carotid artery is patent. A1 segments and ACAs are patent. There is severe narrowing at origin of right A1 segment. MCAs and their cortical branches are patent. The right MCA is within normal limit of size. V4 arteries, basilar artery and PCAs are patent. Bilateral P-comm's are patent.
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Findings: Head CT: There is no intraparenchymal hemorrhage in the right basal ganglia measuring 18 x 13 mm on image 36 series 201. There is mild surrounding vasogenic edema. There is no significant mass effect or midline shift. There is questionable trace right paramedian frontal lobe subarachnoid hemorrhage. There is no other acute intracranial hemorrhage. There is no evidence of acute infarction, intracranial mass or hydrocephalus. There is no acute calvarial fracture. There is a moderate size right parietal occipital scalp subgaleal hematoma. Maxillofacial CT: There is left periorbital and left anterior cheek soft tissue swelling. There is no other evidence of orbital soft tissue injury. There is a chronic fracture of the right posterior lamina papyracea. There are no acute maxillofacial or mandibular fractures or traumatic TMJ dislocation. There is no mucosal thickening in the ethmoid, sphenoid and maxillary sinuses. The middle ears, mastoid antra, and mastoid air cells are clear.
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15,117 |
Brain and neck MR angiogram without contrast HISTORY: Evaluation for carotid artery dissection Technique: MRA of the neck and brain was performed before and after the intravenous administration of contrast. 3-D and MIP images were reconstructed. COMPARISON: MR angiogram dated 6/19/2012 FINDINGS: Aortic arch: The visualized portion of the aortic arch is patent. The origin of the main arteries are also patent. Right carotid circulation: The right common carotid artery is patent. The cervical portion of the right internal carotid artery is diffusely small in size, unchanged since prior MR angiogram of 2012. Left carotid circulation: Normal in course, caliber, and contour. Vertebral arteries: Normal in course, caliber, and contour. Intracranial arterial circulation: The intracranial portion of the right internal carotid artery is diffusely small in size. The flow signal within the cavernosal and paraclinoid segment of right internal carotid artery cannot be visualized concerning for slow flow versus occlusion. Intracranial portion of left internal carotid artery is patent. A1 segments and ACAs are patent. There is severe narrowing at origin of right A1 segment. MCAs and their cortical branches are patent. The right MCA is within normal limit of size. V4 arteries, basilar artery and PCAs are patent. Bilateral P-comm's are patent. IMPRESSION: No obvious interval change since prior MR angiogram of 2012. Diffuse narrowing of entire cervical right internal carotid artery with significantly decreased flow signal versus occlusion of the intracranial portion of the right internal carotid artery. Findings are most consistent with sequela of previous dissection. Reconstitution of the right MCA and right A1 segment . Severe narrowing at origin of right A1 segment. Right MCA is within normal limit of size.
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FINDINGS: Aortic arch: The visualized portion of the aortic arch is patent. The origin of the main arteries are also patent. Right carotid circulation: The right common carotid artery is patent. The cervical portion of the right internal carotid artery is diffusely small in size, unchanged since prior MR angiogram of 2012. Left carotid circulation: Normal in course, caliber, and contour. Vertebral arteries: Normal in course, caliber, and contour. Intracranial arterial circulation: The intracranial portion of the right internal carotid artery is diffusely small in size. The flow signal within the cavernosal and paraclinoid segment of right internal carotid artery cannot be visualized concerning for slow flow versus occlusion. Intracranial portion of left internal carotid artery is patent. A1 segments and ACAs are patent. There is severe narrowing at origin of right A1 segment. MCAs and their cortical branches are patent. The right MCA is within normal limit of size. V4 arteries, basilar artery and PCAs are patent. Bilateral P-comm's are patent.
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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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15,118 |
MR Angio Head wo contrast 1/21/2022 9:36 AM Clinical Information: 73-year-old female, follow-up cerebral aneurysm. Comparison: Brain MR angiograms dated 1/15/2021 and 12/9/2013. Technique: Routine 3-D time-of-flight MRA was performed. 3-D volume rendered and maximum intensity projection segmented MR angiographic projections were generated from the data set. Findings: Unchanged 3 mm aneurysm projecting posteriorly from the right supraclinoid ICA with additional outpouching extending inferiorly in the regions of the anterior choroidal artery and P-comm(series 401, image 85). The tiny outpouching at the origin of the right ACA/anterior communicating artery (series 401, image 90) measures 2 mm and is unchanged in size and morphology. No significant abnormality of the visualized ICAs, ACAs, MCAs and PCAs or the vertebrobasilar system. No abnormal space-occupying lesions within the visualized brain parenchyma. Mild diffuse cerebral volume loss with associated ex vacuo ventriculomegaly. Impression: Unchanged aneurysm of the right supraclinoid ICA and right A2 infundibulum. No new angiographic 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.
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Findings: Unchanged 3 mm aneurysm projecting posteriorly from the right supraclinoid ICA with additional outpouching extending inferiorly in the regions of the anterior choroidal artery and P-comm(series 401, image 85). The tiny outpouching at the origin of the right ACA/anterior communicating artery (series 401, image 90) measures 2 mm and is unchanged in size and morphology. No significant abnormality of the visualized ICAs, ACAs, MCAs and PCAs or the vertebrobasilar system. No abnormal space-occupying lesions within the visualized brain parenchyma. Mild diffuse cerebral volume loss with associated ex vacuo ventriculomegaly.
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Findings: CT head: BRAIN PARENCHYMA: No hemorrhage, intracranial mass, large territory infarct, or edema. Gray-white matter differentiation maintained. Partially empty sella, unchanged. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No acute fracture. No aggressive osseous lesion. VENTRICULAR SYSTEM: Normal. ORBITS: Left lens replacement. SINUSES: Normal.
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15,119 |
EXAM: MR Angio Head wo+w contrast 1/21/2022 10:13 AM CLINICAL INFORMATION: Cerebral aneurysm, s/p coiling, surveillance. Per chart review, history of subarachnoid hemorrhage due to ruptured basilar apex aneurysm status post coiling on 1/14/2020. COMPARISON: MRI/MRA brain dated 1/11/2021, 1/8/2021. CT head dated 10/2/2020. TECHNIQUE: 3-D time-of-flight MRA images of the brain were obtained without contrast followed by postcontrast MRA images. Volume rendered and 3-D MIP reconstructions were performed. Patient weight: 153 lbs. IV contrast: ProHance, 14 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: 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. Basilar tip aneurysm coiling. No significant residual filling. There is no evidence of new saccular aneurysm, vascular malformation, or large vessel occlusion. _________________________ CONCLUSION: Stable post basilar tip aneurysm coiling without significant residual filling. No new aneurysm or significant stenosis of the intracranial vasculature. 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.
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FINDINGS: 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. Basilar tip aneurysm coiling. No significant residual filling. There is no evidence of new saccular aneurysm, vascular malformation, or large vessel occlusion. _________________________
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The trachea and central airways are patent. The ballistic injury to the anterior/inferior right lung with bullet tract coursing through the right middle lobe. Associated lung laceration and contusion is noted both anteriorly and posteriorly. Trace right pneumothorax most pronounced at the apex with associated hemothorax. Lucency at the left apex may represent a small pneumothorax in the setting of trauma. Left lung is otherwise clear aside from faint groundglass densities in the periphery of the left lower lobe. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Suspected diaphragmatic discontinuity involving the posterior/medial aspect of the right hemidiaphragm associated with the previously described ballistic injury. LYMPH NODES: None enlarged. CHEST WALL: Ballistic injury to the anterior right chest with large ballistic fragment noted within the right pectoral muscle. A small amount of associated soft tissue emphysema is noted. ABDOMEN and PELVIS: LIVER: Large superior hepatic laceration/ballistic injury with multiple scattered ballistic fragments within the liver. Moderate size focus of active extravasation is posterior to the hepatic hilum, medially best appreciated on axial series 201 image 242. This laceration and associated gas closely abuts the right aspect of the intrahepatic IVC. Question of possible intrahepatic IVC and right hepatic vein injury is raised. The hepatic veins superiorly appear intact. Mild heterogeneous enhancement/hypoenhancement of the lateral aspect of the right hepatic lobe best appreciated on axial series 201 image 278 is suggestive of at least partial devascularization. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Left adrenal gland is normal. The right adrenal gland closely abuts previously described liver laceration and adjacent hematoma. Injury to the cranial right adrenal gland is suspected. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is not visualized. The colon is unremarkable. PERITONEUM / MESENTERY: No significant free fluid or free intraperitoneal air aside from near the hepatic hilum/medial right hemidiaphragm. RETROPERITONEUM: A small amount of gas is noted tracking along the right psoas muscle. VESSELS: The previously noted right upper quadrant ballistic injury closely abuts the intrahepatic IVC with associated active extravasation and concern for IVC injury. Otherwise unremarkable. Two right renal arteries. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Ballistic injury to the right upper quadrant with a small amount of associated anterior body wall gas. MUSCULOSKELETAL: Ballistic injury to the right lateral aspect of the L1 vertebral body and transverse process soft tissue contusion as well as soft tissue gas throughout this region in the paraspinal musculature. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: Ballistic injury to the right lateral aspect of the L1 vertebral body with comminuted fracture involvement of the right transverse process, lateral aspect of the right pedicle, and right superior facet. There is intra-articular extension involving the right superior facet. Ballistic fragment is noted centrally within the spinal canal at the level of L2-L3. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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MR Femur Right wo+w contrast TECHNIQUE: Multi planar and multisequence MRI of the right femur was obtained without and with intravenous contrast. Patient weight: 185 lbs. IV contrast: ProHance, 18 ml, per protocol. IV contrast injection rate: 1 ml per sec. CLINICAL INFORMATION: Right thigh schwannoma; please eval for stability COMPARISON: 7/16/2021 FINDINGS: Along the course of the sciatic nerve, there is redemonstration of an enhancing T1 hypointense T2 hyperintense ovoid mass measuring 2.0 x 1.8 x 2.5 cm AP, transverse, and craniocaudal dimensions, respectively (image 24, series 2001; image 59, series 1901). This mass measured 1.7 x 1.9 x 2.4 cm AP, transverse, and craniocaudal dimensions, respectively, on the most recent prior exam dated 7/16/2021. There is minimal mass effect on adjacent structures. No surrounding edema. No abnormal bone marrow signal to suggest acute fracture or aggressive osseous lesion. The visualized muscles and tendons are intact and unremarkable. CONCLUSION: Stable size of the known schwannoma of the right sciatic nerve. 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.
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FINDINGS: Along the course of the sciatic nerve, there is redemonstration of an enhancing T1 hypointense T2 hyperintense ovoid mass measuring 2.0 x 1.8 x 2.5 cm AP, transverse, and craniocaudal dimensions, respectively (image 24, series 2001; image 59, series 1901). This mass measured 1.7 x 1.9 x 2.4 cm AP, transverse, and craniocaudal dimensions, respectively, on the most recent prior exam dated 7/16/2021. There is minimal mass effect on adjacent structures. No surrounding edema. No abnormal bone marrow signal to suggest acute fracture or aggressive osseous lesion. The visualized muscles and tendons are intact and unremarkable.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The trachea and central airways are patent. The ballistic injury to the anterior/inferior right lung with bullet tract coursing through the right middle lobe. Associated lung laceration and contusion is noted both anteriorly and posteriorly. Trace right pneumothorax most pronounced at the apex with associated hemothorax. Lucency at the left apex may represent a small pneumothorax in the setting of trauma. Left lung is otherwise clear aside from faint groundglass densities in the periphery of the left lower lobe. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Suspected diaphragmatic discontinuity involving the posterior/medial aspect of the right hemidiaphragm associated with the previously described ballistic injury. LYMPH NODES: None enlarged. CHEST WALL: Ballistic injury to the anterior right chest with large ballistic fragment noted within the right pectoral muscle. A small amount of associated soft tissue emphysema is noted. ABDOMEN and PELVIS: LIVER: Large superior hepatic laceration/ballistic injury with multiple scattered ballistic fragments within the liver. Moderate size focus of active extravasation is posterior to the hepatic hilum, medially best appreciated on axial series 201 image 242. This laceration and associated gas closely abuts the right aspect of the intrahepatic IVC. Question of possible intrahepatic IVC and right hepatic vein injury is raised. The hepatic veins superiorly appear intact. Mild heterogeneous enhancement/hypoenhancement of the lateral aspect of the right hepatic lobe best appreciated on axial series 201 image 278 is suggestive of at least partial devascularization. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Left adrenal gland is normal. The right adrenal gland closely abuts previously described liver laceration and adjacent hematoma. Injury to the cranial right adrenal gland is suspected. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is not visualized. The colon is unremarkable. PERITONEUM / MESENTERY: No significant free fluid or free intraperitoneal air aside from near the hepatic hilum/medial right hemidiaphragm. RETROPERITONEUM: A small amount of gas is noted tracking along the right psoas muscle. VESSELS: The previously noted right upper quadrant ballistic injury closely abuts the intrahepatic IVC with associated active extravasation and concern for IVC injury. Otherwise unremarkable. Two right renal arteries. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Ballistic injury to the right upper quadrant with a small amount of associated anterior body wall gas. MUSCULOSKELETAL: Ballistic injury to the right lateral aspect of the L1 vertebral body and transverse process soft tissue contusion as well as soft tissue gas throughout this region in the paraspinal musculature. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: Ballistic injury to the right lateral aspect of the L1 vertebral body with comminuted fracture involvement of the right transverse process, lateral aspect of the right pedicle, and right superior facet. There is intra-articular extension involving the right superior facet. Ballistic fragment is noted centrally within the spinal canal at the level of L2-L3. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: Liver disease, elevated liver function tests COMPARISON: None. TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 228 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: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Liver morphology is noncirrhotic. There is diffuse hepatic steatosis. Subcentimeter fluid signal intensity cyst in the right hepatic lobe. No suspicious hepatic lesion. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Enlarged ADRENALS: Normal. KIDNEYS: Subcentimeter fluid signal intensity cyst in the interpolar left kidney. The kidneys are otherwise unremarkable. 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: Hepatic steatosis (quantified on MR elastography examination performed same date). No focal hepatic lesion. 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.
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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: Liver morphology is noncirrhotic. There is diffuse hepatic steatosis. Subcentimeter fluid signal intensity cyst in the right hepatic lobe. No suspicious hepatic lesion. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Enlarged ADRENALS: Normal. KIDNEYS: Subcentimeter fluid signal intensity cyst in the interpolar left kidney. The kidneys are otherwise unremarkable. 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.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The trachea and central airways are patent. The ballistic injury to the anterior/inferior right lung with bullet tract coursing through the right middle lobe. Associated lung laceration and contusion is noted both anteriorly and posteriorly. Trace right pneumothorax most pronounced at the apex with associated hemothorax. Lucency at the left apex may represent a small pneumothorax in the setting of trauma. Left lung is otherwise clear aside from faint groundglass densities in the periphery of the left lower lobe. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Suspected diaphragmatic discontinuity involving the posterior/medial aspect of the right hemidiaphragm associated with the previously described ballistic injury. LYMPH NODES: None enlarged. CHEST WALL: Ballistic injury to the anterior right chest with large ballistic fragment noted within the right pectoral muscle. A small amount of associated soft tissue emphysema is noted. ABDOMEN and PELVIS: LIVER: Large superior hepatic laceration/ballistic injury with multiple scattered ballistic fragments within the liver. Moderate size focus of active extravasation is posterior to the hepatic hilum, medially best appreciated on axial series 201 image 242. This laceration and associated gas closely abuts the right aspect of the intrahepatic IVC. Question of possible intrahepatic IVC and right hepatic vein injury is raised. The hepatic veins superiorly appear intact. Mild heterogeneous enhancement/hypoenhancement of the lateral aspect of the right hepatic lobe best appreciated on axial series 201 image 278 is suggestive of at least partial devascularization. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Left adrenal gland is normal. The right adrenal gland closely abuts previously described liver laceration and adjacent hematoma. Injury to the cranial right adrenal gland is suspected. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is not visualized. The colon is unremarkable. PERITONEUM / MESENTERY: No significant free fluid or free intraperitoneal air aside from near the hepatic hilum/medial right hemidiaphragm. RETROPERITONEUM: A small amount of gas is noted tracking along the right psoas muscle. VESSELS: The previously noted right upper quadrant ballistic injury closely abuts the intrahepatic IVC with associated active extravasation and concern for IVC injury. Otherwise unremarkable. Two right renal arteries. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Ballistic injury to the right upper quadrant with a small amount of associated anterior body wall gas. MUSCULOSKELETAL: Ballistic injury to the right lateral aspect of the L1 vertebral body and transverse process soft tissue contusion as well as soft tissue gas throughout this region in the paraspinal musculature. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: Ballistic injury to the right lateral aspect of the L1 vertebral body with comminuted fracture involvement of the right transverse process, lateral aspect of the right pedicle, and right superior facet. There is intra-articular extension involving the right superior facet. Ballistic fragment is noted centrally within the spinal canal at the level of L2-L3. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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MR Elastography CLINICAL INFORMATION: NAFLD and Sarcoid COMPARISON: None TECHNIQUE: MR Elastography. FINDINGS: STIFFNESS: The average liver stiffness calculated on MR Elastography is: 2.4 kPa, which is compatible with normal. Reference values: 5 kPa: cirrhosis These are broad categories and results should be interpreted with clinical and laboratory findings for other possible causes of increased liver stiffness. FAT QUANTIFICATION: The average liver fat content percentage calculated is: 19%. IRON QUANTIFICATION: The R2* value is: 35 sec\S\-1. OTHER FINDINGS: See abdominal MRI performed same date CONCLUSION: 1. MR Elastography demonstrated a stiffness of 2.4 kPa, which is normal (normal < 2.5 kPa). 2. Based on measurements in multiple regions of interest, the fat fraction of the liver is approximately 19%, which is abnormal (normal < 6%). 3. The study was performed at 1.5 T. The R2* value is approximately 35 s\S\-1, which is normal (normal < 60 s\S\-1 at 1.5 T). 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.
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FINDINGS: STIFFNESS: The average liver stiffness calculated on MR Elastography is: 2.4 kPa, which is compatible with normal. Reference values: 5 kPa: cirrhosis These are broad categories and results should be interpreted with clinical and laboratory findings for other possible causes of increased liver stiffness. FAT QUANTIFICATION: The average liver fat content percentage calculated is: 19%. IRON QUANTIFICATION: The R2* value is: 35 sec\S\-1. OTHER FINDINGS: See abdominal MRI performed same date
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The trachea and central airways are patent. The ballistic injury to the anterior/inferior right lung with bullet tract coursing through the right middle lobe. Associated lung laceration and contusion is noted both anteriorly and posteriorly. Trace right pneumothorax most pronounced at the apex with associated hemothorax. Lucency at the left apex may represent a small pneumothorax in the setting of trauma. Left lung is otherwise clear aside from faint groundglass densities in the periphery of the left lower lobe. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Suspected diaphragmatic discontinuity involving the posterior/medial aspect of the right hemidiaphragm associated with the previously described ballistic injury. LYMPH NODES: None enlarged. CHEST WALL: Ballistic injury to the anterior right chest with large ballistic fragment noted within the right pectoral muscle. A small amount of associated soft tissue emphysema is noted. ABDOMEN and PELVIS: LIVER: Large superior hepatic laceration/ballistic injury with multiple scattered ballistic fragments within the liver. Moderate size focus of active extravasation is posterior to the hepatic hilum, medially best appreciated on axial series 201 image 242. This laceration and associated gas closely abuts the right aspect of the intrahepatic IVC. Question of possible intrahepatic IVC and right hepatic vein injury is raised. The hepatic veins superiorly appear intact. Mild heterogeneous enhancement/hypoenhancement of the lateral aspect of the right hepatic lobe best appreciated on axial series 201 image 278 is suggestive of at least partial devascularization. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Left adrenal gland is normal. The right adrenal gland closely abuts previously described liver laceration and adjacent hematoma. Injury to the cranial right adrenal gland is suspected. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is not visualized. The colon is unremarkable. PERITONEUM / MESENTERY: No significant free fluid or free intraperitoneal air aside from near the hepatic hilum/medial right hemidiaphragm. RETROPERITONEUM: A small amount of gas is noted tracking along the right psoas muscle. VESSELS: The previously noted right upper quadrant ballistic injury closely abuts the intrahepatic IVC with associated active extravasation and concern for IVC injury. Otherwise unremarkable. Two right renal arteries. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Ballistic injury to the right upper quadrant with a small amount of associated anterior body wall gas. MUSCULOSKELETAL: Ballistic injury to the right lateral aspect of the L1 vertebral body and transverse process soft tissue contusion as well as soft tissue gas throughout this region in the paraspinal musculature. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: Ballistic injury to the right lateral aspect of the L1 vertebral body with comminuted fracture involvement of the right transverse process, lateral aspect of the right pedicle, and right superior facet. There is intra-articular extension involving the right superior facet. Ballistic fragment is noted centrally within the spinal canal at the level of L2-L3. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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EXAM: MR Cholangiopancreatography MRCP, MR Abdomen wo+w contrast CLINICAL INFORMATION: Liver disease, HCC screening. Medical record indicates primary sclerosing cholangitis. COMPARISON: Abdominal ultrasound 12/2/2021 TECHNIQUE: MR Cholangiopancreatography MRCP, MR Abdomen wo+w contrast Patient weight: 217 lbs. IV contrast: ProHance, 20 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. Patchy fibrosis in the liver. LIVER LESIONS: None LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: None. - Other varices or collaterals: None. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: No abnormality. LYMPH NODES: None enlarged. SPLEEN: Mild splenomegaly PERITONEUM / ASCITES: Trace perisplenic fluid.. 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: No significant abnormality. CONCLUSION: 1. Hepatic cirrhosis. No focal suspicious hepatic lesion. 2. No biliary dilatation, stone or stricture. 3. Mild splenomegaly. 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.
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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. Patchy fibrosis in the liver. LIVER LESIONS: None LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: None. - Other varices or collaterals: None. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: No abnormality. LYMPH NODES: None enlarged. SPLEEN: Mild splenomegaly PERITONEUM / ASCITES: Trace perisplenic fluid.. 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: No significant abnormality.
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FINDINGS: Redemonstration of a large 6.1 x 3.6 x 4.1 cm left temporal parenchymal hematoma with suggestion of layering and loculation. The hemorrhage has decompressed into the left lateral ventricle. There is moderate to large hemorrhage. No significant change in the right frontal and temporal parenchymal hemorrhages with few suggesting layering hemorrhage. No significant change in the bilateral cerebral convexity, parafalcine and tentorial subdural hemorrhages. Diffuse subarachnoid hemorrhage has also slightly increased. There is no significant midline shift. No frank hydrocephalus. No appreciable calvarial fracture. Patient is intubated.
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EXAM: MR Cholangiopancreatography MRCP, MR Abdomen wo+w contrast CLINICAL INFORMATION: Liver disease, HCC screening. Medical record indicates primary sclerosing cholangitis. COMPARISON: Abdominal ultrasound 12/2/2021 TECHNIQUE: MR Cholangiopancreatography MRCP, MR Abdomen wo+w contrast Patient weight: 217 lbs. IV contrast: ProHance, 20 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. Patchy fibrosis in the liver. LIVER LESIONS: None LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: None. - Other varices or collaterals: None. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: No abnormality. LYMPH NODES: None enlarged. SPLEEN: Mild splenomegaly PERITONEUM / ASCITES: Trace perisplenic fluid.. 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: No significant abnormality. CONCLUSION: 1. Hepatic cirrhosis. No focal suspicious hepatic lesion. 2. No biliary dilatation, stone or stricture. 3. Mild splenomegaly. 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.
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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. Patchy fibrosis in the liver. LIVER LESIONS: None LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: None. - Other varices or collaterals: None. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: No abnormality. LYMPH NODES: None enlarged. SPLEEN: Mild splenomegaly PERITONEUM / ASCITES: Trace perisplenic fluid.. 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: No significant abnormality.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Basilar atelectasis. Otherwise normal. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix and colon are normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Accessory inferior right hepatic vein. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Postsurgical changes of tubal ligation. The uterus is present. No adnexal mass. BODY WALL: Subtle contusion/stranding overlying the anterior abdominal wall. Fat-containing umbilical hernia. MUSCULOSKELETAL: Left L5 hemilaminotomy. No acute osseous abnormality.
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EXAM: MR Lumbar Spine wo+w contrast 1/21/2022 10:41 AM CLINICAL INFORMATION: Ependymoma. Per chart review, history of thoracolumbar spine intradural ependymoma (WHO grade II) status post resection x3 with T12-L3 laminectomy, most recently in 2016. COMPARISON: MRI lumbar spine dated 8/20/2021, 2/22/2019. TECHNIQUE: T1 sagittal and axial spin echo, sagittal STIR, T2 sagittal and axial fast spin echo, post contrast sagittal and axial T1. Patient weight: 180 lbs. IV contrast: ProHance, 9 ml, per protocol. FINDINGS: Stable postsurgical changes from prior T12-L3 laminectomy and tumor resection with residual enhancing soft tissue in the resection bed, overall unchanged. No new or focal masslike enhancement. Irregular clumping of the cauda equina nerve roots at the L2-L3 level, overall unchanged and possibly reflecting postsurgical adhesive changes. Multifocal fluid-intensity collections within the ventral thecal sac at the level of L1-L2 and right thecal sac at the level of L3 with posterior displacement of the cauda equina nerve roots, suggestive of subdural collections but overall unchanged. Vertebral body heights are preserved. There are no malignant-appearing lumbar vertebral marrow signal abnormalities. Lumbar intervertebral alignment is normal. The conus medullaris appears normal. The spinal cord terminus is at the L1 level. Multilevel mild lower lumbar spine degenerative changes with mild diffuse disc bulge at L5-S1. No significant spinal canal stenosis. Mild left neuroforaminal stenosis at L5-S1. Retroperitoneal structures and the paravertebral musculature appear normal. Included portions of the sacroiliac joints appear normal. _________________________ CONCLUSION: 1. Stable postsurgical changes from prior T12-L3 laminectomy and tumor resection without new or focal masslike enhancement to suggest residual/recurrent disease. 2. 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.
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FINDINGS: Stable postsurgical changes from prior T12-L3 laminectomy and tumor resection with residual enhancing soft tissue in the resection bed, overall unchanged. No new or focal masslike enhancement. Irregular clumping of the cauda equina nerve roots at the L2-L3 level, overall unchanged and possibly reflecting postsurgical adhesive changes. Multifocal fluid-intensity collections within the ventral thecal sac at the level of L1-L2 and right thecal sac at the level of L3 with posterior displacement of the cauda equina nerve roots, suggestive of subdural collections but overall unchanged. Vertebral body heights are preserved. There are no malignant-appearing lumbar vertebral marrow signal abnormalities. Lumbar intervertebral alignment is normal. The conus medullaris appears normal. The spinal cord terminus is at the L1 level. Multilevel mild lower lumbar spine degenerative changes with mild diffuse disc bulge at L5-S1. No significant spinal canal stenosis. Mild left neuroforaminal stenosis at L5-S1. Retroperitoneal structures and the paravertebral musculature appear normal. Included portions of the sacroiliac joints appear normal. _________________________
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Basilar atelectasis. Otherwise normal. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix and colon are normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Accessory inferior right hepatic vein. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Postsurgical changes of tubal ligation. The uterus is present. No adnexal mass. BODY WALL: Subtle contusion/stranding overlying the anterior abdominal wall. Fat-containing umbilical hernia. MUSCULOSKELETAL: Left L5 hemilaminotomy. No acute osseous abnormality.
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EXAM: MR Lumbar Spine wo+w contrast 1/21/2022 10:28 AM CLINICAL INFORMATION: Lumbosacral spondylosis, increased lumbosacral pain; post lumbar decompression. Per chart review, history of L3-L5 dorsal decompression August 2015. COMPARISON: CT lumbar spine dated 4/1/2021. MRI lumbar spine dated 5/7/2019. 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. Patient weight: 140 lbs. IV contrast: ProHance, 6 ml, per protocol. IV contrast injection rate: 1 ml per sec. FINDINGS: Stable postsurgical changes related to L3-L5 decompressive laminectomy with posterior element resection. Sagittal imaging demonstrates mild stepwise degenerative retrolisthesis of L1 on L2 and L2 on L3, unchanged. Mild stepwise degenerative anterolisthesis of L4 on L5 and L5 on S1, unchanged. Chronic mild anterior wedge compression deformity of the T11 and T12 vertebral bodies, unchanged. Multilevel degenerative discogenic disease and facet arthropathy with thoracolumbar disc desiccation. Severe disc space height loss with sclerotic endplate changes at T11-T12, L2-L3, and L4-L5 (Modic type III), overall unchanged. The conus terminates at the pedicle level of L1. Axial images are evaluated on a level by level basis: T11-T12: Mild diffuse disc bulge, bilateral facet arthropathy, and right ligamentum flavum thickening, resulting in mild spinal canal stenosis and mild effacement of the right lateral recess with contact upon the transiting right T12 nerve root. Mild bilateral neuroforaminal stenosis. T12-L1: There are bilateral facet joint synovial cysts projecting along the lateral margins of the spinal canal without significant spinal canal narrowing. L1-2: Minimal diffuse disc bulge and mild bilateral facet arthropathy without significant spinal canal stenosis. Mild bilateral foraminal narrowing. L2-3: Moderate diffuse disc bulge, bilateral facet arthropathy, and right ligamentum flavum thickening, resulting in moderate spinal canal stenosis with effacement of both lateral recesses and contact upon the transiting L3 nerve roots bilaterally. Severe right and moderate left neuroforaminal stenosis with likely impingement on the exiting right L2 nerve root. L3-4: Mild diffuse disc bulge and moderate bilateral facet arthropathy, resulting in mild spinal canal stenosis. Moderate bilateral neuroforaminal stenosis. L4-5: Moderate diffuse disc bulge, mild right and severe left facet arthropathy, and left ligamentum flavum thickening, resulting in mild spinal canal stenosis. Severe left foraminal narrowing with impingement on the exiting left L4 nerve root. There is mild right foraminal narrowing. L5-S1: Mild diffuse disc bulge and moderate bilateral facet arthropathy without significant spinal canal stenosis. Moderate left and mild right foraminal narrowing. No abnormal postcontrast enhancement. The visualized paraspinal structures appear otherwise within normal limits. The remaining visualized osseous and soft tissue structures demonstrate normal MR signal characteristics. _________________________ CONCLUSION: 1. Stable L3-L5 decompressive laminectomy postsurgical changes. No pathologic enhancement is identified. 2. Mild stepwise degenerative retrolisthesis of L1 on L2 and L2 on L3, unchanged. Mild stepwise degenerative anterolisthesis of L4 on L5 and L5 on S1, unchanged. 3. Advanced multilevel degenerative changes, overall similar compared to prior. Moderate spinal canal stenosis at L2-L3 and multilevel foraminal narrowing, most prominent on the right at L2-3 and left at L4-5, as detailed above. 4. Chronic T11 and T12 mild anterior wedge compression deformities, unchanged.. 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.
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FINDINGS: Stable postsurgical changes related to L3-L5 decompressive laminectomy with posterior element resection. Sagittal imaging demonstrates mild stepwise degenerative retrolisthesis of L1 on L2 and L2 on L3, unchanged. Mild stepwise degenerative anterolisthesis of L4 on L5 and L5 on S1, unchanged. Chronic mild anterior wedge compression deformity of the T11 and T12 vertebral bodies, unchanged. Multilevel degenerative discogenic disease and facet arthropathy with thoracolumbar disc desiccation. Severe disc space height loss with sclerotic endplate changes at T11-T12, L2-L3, and L4-L5 (Modic type III), overall unchanged. The conus terminates at the pedicle level of L1. Axial images are evaluated on a level by level basis: T11-T12: Mild diffuse disc bulge, bilateral facet arthropathy, and right ligamentum flavum thickening, resulting in mild spinal canal stenosis and mild effacement of the right lateral recess with contact upon the transiting right T12 nerve root. Mild bilateral neuroforaminal stenosis. T12-L1: There are bilateral facet joint synovial cysts projecting along the lateral margins of the spinal canal without significant spinal canal narrowing. L1-2: Minimal diffuse disc bulge and mild bilateral facet arthropathy without significant spinal canal stenosis. Mild bilateral foraminal narrowing. L2-3: Moderate diffuse disc bulge, bilateral facet arthropathy, and right ligamentum flavum thickening, resulting in moderate spinal canal stenosis with effacement of both lateral recesses and contact upon the transiting L3 nerve roots bilaterally. Severe right and moderate left neuroforaminal stenosis with likely impingement on the exiting right L2 nerve root. L3-4: Mild diffuse disc bulge and moderate bilateral facet arthropathy, resulting in mild spinal canal stenosis. Moderate bilateral neuroforaminal stenosis. L4-5: Moderate diffuse disc bulge, mild right and severe left facet arthropathy, and left ligamentum flavum thickening, resulting in mild spinal canal stenosis. Severe left foraminal narrowing with impingement on the exiting left L4 nerve root. There is mild right foraminal narrowing. L5-S1: Mild diffuse disc bulge and moderate bilateral facet arthropathy without significant spinal canal stenosis. Moderate left and mild right foraminal narrowing. No abnormal postcontrast enhancement. The visualized paraspinal structures appear otherwise within normal limits. The remaining visualized osseous and soft tissue structures demonstrate normal MR signal characteristics. _________________________
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FINDINGS: NECK ANGIOGRAM: AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. LEFT CAROTID: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. RIGHT VERTEBRAL ARTERY: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. LEFT VERTEBRAL ARTERY: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. No contrast extravasation or pseudoaneurysm is identified. Visualized intracranial arteries: Fetal origin of the right PCA. No acute abnormality as visualized. SOFT TISSUES: No soft tissue abnormality within the neck. CERVICAL SPINE: The imaged skull base, occipital bone, and occipital condyles demonstrate no acute fracture. Atlantodental and basion dens intervals are within normal limits. No acute vertebral body fracture identified. No acute disc space or facet joint injury. Normal appearance of the prevertebral soft tissues. Normal cervical spine alignment.
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MR Lumbar Spine wo+w contrast 1/23/2022 3:17 AM CLINICAL INFORMATION: 64 years Male COVID Confirmed weakness COMPARISON: Lumbar spine radiographs 1/21/2022 TECHNIQUE: Multisequence, multiplanar images of the lumbar spine were obtained before and after the administration of IV contrast. Patient weight: 161 lbs. IV contrast: ProHance, 15 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: VERTEBRA: Vertebral body height and anterior/posterior alignment are preserved throughout the lumbar spine. Vertebra demonstrate nonspecific diffusely heterogeneous marrow signal which may simply represent marrow reconversion. DISC SPACES AND FACET JOINTS: Multilevel disc bulge in the lower lumbar spine resulting in bilateral neural foraminal narrowing. Vertebral levels are discussed individually below. SPINAL CORD: Conus medullaris terminates at the L1-L2 vertebral level. The spinal cord and cauda equina nerve roots demonstrate normal intrinsic signal. There is no abnormal clumping of the nerve roots No abnormal enhancement. PARAVERTEBRAL SOFT TISSUES: Normal. RETROPERITONEUM: Simple cyst is noted in the lateral right upper pole. Additional subcentimeter T2 hyperintense, T1 hypointense nonenhancing lesions in the left kidney are technically indeterminant, but are also suggestive of cysts. VERTEBRAL LEVELS: T12-L1: No significant spinal canal narrowing or neural foraminal narrowing. L1-L2: No significant spinal canal narrowing or neural foraminal narrowing. L2-L3: No significant spinal canal narrowing or neural foraminal narrowing. L3-L4: Small right foraminal disc protrusion, resulting in mild right neural foraminal narrowing. No significant neural foraminal narrowing on the left. There is no central canal narrowing L4-L5: Circumferential disc bulge with bilateral foraminal disc protrusion, worse on the right, with ligamentum flavum thickening and hypertrophic facet arthropathy resulting in moderate to severe right neural foraminal narrowing with exiting nerve root contact and possible compression, and moderate left neural foraminal narrowing. L5-S1: Circumferential disc bulge, hypertrophic facet arthropathy and ligamentum flavum thickening resulting in mild spinal canal and moderate-severe bilateral neural foraminal narrowing with contact of the exiting nerve roots. IMPRESSION: 01. Inferior lumbar spine degenerative disc disease and facet arthropathy. At L4-L5, there is moderate to severe right neural foraminal narrowing with contact of the exiting right L4 nerve root and possible compression. At L5-S1 there is moderate-severe bilateral neural foraminal narrowing with contact of the exiting nerve roots.. 02. No abnormal enhancement of the nerve roots 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.
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FINDINGS: VERTEBRA: Vertebral body height and anterior/posterior alignment are preserved throughout the lumbar spine. Vertebra demonstrate nonspecific diffusely heterogeneous marrow signal which may simply represent marrow reconversion. DISC SPACES AND FACET JOINTS: Multilevel disc bulge in the lower lumbar spine resulting in bilateral neural foraminal narrowing. Vertebral levels are discussed individually below. SPINAL CORD: Conus medullaris terminates at the L1-L2 vertebral level. The spinal cord and cauda equina nerve roots demonstrate normal intrinsic signal. There is no abnormal clumping of the nerve roots No abnormal enhancement. PARAVERTEBRAL SOFT TISSUES: Normal. RETROPERITONEUM: Simple cyst is noted in the lateral right upper pole. Additional subcentimeter T2 hyperintense, T1 hypointense nonenhancing lesions in the left kidney are technically indeterminant, but are also suggestive of cysts. VERTEBRAL LEVELS: T12-L1: No significant spinal canal narrowing or neural foraminal narrowing. L1-L2: No significant spinal canal narrowing or neural foraminal narrowing. L2-L3: No significant spinal canal narrowing or neural foraminal narrowing. L3-L4: Small right foraminal disc protrusion, resulting in mild right neural foraminal narrowing. No significant neural foraminal narrowing on the left. There is no central canal narrowing L4-L5: Circumferential disc bulge with bilateral foraminal disc protrusion, worse on the right, with ligamentum flavum thickening and hypertrophic facet arthropathy resulting in moderate to severe right neural foraminal narrowing with exiting nerve root contact and possible compression, and moderate left neural foraminal narrowing. L5-S1: Circumferential disc bulge, hypertrophic facet arthropathy and ligamentum flavum thickening resulting in mild spinal canal and moderate-severe bilateral neural foraminal narrowing with contact of the exiting nerve roots.
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Findings: Head CT: There is small left frontal scalp subgaleal hematoma with a density in the left supraorbital soft tissues measuring 5 mm.. No acute calvarial fracture. There is a questionable subdural hematoma along the left frontal convexity versus artifact. There is no significant mass effect or brain edema. No other definite intracranial hemorrhage. No acute infarction, intracranial mass or hydrocephalus. Maxillofacial CT: There are no acute maxillofacial or mandibular fractures or traumatic TMJ dislocation . There is no evidence of orbital soft tissue injury. The paranasal sinuses, middle ears, mastoid antra, and mastoid air cells are clear.
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MR Breast Diagnostic Bil wo+w contrast CLINICAL INFORMATION: 72-year-old female with a history of bilateral breast cancer now status post right breast mastectomy and breast conservation therapy in the left breast. 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: 164 lbs. IV contrast: ProHance, 15 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: Prior breast MRI 11/16/2020 MRI FINDINGS: The left breast is composed of heterogeneous fibroglandular tissue. Following contrast administration, there is minimal background enhancement. RIGHT BREAST: There are postoperative changes of right breast mastectomy. There is subcutaneous edema and a 25 mm seroma within the chest wall. There is no suspicious enhancement within the surgical bed. LEFT BREAST: There is no suspicious enhancing mass or nonmass enhancement. There is susceptibility artifact in the medial breast from patient's loop recorder. LYMPH NODES: There are postsurgical changes in the right axilla including an 11 mm seroma. There is no axillary or internal mammary adenopathy. OTHER: Right hydronephrosis as seen on prior exams is again partially seen on localizer images. IMPRESSION: RIGHT BREAST: Postoperative changes of mastectomy without evidence of malignancy within the surgical bed. BI-RADS 2: Benign LEFT BREAST: No MRI evidence of malignancy. BI-RADS 2: Benign Recommend continued annual screening with mammogram and MRI.
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FINDINGS: The left breast is composed of heterogeneous fibroglandular tissue. Following contrast administration, there is minimal background enhancement. RIGHT BREAST: There are postoperative changes of right breast mastectomy. There is subcutaneous edema and a 25 mm seroma within the chest wall. There is no suspicious enhancement within the surgical bed. LEFT BREAST: There is no suspicious enhancing mass or nonmass enhancement. There is susceptibility artifact in the medial breast from patient's loop recorder. LYMPH NODES: There are postsurgical changes in the right axilla including an 11 mm seroma. There is no axillary or internal mammary adenopathy. OTHER: Right hydronephrosis as seen on prior exams is again partially seen on localizer images.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Trace right basilar pneumothorax. No other significant abnormality. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Increased attenuation in the anterior mediastinum is likely residual thymus. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: The kidneys are normal. The distal aspect of the right ureter is dilated with a large intraurinary bladder cyst at its insertion, likely ureterocele. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Two right renal arteries. Perivascular stranding surrounding the right common femoral artery likely related to recent vascular access. URINARY BLADDER: Unremarkable aside from a right ureterocele. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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MRI brain with and without contrast Clinical Information: Male aged 48 years follow up right temporal AVM with hemorrhage, surveillance Comparison: MR 9/10/2021 and angiogram dated 9/29/2021. Technique: Multiplanar, multisequence MRI of the brain were obtained in multiple planes pre-and post administration of intravenous contrast per departmental protocol. Patient weight: 183 lbs. IV contrast: ProHance, 9 ml, per protocol. Findings: No acute infarct or hemorrhage. Interval resolution of previously seen right superior temporal gyrus evolving hemorrhage with residual susceptibility compatible with chronic blood products. There is corresponding Serpiginous T2 hypointensity of the right superior temporal gyrus. No evidence of recurrent hemorrhage. There is no significant surrounding vasogenic edema. There are scattered foci of FLAIR hyperintensity in the periventricular and subcortical white matter, likely microangiopathic changes. No abnormal parenchymal or leptomeningeal enhancement. Conclusion: 1. Interval resolution of previously seen right superior temporal gyrus hematoma with residual chronic blood products. No recurrent hemorrhage or associated edema. No associated abnormal enhancement. 2. 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.
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Findings: No acute infarct or hemorrhage. Interval resolution of previously seen right superior temporal gyrus evolving hemorrhage with residual susceptibility compatible with chronic blood products. There is corresponding Serpiginous T2 hypointensity of the right superior temporal gyrus. No evidence of recurrent hemorrhage. There is no significant surrounding vasogenic edema. There are scattered foci of FLAIR hyperintensity in the periventricular and subcortical white matter, likely microangiopathic changes. No abnormal parenchymal or leptomeningeal enhancement.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Trace right basilar pneumothorax. No other significant abnormality. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Increased attenuation in the anterior mediastinum is likely residual thymus. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: The kidneys are normal. The distal aspect of the right ureter is dilated with a large intraurinary bladder cyst at its insertion, likely ureterocele. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Two right renal arteries. Perivascular stranding surrounding the right common femoral artery likely related to recent vascular access. URINARY BLADDER: Unremarkable aside from a right ureterocele. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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EXAM: MR Pelvis wo+w contrast CLINICAL INFORMATION: Rectal adenocarcinoma, status post neoadjuvant chemotherapy. COMPARISON: Rectal MRI 7/14/2021. CT 1/11/2022 TECHNIQUE: MR Pelvis wo+w contrast Patient weight: 165 lbs. IV contrast: ProHance, 7 ml, per protocol. FINDINGS: STRUCTURED REPORT: MRI Pelvis Rectal Restaging TREATED TUMOR/TUMOR BED CHARACTERISTICS: The primary tumor and extramural disease shows residual tumor/mucin with no fibrosis. Distance of inferior margin of treated tumor/treated area to the anal verge: 3.3 cm Distance of inferior margin of treated tumor/treated area to the anorectal junction: Involves anorectal junction Relationship to anterior peritoneal reflection: Below Craniocaudal length: 6.0 cm (Previous craniocaudal length: 5. cm) Maximal width: 2.8 cm (Previous width: 2.3 cm) yMR?T category: Suspected T4b (tumor invades or adherent to adjacent organs or structures) If T4b, structures with possible invasion: Suspected invasion of the right puborectalis musculature (series 401 image 31). Questionable EMVI at this level with T2 tubular signal appearing to extend into the adjacent vessel. FUNCTIONAL SEQUENCES DWI - restricted diffusion in tumor or tumor bed: Present FOR LOW RECTAL TUMORS ? Invasion of anal sphincter complex: Invades internal sphincter (IS) only IF present: Upper anal canal Extramural venous invasion: No Is there a separate tumor deposit, LN, or EMVI threatening (? 1mm and ?2 mm) or invading (< 1 mm) the MRF? Yes . Interval decrease in size of previously observed lymph nodes/tumor deposit adjacent to the right aspect of the mesorectal fascia with only mild soft tissue thickening/scarring remaining measuring about 0.9 x 0.7 cm (series 401 image 55). LYMPH NODES: Mesorectal/superior rectal lymph nodes and/or tumor deposits: N+ (suspicious lymph nodes present) Superior most suspicious lymph node/deposit is located: Superior to the rectosigmoid junction at the level of the mid sacrum (series 1/1/2001 image 148) Total number of suspicious mesorectal lymph nodes: At least 7 Extra mesorectal lymph nodes: any suspicious? Yes unchanged right external iliac lymph node measuring 8 mm (series 701 image 153) Osseous metastases: None. Peritoneal metastases: None. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostatomegaly, heterogeneous with calcification. BODY WALL: No significant abnormality. CONCLUSION: Since 7/14/2021, the primary tumor and extramural disease shows: Interval progression. The mesorectal implant has improved but the primary tumor has enlarged with numerous new mesorectal nodes and new possible muscular invasion and EMVI. Post treatment category: ymrT4b, ymrN2 Sphincter involvement: Yes Suspicious extra mesorectal lymph nodes: Yes 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. 'd, Jan 2022 'd, Jan 2022
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FINDINGS: STRUCTURED REPORT: MRI Pelvis Rectal Restaging TREATED TUMOR/TUMOR BED CHARACTERISTICS: The primary tumor and extramural disease shows residual tumor/mucin with no fibrosis. Distance of inferior margin of treated tumor/treated area to the anal verge: 3.3 cm Distance of inferior margin of treated tumor/treated area to the anorectal junction: Involves anorectal junction Relationship to anterior peritoneal reflection: Below Craniocaudal length: 6.0 cm (Previous craniocaudal length: 5. cm) Maximal width: 2.8 cm (Previous width: 2.3 cm) yMR?T category: Suspected T4b (tumor invades or adherent to adjacent organs or structures) If T4b, structures with possible invasion: Suspected invasion of the right puborectalis musculature (series 401 image 31). Questionable EMVI at this level with T2 tubular signal appearing to extend into the adjacent vessel. FUNCTIONAL SEQUENCES DWI - restricted diffusion in tumor or tumor bed: Present FOR LOW RECTAL TUMORS ? Invasion of anal sphincter complex: Invades internal sphincter (IS) only IF present: Upper anal canal Extramural venous invasion: No Is there a separate tumor deposit, LN, or EMVI threatening (? 1mm and ?2 mm) or invading (< 1 mm) the MRF? Yes . Interval decrease in size of previously observed lymph nodes/tumor deposit adjacent to the right aspect of the mesorectal fascia with only mild soft tissue thickening/scarring remaining measuring about 0.9 x 0.7 cm (series 401 image 55). LYMPH NODES: Mesorectal/superior rectal lymph nodes and/or tumor deposits: N+ (suspicious lymph nodes present) Superior most suspicious lymph node/deposit is located: Superior to the rectosigmoid junction at the level of the mid sacrum (series 1/1/2001 image 148) Total number of suspicious mesorectal lymph nodes: At least 7 Extra mesorectal lymph nodes: any suspicious? Yes unchanged right external iliac lymph node measuring 8 mm (series 701 image 153) Osseous metastases: None. Peritoneal metastases: None. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostatomegaly, heterogeneous with calcification. BODY WALL: No significant abnormality.
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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 Pelvis wo+w contrast CLINICAL INFORMATION: Pelvic and perineal pain. Ovarian remnant syndrome. Status post hysterectomy and bilateral Oophorectomy. COMPARISON: None. TECHNIQUE: MR Pelvis wo+w contrast Patient weight: 262 lbs. IV contrast: ProHance, 20 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: Uterus is surgically absent. Ovaries are not visualized consistent with prior oophorectomy. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Unremarkable exam status post hysterectomy and bilateral oophorectomy without overt ovarian remnant seen. No findings to findings to account for pelvic pain are 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.
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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: Uterus is surgically absent. Ovaries are not visualized consistent with prior oophorectomy. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Trace right basilar pneumothorax. No other significant abnormality. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Increased attenuation in the anterior mediastinum is likely residual thymus. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: The kidneys are normal. The distal aspect of the right ureter is dilated with a large intraurinary bladder cyst at its insertion, likely ureterocele. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Two right renal arteries. Perivascular stranding surrounding the right common femoral artery likely related to recent vascular access. URINARY BLADDER: Unremarkable aside from a right ureterocele. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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MR Brain wo contrast Clinical Information: 42-year-old female with altered mental status after MVC. Comparison: CT head dated 1/19/2022. Technique: Multiplanar, multisequence MR images of the brain without contrast. Findings: Some sequences were repeated secondary to motion. Normal brain volume and gray-white matter differentiation. No acute infarct or hemorrhage. No mass, edema, hydrocephalus, or midline shift. Orbits appear normal. Paranasal sinuses are clear. There are bilateral mastoid effusions. Major proximal intracranial flow voids are intact. No aggressive osseous lesion. Conclusion: No acute intracranial abnormality. No MRI evidence for traumatic axonal injury. 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.
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Findings: Some sequences were repeated secondary to motion. Normal brain volume and gray-white matter differentiation. No acute infarct or hemorrhage. No mass, edema, hydrocephalus, or midline shift. Orbits appear normal. Paranasal sinuses are clear. There are bilateral mastoid effusions. Major proximal intracranial flow voids are intact. No aggressive osseous lesion.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Trace right basilar pneumothorax. No other significant abnormality. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Increased attenuation in the anterior mediastinum is likely residual thymus. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: The kidneys are normal. The distal aspect of the right ureter is dilated with a large intraurinary bladder cyst at its insertion, likely ureterocele. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Two right renal arteries. Perivascular stranding surrounding the right common femoral artery likely related to recent vascular access. URINARY BLADDER: Unremarkable aside from a right ureterocele. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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MRI brain without, MR cervical spine without Indication: LUE weakness Spec Inst: stroke protocol Comparison: CT head without contrast 1/21/2022 Technique: Multiple T1 and T2-weighted MR sequence images of the brain were obtained in the sagittal axial and coronal planes without the use of intravenous contrast per departmental protocol. T2 sagittal and axial fast spin spin echo, T1 sagittal spin echo, sagittal STIR, axial T2* gradient echo. Findings: Brain: Restricted diffusion is seen in the right midbrain and pons at the pontomesencephalic junction. Additional tiny foci of restricted diffusion seen in the left frontal deep white matter. There is abnormal DWI signal in the splenium of the corpus callosum. There are innumerable punctate foci of susceptibility consistent diffuse axonal injury prominently in the supratentorial and a few in the infratentorial brain parenchyma. Trace intraventricular hemorrhage with layering of blood products in the posterior horn of the lateral ventricles and fourth ventricle. Inadequate CSF suppression on FLAIR images due to supplemental oxygen. The posterior fossa subarachnoid hemorrhage is better appreciated on the comparison CT. Scattered paranasal sinus mucosal thickening. The mastoids appear clear. . Cervical spine: There is type II odontoid fracture with mild displaced fracture fragments. Disruption of the ligaments around the dens is seen with anterior and posterior epidural hemorrhage is with mild mass effect on the upper cervical cord. No definite cord contusion or cord signal abnormality is identified. Effusions at both lateral atlantooccipital articular relation. There is apparent obscuration of the right V3 flow void with narrow caliber right V4. No significant degenerative changes are seen. Retropharyngeal soft tissue edema maximum thickness 11 mm at C2 The spinal alignment is normal. Vertebral body heights are preserved. There are no suspicious bone marrow signal abnormalities. No definite cord signal abnormality is identified. Impression: 1. Restricted diffusion in the right midbrain and pons and pontomesencephalic junction. 2. Findings a history of diffuse axonal injury with multifocal microhemorrhages in the brain parenchyma and scattered foci of restricted diffusion. 3. Trace intraventricular hemorrhage. 4. Type II dens fracture with disruption of the periapical ligaments and anterior and posterior epidural hemorrhages. Mass effect on the cervical medullary junction and upper cervical cord with no cord signal abnormality. 5. Apparent obscuration of the right vertebral artery V3 segment, recommend CT angiogram to rule out vascular injury.
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Findings: Brain: Restricted diffusion is seen in the right midbrain and pons at the pontomesencephalic junction. Additional tiny foci of restricted diffusion seen in the left frontal deep white matter. There is abnormal DWI signal in the splenium of the corpus callosum. There are innumerable punctate foci of susceptibility consistent diffuse axonal injury prominently in the supratentorial and a few in the infratentorial brain parenchyma. Trace intraventricular hemorrhage with layering of blood products in the posterior horn of the lateral ventricles and fourth ventricle. Inadequate CSF suppression on FLAIR images due to supplemental oxygen. The posterior fossa subarachnoid hemorrhage is better appreciated on the comparison CT. Scattered paranasal sinus mucosal thickening. The mastoids appear clear. . Cervical spine: There is type II odontoid fracture with mild displaced fracture fragments. Disruption of the ligaments around the dens is seen with anterior and posterior epidural hemorrhage is with mild mass effect on the upper cervical cord. No definite cord contusion or cord signal abnormality is identified. Effusions at both lateral atlantooccipital articular relation. There is apparent obscuration of the right V3 flow void with narrow caliber right V4. No significant degenerative changes are seen. Retropharyngeal soft tissue edema maximum thickness 11 mm at C2 The spinal alignment is normal. Vertebral body heights are preserved. There are no suspicious bone marrow signal abnormalities. No definite cord signal abnormality is identified.
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Findings: Head CT: There is small left frontal scalp subgaleal hematoma with a density in the left supraorbital soft tissues measuring 5 mm.. No acute calvarial fracture. There is a questionable subdural hematoma along the left frontal convexity versus artifact. There is no significant mass effect or brain edema. No other definite intracranial hemorrhage. No acute infarction, intracranial mass or hydrocephalus. Maxillofacial CT: There are no acute maxillofacial or mandibular fractures or traumatic TMJ dislocation . There is no evidence of orbital soft tissue injury. The paranasal sinuses, middle ears, mastoid antra, and mastoid air cells are clear.
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MR Cervical Spine wo+w contrast 1/21/2022 11:13 AM Clinical Information: Demyelinating disease, G37.9 Demyelinating disease of central nervous system, unspecified, G81.94 Hemiplegia, unspecified affecting left nondominant side, R20.0 Anesthesia of skin, R20.2 Paresthesia of skin, R25.2 Cramp and spasm Comparison: None available. Technique: T2 sagittal and axial fast spin spin echo, T1 sagittal spin echo, sagittal STIR, axial T2* gradient echo. Patient weight: 208 lbs. IV contrast: ProHance, 20 ml, per protocol. Findings: Motion artifact on multiple sequences limits evaluation. Mild degenerative changes with multilevel disc desiccation. No significant disc bulge canal or neuroforaminal stenosis. Multilevel bilateral facet arthropathy. Eccentric intramedullary cord signal is seen at C2, C3-4 levels annotated on sagittal PD series 5 and axial T2 series 7. No definite contrast enhancement identified. The spinal alignment is normal. Vertebral body heights are preserved. There are no suspicious bone marrow signal abnormalities. The cranial vertebral junction appears unremarkable. Impression: Multiple eccentric nonenhancing cervical cord lesions consistent with demyelinating process. No definite enhancing lesion identified.
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Findings: Motion artifact on multiple sequences limits evaluation. Mild degenerative changes with multilevel disc desiccation. No significant disc bulge canal or neuroforaminal stenosis. Multilevel bilateral facet arthropathy. Eccentric intramedullary cord signal is seen at C2, C3-4 levels annotated on sagittal PD series 5 and axial T2 series 7. No definite contrast enhancement identified. The spinal alignment is normal. Vertebral body heights are preserved. There are no suspicious bone marrow signal abnormalities. The cranial vertebral junction appears unremarkable.
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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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MR Cervical Spine wo contrast 1/21/2022 11:07 AM Clinical Information: gait instability, M50.00 Cervical disc disorder with myelopathy, unspecified cervical region Comparison: CT cervical spine without contrast 2/26/2020 Technique: T2 sagittal and axial fast spin spin echo, T1 sagittal spin echo, sagittal STIR, axial T2* gradient echo. Findings: There is loss of normal cervical lordotic curvature with mild reversal. Trace retrolisthesis, 2 mm, C3 on C4 and C7 on T1.. Multilevel degenerative changes with anterior and posterior osteophytes irregular endplate changes disc desiccation and disc height reduction at C3-4 C4-5 C5-6 Vertebral body heights are preserved. There are no suspicious bone marrow signal abnormalities. The cranial vertebral junction appears unremarkable. Trace effusions at atlantooccipital and atlantoaxial articulations. No definite cord signal abnormality is identified. Degenerative findings are discussed on a level by level basis: C2-3: No significant disc bulge. No central canal stenosis or significant neuroforaminal stenosis. Bilateral facet arthropathy left greater than right. C3-4: Posterior disc osteophyte complex effacing the ventral compartment space. No cord compression or cord signal abnormality. Bilateral facet arthropathy left greater than right with mild right and severe left neuroforaminal stenosis. C4-5: Posterior disc osteophyte complex effacing the ventral subarachnoid space. Mild ventral cord surface deformation. No cord compression cord signal noted. Moderate left and moderate to severe right neural foraminal stenosis. C5-6: Posterior disc osteophyte complex deforming the ventral cord surface. No cord signal abnormality. Moderate right and severe left neuroforaminal stenosis. C6-7: Posterior disc osteophyte complex causing severe bilateral neuroforaminal stenosis. No central stenosis. No cord compression or cord signal abnormality. Mild right-sided facet arthropathy. C7-T1: Posterior disc osteophyte complex with no significant neuroforaminal or central stenosis. Left-sided facet arthropathy. Ligamentum flavum thickening/buckling. Simple appearing bilateral parotid cysts. Impression: Multilevel degenerative changes with no significant cord compression or cord signal abnormality. Multilevel neural foraminal stenosis of varying degree. Multilevel facet arthropathy.
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Findings: There is loss of normal cervical lordotic curvature with mild reversal. Trace retrolisthesis, 2 mm, C3 on C4 and C7 on T1.. Multilevel degenerative changes with anterior and posterior osteophytes irregular endplate changes disc desiccation and disc height reduction at C3-4 C4-5 C5-6 Vertebral body heights are preserved. There are no suspicious bone marrow signal abnormalities. The cranial vertebral junction appears unremarkable. Trace effusions at atlantooccipital and atlantoaxial articulations. No definite cord signal abnormality is identified. Degenerative findings are discussed on a level by level basis: C2-3: No significant disc bulge. No central canal stenosis or significant neuroforaminal stenosis. Bilateral facet arthropathy left greater than right. C3-4: Posterior disc osteophyte complex effacing the ventral compartment space. No cord compression or cord signal abnormality. Bilateral facet arthropathy left greater than right with mild right and severe left neuroforaminal stenosis. C4-5: Posterior disc osteophyte complex effacing the ventral subarachnoid space. Mild ventral cord surface deformation. No cord compression cord signal noted. Moderate left and moderate to severe right neural foraminal stenosis. C5-6: Posterior disc osteophyte complex deforming the ventral cord surface. No cord signal abnormality. Moderate right and severe left neuroforaminal stenosis. C6-7: Posterior disc osteophyte complex causing severe bilateral neuroforaminal stenosis. No central stenosis. No cord compression or cord signal abnormality. Mild right-sided facet arthropathy. C7-T1: Posterior disc osteophyte complex with no significant neuroforaminal or central stenosis. Left-sided facet arthropathy. Ligamentum flavum thickening/buckling. Simple appearing bilateral parotid cysts.
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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. Empty sella. Bilateral cerebellar tonsillar ectopia with crowding of the foramen magnum. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Paranasal sinuses are clear. Unerupted bilateral maxillary molars. VESSELS: Normal noncontrast appearance of the vessels. OTHER: Dystrophic calcification in the left maxillary soft tissues.
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EXAM: MR Enterography CLINICAL INFORMATION: Crohn s disease, K50.90 Crohn s disease, unspecified, without complications COMPARISON: MR enterography dated 12/15/2020 TECHNIQUE: MR Enterography Patient weight: 132 lbs. IV contrast: ProHance, 12 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: STRUCTURED REPORT: MRI Enterography LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN AND PELVIS: STOMACH: No abnormality. SMALL BOWEL: Thickened loop of small bowel in the left mid and upper abdomen, for example on series 7 image 39 appears primarily within the jejunum which can sometimes have this appearance normally. No definite abnormal enhancement is present on the postcontrast examinations. Mild enhancement in the region of the terminal ileum is less prominent than prior. PERITONEUM / MESENTERY: Normal. COLORECTAL: No abnormal bowel wall thickening or enhancement. APPENDIX: Normal. LIVER: Partially imaged portions are normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. SPLEEN: Partially imaged portions are normal. PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Mild enhancement of the region of the terminal ileum is less prominent than prior. Areas of mildly thickened jejunum may be within normal limits as there is no corresponding abnormality on the additional images. No convincing new evidence of active inflammatory bowel 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.
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FINDINGS: STRUCTURED REPORT: MRI Enterography LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN AND PELVIS: STOMACH: No abnormality. SMALL BOWEL: Thickened loop of small bowel in the left mid and upper abdomen, for example on series 7 image 39 appears primarily within the jejunum which can sometimes have this appearance normally. No definite abnormal enhancement is present on the postcontrast examinations. Mild enhancement in the region of the terminal ileum is less prominent than prior. PERITONEUM / MESENTERY: Normal. COLORECTAL: No abnormal bowel wall thickening or enhancement. APPENDIX: Normal. LIVER: Partially imaged portions are normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. SPLEEN: Partially imaged portions are normal. PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: CT of the head with and without contrast: Please see separately reported same day noncontrast CT head. No abnormal intracranial enhancement within the 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: There is moderate focal luminal narrowing of the left A2 segment of the ACA. The left MCA distal branches appear diffusely diminished in caliber compared to the contralateral side. No intraluminal thrombus is identified. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: Limited evaluation of the proximal vessels due to photon starvation artifact. AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. Bovine arch. RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. Tortuous retropharyngeal course. Atherosclerotic disease at the carotid bifurcation with less than 50% luminal narrowing. LEFT CAROTID: Mild atherosclerosis of the proximal ICA without flow limiting stenosis. There is no evidence of occlusion or aneurysmal dilation. Tortuous retropharyngeal course. RIGHT VERTEBRAL ARTERY: Limited evaluation proximally. There is no evidence of stenosis, occlusion, or aneurysmal dilation of the distal vertebral artery. LEFT VERTEBRAL ARTERY: Limited evaluation proximally. There is no evidence of stenosis, occlusion, or aneurysmal dilation of the distal vertebral artery. SOFT TISSUES: No soft tissue abnormality within the neck. CERVICAL SPINE: Mild multilevel discogenic degenerative change of the cervical spine, most prominent at C6-C7.
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MR Thoracic Spine wo+w contrast 1/21/2022 12:39 PM Clinical Information: Metastatic spine tumor, follow up, C79.9 Secondary malignant neoplasm of unspecified site, Z92.3 Personal history of irradiation Comparison: Thoracic spine MRI dated 8/5/2021. Technique: Axial T1/T2 and sagittal T1/T2/STIR and postcontrast axial and sagittal fat-sat T1-weighted images. Patient weight: 150 lbs. IV contrast: ProHance, 14 ml, per protocol. Findings: T6 laminectomy/facetectomy with T4-T8 posterior fusion and T4/T5/T7/T8 vertebroplasty changes are noted. Previous tumor replaced T6 vertebral body shows mild compressive deformity with cortical bone irregularity and mild residual contrast enhancement. Enhancing dural thickening and epidural mass effect are resolved. No residual enhancing anterior paraspinal mass is discerned. The spinal canal is patently visualized. The thoracic cord is normally preserved. No intradural enhancing abnormality is noted. There is no evidence of new osseous metastatic disease involving the thoracic spine elsewhere. Impression: Interval resolution of vertebral metastatic tumor and anterior paraspinal mass at T6.
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Findings: T6 laminectomy/facetectomy with T4-T8 posterior fusion and T4/T5/T7/T8 vertebroplasty changes are noted. Previous tumor replaced T6 vertebral body shows mild compressive deformity with cortical bone irregularity and mild residual contrast enhancement. Enhancing dural thickening and epidural mass effect are resolved. No residual enhancing anterior paraspinal mass is discerned. The spinal canal is patently visualized. The thoracic cord is normally preserved. No intradural enhancing abnormality is noted. There is no evidence of new osseous metastatic disease involving the thoracic spine elsewhere.
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FINDINGS: CT of the head with and without contrast: Please see separately reported same day noncontrast CT head. No abnormal intracranial enhancement within the 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: There is moderate focal luminal narrowing of the left A2 segment of the ACA. The left MCA distal branches appear diffusely diminished in caliber compared to the contralateral side. No intraluminal thrombus is identified. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: Limited evaluation of the proximal vessels due to photon starvation artifact. AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. Bovine arch. RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. Tortuous retropharyngeal course. Atherosclerotic disease at the carotid bifurcation with less than 50% luminal narrowing. LEFT CAROTID: Mild atherosclerosis of the proximal ICA without flow limiting stenosis. There is no evidence of occlusion or aneurysmal dilation. Tortuous retropharyngeal course. RIGHT VERTEBRAL ARTERY: Limited evaluation proximally. There is no evidence of stenosis, occlusion, or aneurysmal dilation of the distal vertebral artery. LEFT VERTEBRAL ARTERY: Limited evaluation proximally. There is no evidence of stenosis, occlusion, or aneurysmal dilation of the distal vertebral artery. SOFT TISSUES: No soft tissue abnormality within the neck. CERVICAL SPINE: Mild multilevel discogenic degenerative change of the cervical spine, most prominent at C6-C7.
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MRI brain with and without contrast MR angiogram head without contrast MR angiogram neck without contrast Clinical Information: Male aged 64 years. Per chart review well-controlled HIV, DM, hypertension, status post renal transplant in 2019. Patient reports "episodes of vision loss described as whitening of vision in both eyes" with normal neurologic exam. Comparison: None. Technique: Multiplanar, multisequence MRI of the brain were obtained in multiple planes pre-and post administration of intravenous contrast per departmental protocol. MR angiogram head and neck were obtained without contrast with 3-D volume rendered and MIP reconstructions. Patient weight: 143 lbs. IV contrast: ProHance, 7 ml, per protocol. IV contrast injection rate: 2 ml per sec. Findings: No acute infarct or intracranial hemorrhage. Mild diffuse cerebral volume loss with associated ex vacuo ventriculomegaly. No midline shift, hydrocephalus, mass effect, or other space-occupying lesion. T2/FLAIR hyperintensities in the deep white and periventricular white matter consistent with chronic microangiopathic disease. No abnormal parenchymal or leptomeningeal enhancement. MR angiogram head and neck demonstrate asymmetric diffusely decreased caliber of the left ICA compared to the right ICA without flow-limiting stenosis. There are atherosclerotic changes at the carotid bifurcations extending into the right ICA with moderate narrowing. There is prominent atherosclerotic plaque on the left carotid bifurcation with focal lack of flow related signal in the proximal ICA at the origin with distal reconstitution. No flow limiting stenosis seen within the remaining portions of the carotid arteries, ACA, MCA, PCA and vertebrobasilar arteries. There is antegrade flow within the vertebral arteries. The visualized origins of the great vessels appear unremarkable. Postsurgical appearance of left antrostomy. There is a left maxillary sinus mucus retention cyst. Sinuses are otherwise clear. Conclusion: 1. No acute intracranial or angiographic abnormality. 2. Atherosclerotic changes at bilateral carotid bifurcations and proximal ICAs with focal flow limiting stenosis/occlusion of the proximal left ICA and immediate reconstitution of a relatively diffusely narrowed ICA. Moderate narrowing on the right. CT angiogram of the neck would be helpful for further evaluation, unless otherwise contraindicated for any reason. 3. Diffusely decreased caliber of the left ICA beginning at its origin extending into the intracranial portions. 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.
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Findings: No acute infarct or intracranial hemorrhage. Mild diffuse cerebral volume loss with associated ex vacuo ventriculomegaly. No midline shift, hydrocephalus, mass effect, or other space-occupying lesion. T2/FLAIR hyperintensities in the deep white and periventricular white matter consistent with chronic microangiopathic disease. No abnormal parenchymal or leptomeningeal enhancement. MR angiogram head and neck demonstrate asymmetric diffusely decreased caliber of the left ICA compared to the right ICA without flow-limiting stenosis. There are atherosclerotic changes at the carotid bifurcations extending into the right ICA with moderate narrowing. There is prominent atherosclerotic plaque on the left carotid bifurcation with focal lack of flow related signal in the proximal ICA at the origin with distal reconstitution. No flow limiting stenosis seen within the remaining portions of the carotid arteries, ACA, MCA, PCA and vertebrobasilar arteries. There is antegrade flow within the vertebral arteries. The visualized origins of the great vessels appear unremarkable. Postsurgical appearance of left antrostomy. There is a left maxillary sinus mucus retention cyst. Sinuses are otherwise clear.
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Findings: There is no acute infarction, hemorrhage, or brain edema. There is no intracranial mass or hydrocephalus. There is no acute osseous abnormality. The paranasal sinuses and mastoid air cells are clear.
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15,139 |
MRI brain with and without contrast MR angiogram head without contrast MR angiogram neck without contrast Clinical Information: Male aged 64 years. Per chart review well-controlled HIV, DM, hypertension, status post renal transplant in 2019. Patient reports "episodes of vision loss described as whitening of vision in both eyes" with normal neurologic exam. Comparison: None. Technique: Multiplanar, multisequence MRI of the brain were obtained in multiple planes pre-and post administration of intravenous contrast per departmental protocol. MR angiogram head and neck were obtained without contrast with 3-D volume rendered and MIP reconstructions. Patient weight: 143 lbs. IV contrast: ProHance, 7 ml, per protocol. IV contrast injection rate: 2 ml per sec. Findings: No acute infarct or intracranial hemorrhage. Mild diffuse cerebral volume loss with associated ex vacuo ventriculomegaly. No midline shift, hydrocephalus, mass effect, or other space-occupying lesion. T2/FLAIR hyperintensities in the deep white and periventricular white matter consistent with chronic microangiopathic disease. No abnormal parenchymal or leptomeningeal enhancement. MR angiogram head and neck demonstrate asymmetric diffusely decreased caliber of the left ICA compared to the right ICA without flow-limiting stenosis. There are atherosclerotic changes at the carotid bifurcations extending into the right ICA with moderate narrowing. There is prominent atherosclerotic plaque on the left carotid bifurcation with focal lack of flow related signal in the proximal ICA at the origin with distal reconstitution. No flow limiting stenosis seen within the remaining portions of the carotid arteries, ACA, MCA, PCA and vertebrobasilar arteries. There is antegrade flow within the vertebral arteries. The visualized origins of the great vessels appear unremarkable. Postsurgical appearance of left antrostomy. There is a left maxillary sinus mucus retention cyst. Sinuses are otherwise clear. Conclusion: 1. No acute intracranial or angiographic abnormality. 2. Atherosclerotic changes at bilateral carotid bifurcations and proximal ICAs with focal flow limiting stenosis/occlusion of the proximal left ICA and immediate reconstitution of a relatively diffusely narrowed ICA. Moderate narrowing on the right. CT angiogram of the neck would be helpful for further evaluation, unless otherwise contraindicated for any reason. 3. Diffusely decreased caliber of the left ICA beginning at its origin extending into the intracranial portions. 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.
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Findings: No acute infarct or intracranial hemorrhage. Mild diffuse cerebral volume loss with associated ex vacuo ventriculomegaly. No midline shift, hydrocephalus, mass effect, or other space-occupying lesion. T2/FLAIR hyperintensities in the deep white and periventricular white matter consistent with chronic microangiopathic disease. No abnormal parenchymal or leptomeningeal enhancement. MR angiogram head and neck demonstrate asymmetric diffusely decreased caliber of the left ICA compared to the right ICA without flow-limiting stenosis. There are atherosclerotic changes at the carotid bifurcations extending into the right ICA with moderate narrowing. There is prominent atherosclerotic plaque on the left carotid bifurcation with focal lack of flow related signal in the proximal ICA at the origin with distal reconstitution. No flow limiting stenosis seen within the remaining portions of the carotid arteries, ACA, MCA, PCA and vertebrobasilar arteries. There is antegrade flow within the vertebral arteries. The visualized origins of the great vessels appear unremarkable. Postsurgical appearance of left antrostomy. There is a left maxillary sinus mucus retention cyst. Sinuses are otherwise clear.
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Findings: Color parametric and Prognostic maps are normal.
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15,140 |
MRI brain with and without contrast MR angiogram head without contrast MR angiogram neck without contrast Clinical Information: Male aged 64 years. Per chart review well-controlled HIV, DM, hypertension, status post renal transplant in 2019. Patient reports "episodes of vision loss described as whitening of vision in both eyes" with normal neurologic exam. Comparison: None. Technique: Multiplanar, multisequence MRI of the brain were obtained in multiple planes pre-and post administration of intravenous contrast per departmental protocol. MR angiogram head and neck were obtained without contrast with 3-D volume rendered and MIP reconstructions. Patient weight: 143 lbs. IV contrast: ProHance, 7 ml, per protocol. IV contrast injection rate: 2 ml per sec. Findings: No acute infarct or intracranial hemorrhage. Mild diffuse cerebral volume loss with associated ex vacuo ventriculomegaly. No midline shift, hydrocephalus, mass effect, or other space-occupying lesion. T2/FLAIR hyperintensities in the deep white and periventricular white matter consistent with chronic microangiopathic disease. No abnormal parenchymal or leptomeningeal enhancement. MR angiogram head and neck demonstrate asymmetric diffusely decreased caliber of the left ICA compared to the right ICA without flow-limiting stenosis. There are atherosclerotic changes at the carotid bifurcations extending into the right ICA with moderate narrowing. There is prominent atherosclerotic plaque on the left carotid bifurcation with focal lack of flow related signal in the proximal ICA at the origin with distal reconstitution. No flow limiting stenosis seen within the remaining portions of the carotid arteries, ACA, MCA, PCA and vertebrobasilar arteries. There is antegrade flow within the vertebral arteries. The visualized origins of the great vessels appear unremarkable. Postsurgical appearance of left antrostomy. There is a left maxillary sinus mucus retention cyst. Sinuses are otherwise clear. Conclusion: 1. No acute intracranial or angiographic abnormality. 2. Atherosclerotic changes at bilateral carotid bifurcations and proximal ICAs with focal flow limiting stenosis/occlusion of the proximal left ICA and immediate reconstitution of a relatively diffusely narrowed ICA. Moderate narrowing on the right. CT angiogram of the neck would be helpful for further evaluation, unless otherwise contraindicated for any reason. 3. Diffusely decreased caliber of the left ICA beginning at its origin extending into the intracranial portions. 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.
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Findings: No acute infarct or intracranial hemorrhage. Mild diffuse cerebral volume loss with associated ex vacuo ventriculomegaly. No midline shift, hydrocephalus, mass effect, or other space-occupying lesion. T2/FLAIR hyperintensities in the deep white and periventricular white matter consistent with chronic microangiopathic disease. No abnormal parenchymal or leptomeningeal enhancement. MR angiogram head and neck demonstrate asymmetric diffusely decreased caliber of the left ICA compared to the right ICA without flow-limiting stenosis. There are atherosclerotic changes at the carotid bifurcations extending into the right ICA with moderate narrowing. There is prominent atherosclerotic plaque on the left carotid bifurcation with focal lack of flow related signal in the proximal ICA at the origin with distal reconstitution. No flow limiting stenosis seen within the remaining portions of the carotid arteries, ACA, MCA, PCA and vertebrobasilar arteries. There is antegrade flow within the vertebral arteries. The visualized origins of the great vessels appear unremarkable. Postsurgical appearance of left antrostomy. There is a left maxillary sinus mucus retention cyst. Sinuses are otherwise clear.
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Findings: There is no acute hemorrhage or brain edema. There is no evidence of acute infarction, intracranial mass or hydrocephalus. There is diffuse cortical involution. There is no acute osseous abnormality. Trace fluid in the right maxillary sinus. The remaining paranasal sinuses and mastoid air cells are clear. The orbits appear normal status post bilateral lens replacements.
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15,141 |
EXAM: MR Abdomen wo+w contrast, MR Cholangiopancreatography MRCP CLINICAL INFORMATION: Alcohol related liver disease. COMPARISON: None. TECHNIQUE: MR Abdomen wo+w contrast, MR Cholangiopancreatography MRCP Patient weight: 233 lbs. IV contrast: ProHance, 10 ml, per protocol. IV contrast injection rate: 1 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: Liver morphology is not overtly cirrhotic . Mild diffuse hepatic steatosis LIVER LESIONS: None LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Suboptimally evaluated due to motion but appears conventional. - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: None. - Other varices or collaterals: None. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: Layering sludge. No discrete gallstones are visualized LYMPH NODES: Borderline enlarged periportal lymph nodes. SPLEEN: Normal size and appearance. 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: No significant abnormality. CONCLUSION: 1. Diffuse hepatic steatosis. Liver morphology is not overtly cirrhotic. No focal hepatic lesion. 2. No biliary dilatation, stricture or stone. 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.
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FINDINGS: STRUCTURED REPORT: MR HCC Screening IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Liver morphology is not overtly cirrhotic . Mild diffuse hepatic steatosis LIVER LESIONS: None LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Suboptimally evaluated due to motion but appears conventional. - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: None. - Other varices or collaterals: None. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: Layering sludge. No discrete gallstones are visualized LYMPH NODES: Borderline enlarged periportal lymph nodes. SPLEEN: Normal size and appearance. 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: No significant abnormality.
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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 (
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EXAM: MR Abdomen wo+w contrast, MR Cholangiopancreatography MRCP CLINICAL INFORMATION: Alcohol related liver disease. COMPARISON: None. TECHNIQUE: MR Abdomen wo+w contrast, MR Cholangiopancreatography MRCP Patient weight: 233 lbs. IV contrast: ProHance, 10 ml, per protocol. IV contrast injection rate: 1 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: Liver morphology is not overtly cirrhotic . Mild diffuse hepatic steatosis LIVER LESIONS: None LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Suboptimally evaluated due to motion but appears conventional. - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: None. - Other varices or collaterals: None. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: Layering sludge. No discrete gallstones are visualized LYMPH NODES: Borderline enlarged periportal lymph nodes. SPLEEN: Normal size and appearance. 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: No significant abnormality. CONCLUSION: 1. Diffuse hepatic steatosis. Liver morphology is not overtly cirrhotic. No focal hepatic lesion. 2. No biliary dilatation, stricture or stone. 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.
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FINDINGS: STRUCTURED REPORT: MR HCC Screening IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Liver morphology is not overtly cirrhotic . Mild diffuse hepatic steatosis LIVER LESIONS: None LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Suboptimally evaluated due to motion but appears conventional. - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: None. - Other varices or collaterals: None. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: Layering sludge. No discrete gallstones are visualized LYMPH NODES: Borderline enlarged periportal lymph nodes. SPLEEN: Normal size and appearance. 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: No significant abnormality.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Bilateral pseudophakia. SINUSES: Minimal mucosal thickening of the bilateral maxillary sinuses. The rest of the paranasal sinuses and mastoid air cells are clear.
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MRI brain without, MR cervical spine without Indication: LUE weakness Spec Inst: stroke protocol Comparison: CT head without contrast 1/21/2022 Technique: Multiple T1 and T2-weighted MR sequence images of the brain were obtained in the sagittal axial and coronal planes without the use of intravenous contrast per departmental protocol. T2 sagittal and axial fast spin spin echo, T1 sagittal spin echo, sagittal STIR, axial T2* gradient echo. Findings: Brain: Restricted diffusion is seen in the right midbrain and pons at the pontomesencephalic junction. Additional tiny foci of restricted diffusion seen in the left frontal deep white matter. There is abnormal DWI signal in the splenium of the corpus callosum. There are innumerable punctate foci of susceptibility consistent diffuse axonal injury prominently in the supratentorial and a few in the infratentorial brain parenchyma. Trace intraventricular hemorrhage with layering of blood products in the posterior horn of the lateral ventricles and fourth ventricle. Inadequate CSF suppression on FLAIR images due to supplemental oxygen. The posterior fossa subarachnoid hemorrhage is better appreciated on the comparison CT. Scattered paranasal sinus mucosal thickening. The mastoids appear clear. . Cervical spine: There is type II odontoid fracture with mild displaced fracture fragments. Disruption of the ligaments around the dens is seen with anterior and posterior epidural hemorrhage is with mild mass effect on the upper cervical cord. No definite cord contusion or cord signal abnormality is identified. Effusions at both lateral atlantooccipital articular relation. There is apparent obscuration of the right V3 flow void with narrow caliber right V4. No significant degenerative changes are seen. Retropharyngeal soft tissue edema maximum thickness 11 mm at C2 The spinal alignment is normal. Vertebral body heights are preserved. There are no suspicious bone marrow signal abnormalities. No definite cord signal abnormality is identified. Impression: 1. Restricted diffusion in the right midbrain and pons and pontomesencephalic junction. 2. Findings a history of diffuse axonal injury with multifocal microhemorrhages in the brain parenchyma and scattered foci of restricted diffusion. 3. Trace intraventricular hemorrhage. 4. Type II dens fracture with disruption of the periapical ligaments and anterior and posterior epidural hemorrhages. Mass effect on the cervical medullary junction and upper cervical cord with no cord signal abnormality. 5. Apparent obscuration of the right vertebral artery V3 segment, recommend CT angiogram to rule out vascular injury.
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Findings: Brain: Restricted diffusion is seen in the right midbrain and pons at the pontomesencephalic junction. Additional tiny foci of restricted diffusion seen in the left frontal deep white matter. There is abnormal DWI signal in the splenium of the corpus callosum. There are innumerable punctate foci of susceptibility consistent diffuse axonal injury prominently in the supratentorial and a few in the infratentorial brain parenchyma. Trace intraventricular hemorrhage with layering of blood products in the posterior horn of the lateral ventricles and fourth ventricle. Inadequate CSF suppression on FLAIR images due to supplemental oxygen. The posterior fossa subarachnoid hemorrhage is better appreciated on the comparison CT. Scattered paranasal sinus mucosal thickening. The mastoids appear clear. . Cervical spine: There is type II odontoid fracture with mild displaced fracture fragments. Disruption of the ligaments around the dens is seen with anterior and posterior epidural hemorrhage is with mild mass effect on the upper cervical cord. No definite cord contusion or cord signal abnormality is identified. Effusions at both lateral atlantooccipital articular relation. There is apparent obscuration of the right V3 flow void with narrow caliber right V4. No significant degenerative changes are seen. Retropharyngeal soft tissue edema maximum thickness 11 mm at C2 The spinal alignment is normal. Vertebral body heights are preserved. There are no suspicious bone marrow signal abnormalities. No definite cord signal abnormality is identified.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is normal. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Right scleral calcifications. Globes are intact. No orbital fracture. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. FACIAL BONES: Acute, comminuted and displaced bilateral nasal bone fractures also involving the frontal processes of the maxilla. Displaced segmental nasal septum fractures. No significant nasal septal hematoma. Pterygoid plates are intact. Forehead, nasal, and upper lip contusions. Scattered dental caries. There is a moderate size defect in the right cheek soft tissues superficial to the right masseter muscle. There is asymmetric soft tissue swelling of the right masseter muscle. MANDIBLE: No fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Small amount of hemorrhage in the bilateral ethmoid sinuses.
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MRI brain with and without Indication: HA, multiple neuro sx separated by time and space, eval for MS Comparison: CT angiogram from 1/21/2022 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: 266 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 2 ml per sec. Findings: There is no restricted diffusion. There is no definite T-2/flair hyperintense foci in the bilateral periventricular and subcortical white matter. Bilateral optic nerves are within normal limits given the limitation of the technique. Postcontrast images demonstrate no abnormal enhancement in the brain parenchyma. There is tiny focus of enhancement in the right choroid plexus of the lateral ventricle, likely vascular structure. Posterior fossa and midline structures are within normal limits. Pituitary gland is within normal limits. Intracranial vascular flow voids are well preserved. Impression: No acute intracranial process. No pathologic enhancement is appreciated. No definite MRI features to suggest multiple sclerosis.
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Findings: There is no restricted diffusion. There is no definite T-2/flair hyperintense foci in the bilateral periventricular and subcortical white matter. Bilateral optic nerves are within normal limits given the limitation of the technique. Postcontrast images demonstrate no abnormal enhancement in the brain parenchyma. There is tiny focus of enhancement in the right choroid plexus of the lateral ventricle, likely vascular structure. Posterior fossa and midline structures are within normal limits. Pituitary gland is within normal limits. Intracranial vascular flow voids are well preserved.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is normal. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Right scleral calcifications. Globes are intact. No orbital fracture. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. FACIAL BONES: Acute, comminuted and displaced bilateral nasal bone fractures also involving the frontal processes of the maxilla. Displaced segmental nasal septum fractures. No significant nasal septal hematoma. Pterygoid plates are intact. Forehead, nasal, and upper lip contusions. Scattered dental caries. There is a moderate size defect in the right cheek soft tissues superficial to the right masseter muscle. There is asymmetric soft tissue swelling of the right masseter muscle. MANDIBLE: No fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Small amount of hemorrhage in the bilateral ethmoid sinuses.
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EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: Cholangiocarcinoma COMPARISON: MRI 11/17/2021 TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 315 lbs. IV contrast: Eovist, 10 ml, per protocol. IV contrast injection rate: 1 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: Diffuse hepatic steatosis. Noncirrhotic morphology. Previously visualized mildly T2 hyperintense enhancing mass in the periphery of the right hepatic lobe segment 8 extending into segment 4 demonstrates mild interval increase in size, today measuring 5.9 x 4.3 cm on series 11 image 43 (previously measuring 5.7 x 3.7 cm). As well there is a new, satellite lesion immediately adjacent to the larger lesion measuring about 0.7 cm, best visualized on T2-weighted imaging (series 3 image 35). BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Unchanged T2 hyperintense lesions in the spleen, likely benign and unchanged since 2011. ADRENALS: Normal. KIDNEYS: Subcentimeter cyst in the superior pole right kidney. Kidneys are otherwise unremarkable 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: Mild interval enlargement of the right hepatic lobe lesion consistent with cholangiocarcinoma demonstrated on prior biopsy. Additional interval appearance of a subcentimeter satellite lesion adjacent to the larger lesion as described. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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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: Diffuse hepatic steatosis. Noncirrhotic morphology. Previously visualized mildly T2 hyperintense enhancing mass in the periphery of the right hepatic lobe segment 8 extending into segment 4 demonstrates mild interval increase in size, today measuring 5.9 x 4.3 cm on series 11 image 43 (previously measuring 5.7 x 3.7 cm). As well there is a new, satellite lesion immediately adjacent to the larger lesion measuring about 0.7 cm, best visualized on T2-weighted imaging (series 3 image 35). BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Unchanged T2 hyperintense lesions in the spleen, likely benign and unchanged since 2011. ADRENALS: Normal. KIDNEYS: Subcentimeter cyst in the superior pole right kidney. Kidneys are otherwise unremarkable 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.
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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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MRI brain with and without Indication: Transient ischemic attack (TIA), G45.9 Transient cerebral ischemic attack, unspecified Spec Inst: 53 yo RH F avid horseback rider with no trauma but worsening idiopathic fatigue and R paresthesias dysesthesias R worse than L hx of L hip Total hip 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: 115 lbs. IV contrast: ProHance, 11 ml, per protocol. IV contrast injection rate: 0.50 ml per sec. Findings: Echoplanar diffusion-weighted imaging demonstrates no evidence of restricted diffusion at this time. Whole brain T2 and FLAIR imaging demonstrate no midline shift, mass effect, or other space-occupying lesion. There are no significant white matter FLAIR hyperintensities . The ventricular system is of normal morphology. The basal cisterns are clear. The visualized vascular flow voids appear normal. Post administration of contrast material, there is no other abnormal enhancement. The remaining visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Impression: No acute intracranial process. No pathologic enhancement is appreciated.
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Findings: Echoplanar diffusion-weighted imaging demonstrates no evidence of restricted diffusion at this time. Whole brain T2 and FLAIR imaging demonstrate no midline shift, mass effect, or other space-occupying lesion. There are no significant white matter FLAIR hyperintensities . The ventricular system is of normal morphology. The basal cisterns are clear. The visualized vascular flow voids appear normal. Post administration of contrast material, there is no other abnormal enhancement. The remaining visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics.
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FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Prominent secretions within the trachea and bilateral mainstem bronchi. Numerous centrilobular and tree-in-bud nodules throughout both lungs. More dense consolidation is noted at the left base with associated asymmetric left hemidiaphragm elevation, likely atelectasis. Trace bilateral pleural effusions, improved. Linear hyperdensity along the left base overlying the left hemidiaphragm slightly change in position. HEART / VESSELS: Right approach central venous catheter distal tip terminates at the caval atrial junction. Small pericardial effusion. MEDIASTINUM / ESOPHAGUS: Distal esophageal wall thickening, more pronounced than when compared to prior. Esophagogastric catheter in place. LYMPH NODES: None enlarged. CHEST WALL: Anterior midline chest wall peripherally enhancing fluid collection again seen. See discussion below. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Interval development of bilateral hydroureteronephrosis. No distal obstruction identified. Patchy hypoenhancement in the bilateral kidneys. No other significant abnormality. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Weighted enteric feeding tube is coiled within the stomach. Distal tip is within the first portion of the duodenum. Stomach is normal. Mucosal hyperenhancement within the proximal duodenum with mild surrounding fat stranding. Small bowel is normal in caliber. COLON / APPENDIX: Partially visualized appendix is normal. There is moderate volume liquid stool within the cecum. PERITONEUM / MESENTERY: Interval removal of the right lower quadrant pigtail drain with only a small residual collection approximating 2.4 x 1.0 cm. Persistent mild mesenteric congestion. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Interval retraction of the Foley catheter with the Foley balloon within the urethra below the prostate gland. There is associated is significant distention of the urinary bladder. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Anasarca. Redemonstrated right anterior body wall abscess shows slight interval reduction in size now measuring 4.6 x 1.6 cm (previously 4.5 x 1.9 cm). This collection tracks superiorly with multifocal regions of collecting fluid the largest of these measures 2.3 x 1.1 cm on axial series 501 image 129. This continues to track superiorly anterior to the sternum measuring 3.0 x 1.4 cm on axial series 501 image 45. MUSCULOSKELETAL: Chronic superior subluxation/dislocation of the left hip. Redemonstrated dysraphism with small posterior meningocele. Redemonstrated S-shaped scoliosis. Spinal catheter entering the interlaminar space of the T3 and T4.
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MRI brain with and without Indication: inreased opening pressure on LP Spec Inst: high suspicion for leukemic CNS involovement Comparison: 8/9/2021 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: 187 lbs. IV contrast: ProHance, 18 ml, per protocol. Findings: There is no restricted diffusion. There is no increased susceptibility on SWI. There is no hydrocephalus. Supratentorial brain parenchyma is within normal limits. Posterior fossa and midline structures are within normal limits. Postcontrast images demonstrate no abnormal enhancement in the brain parenchyma, along the cranial nerves or meningeal enhancement, given the limitation of movement artifacts. Impression: No acute intracranial process. No definite abnormal enhancement is identified.
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Findings: There is no restricted diffusion. There is no increased susceptibility on SWI. There is no hydrocephalus. Supratentorial brain parenchyma is within normal limits. Posterior fossa and midline structures are within normal limits. Postcontrast images demonstrate no abnormal enhancement in the brain parenchyma, along the cranial nerves or meningeal enhancement, given the limitation of movement artifacts.
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FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Prominent secretions within the trachea and bilateral mainstem bronchi. Numerous centrilobular and tree-in-bud nodules throughout both lungs. More dense consolidation is noted at the left base with associated asymmetric left hemidiaphragm elevation, likely atelectasis. Trace bilateral pleural effusions, improved. Linear hyperdensity along the left base overlying the left hemidiaphragm slightly change in position. HEART / VESSELS: Right approach central venous catheter distal tip terminates at the caval atrial junction. Small pericardial effusion. MEDIASTINUM / ESOPHAGUS: Distal esophageal wall thickening, more pronounced than when compared to prior. Esophagogastric catheter in place. LYMPH NODES: None enlarged. CHEST WALL: Anterior midline chest wall peripherally enhancing fluid collection again seen. See discussion below. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Interval development of bilateral hydroureteronephrosis. No distal obstruction identified. Patchy hypoenhancement in the bilateral kidneys. No other significant abnormality. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Weighted enteric feeding tube is coiled within the stomach. Distal tip is within the first portion of the duodenum. Stomach is normal. Mucosal hyperenhancement within the proximal duodenum with mild surrounding fat stranding. Small bowel is normal in caliber. COLON / APPENDIX: Partially visualized appendix is normal. There is moderate volume liquid stool within the cecum. PERITONEUM / MESENTERY: Interval removal of the right lower quadrant pigtail drain with only a small residual collection approximating 2.4 x 1.0 cm. Persistent mild mesenteric congestion. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Interval retraction of the Foley catheter with the Foley balloon within the urethra below the prostate gland. There is associated is significant distention of the urinary bladder. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Anasarca. Redemonstrated right anterior body wall abscess shows slight interval reduction in size now measuring 4.6 x 1.6 cm (previously 4.5 x 1.9 cm). This collection tracks superiorly with multifocal regions of collecting fluid the largest of these measures 2.3 x 1.1 cm on axial series 501 image 129. This continues to track superiorly anterior to the sternum measuring 3.0 x 1.4 cm on axial series 501 image 45. MUSCULOSKELETAL: Chronic superior subluxation/dislocation of the left hip. Redemonstrated dysraphism with small posterior meningocele. Redemonstrated S-shaped scoliosis. Spinal catheter entering the interlaminar space of the T3 and T4.
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EXAM: MR Hip Right wo contrast CLINICAL INFORMATION: Right groin pain COMPARISON: 1/19/2022 TECHNIQUE: Multiplanar and multisequence MRI of the right hip was obtained without intravenous contrast. FINDINGS: BONES: Marrow edema is noted within the right femoral head. Along the anterior articular surface, there is a serpiginous T1 hypointense and T2 hyperintense subchondral line. There is mild irregularity of the articular surface suggesting early collapse. HIP JOINTS: Alignment: Normal. Effusion: Small. Labrum: Normal for non-arthrographic technique. Cartilage: Normal. Capsule and ligaments:Normal. 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: 1. Osteonecrosis of the right femoral head with subchondral fracture associated marrow edema. Additionally, there is irregularity of the articular surface anteriorly suggesting early collapse. 2. Small right hip 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.
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FINDINGS: BONES: Marrow edema is noted within the right femoral head. Along the anterior articular surface, there is a serpiginous T1 hypointense and T2 hyperintense subchondral line. There is mild irregularity of the articular surface suggesting early collapse. HIP JOINTS: Alignment: Normal. Effusion: Small. Labrum: Normal for non-arthrographic technique. Cartilage: Normal. Capsule and ligaments:Normal. 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.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Basilar atelectasis. DISTAL ESOPHAGUS: Distal esophageal varices are noted. HEART / VESSELS: LAD atherosclerosis versus stent ABDOMEN and PELVIS: LIVER: Cirrhotic morphology of the liver. No hyperenhancing lesion. BILIARY TRACT: Normal. GALLBLADDER: Gallbladder contents are mildly hyperdense. PANCREAS: Normal. SPLEEN: The spleen is enlarged. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: Scattered prominent mesenteric and periaortic lymph nodes. STOMACH / SMALL BOWEL: Esophagogastric tube distal tip terminates within the gastric body. COLON / APPENDIX: The appendix is distended but predominantly gas-filled. The colon is fluid-filled, new from prior. PERITONEUM / MESENTERY: Moderate volume ascites. Marked mesenteric congestion. RETROPERITONEUM: Normal. VESSELS: Scattered vascular calcifications. Persistent nonocclusive SMV thrombus shows slight interval decrease in conspicuity when compared to prior. Esophageal and perigastric varices again seen. URINARY BLADDER: Collapsed around a Foley balloon. REPRODUCTIVE ORGANS: The right testicle is within the right inguinal canal. BODY WALL: Fat-containing umbilical hernia. MUSCULOSKELETAL: Multilevel discogenic degenerative change with lower lumbar spine facet arthropathy. Chronic Wedging of numerous mid to lower thoracic vertebrae.
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MR Breast Diagnostic Bil wo+w contrast CLINICAL INFORMATION: BRCA 1+, Z15.01 Genetic susceptibility to malignant neoplasm of breast Spec Inst: dense tissue. TECHNIQUE: T1 axial, FSE T2 fat sat axial, pre and post contrast vibrant sequence with 3D reconstructions. Fast scan. A dedicated 8 channel breast imaging coil was utilized. Patient weight: 144 lbs. IV contrast: ProHance, 14 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: Prior studies including most recent MRI from 2021 FINDINGS: All measurements provided in the format AP, TV, CC dimensions Breast tissue is scattered fibroglandular tissue. Postcontrast administration there is mild background enhancement. RIGHT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. LEFT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. BILATERAL Scattered bilateral foci are similar in appearance. None stands out from background. These do limit detection of small invasive cancers. Internal mammary nodes are normal. Axillary lymph nodes are normal. EXTRAMAMMARY: There is no suspicious abnormality in the visualized lung fields. Visualized upper abdomen unremarkable. Marrow signal is normal. IMPRESSION: RIGHT BREAST: No MRI evidence of malignancy. BI-RADS 2: Benign LEFT BREAST: No MRI evidence of malignancy. BI-RADS 2: Benign Overall BI-RADS assessment: BI-RADS 2: Benign
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FINDINGS: All measurements provided in the format AP, TV, CC dimensions Breast tissue is scattered fibroglandular tissue. Postcontrast administration there is mild background enhancement. RIGHT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. LEFT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. BILATERAL Scattered bilateral foci are similar in appearance. None stands out from background. These do limit detection of small invasive cancers. Internal mammary nodes are normal. Axillary lymph nodes are normal. EXTRAMAMMARY: There is no suspicious abnormality in the visualized lung fields. Visualized upper abdomen unremarkable. Marrow signal is normal.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is normal. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Upper normal limits ventricular size ORBITS: Globes are intact. No fracture. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. Left frontal scalp contusion. Extensive soft tissue emphysema in the left upper neck and retropharyngeal soft tissues. Small avulsion fracture of the right occipital condyle. Asymmetry in the appearance of the right and left atlantooccipital joints. FACIAL BONES: No fracture. Pterygoid plates are intact. MANDIBLE: Acute displaced fracture of the left mandibular condyle near the ramus. Acute comminuted and mildly displaced fracture of the symphyseal/left parasymphyseal hemimandible alveolar processes of the mandibular central incisors. SINONASAL CAVITIES: Mild mucosal thickening of the bilateral ethmoid, sphenoid, and bilateral maxillary sinuses.
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MR Thoracic Spine wo+w contrast, MR Lumbar Spine wo+w contrast 1/21/2022 12:48 PM CLINICAL INFORMATION: Metastatic thymoma sp T10-T12 laminectomy at MDACC. Post-surgery and post-RT surveillance, C79.49 Secondary malignant neoplasm of other parts of nervous system, D49.89 Neoplasm of unspecified behavior of other specified sites Spec Inst: Please schedule in 3 months with RET to follow COMPARISON: MRI of the thoracic spine dated 9/28/2021. TECHNIQUE: MRI of thoracic and lumbar spine including axial T1/T2 and sagittal T1/T2/STIR and postcontrast axial and sagittal fat-sat T1-weighted images. . Patient weight: 198 lbs. IV contrast: ProHance, 19 ml, per protocol. FINDINGS: T11-T12 right hemilaminectomy/facetectomy and T10-L1 posterior fusion remain stable in appearance. Residual right anterior paraspinal mass measures approximately 2.7 x 1.0 cm at T10 level. No intraspinal enhancing abnormality is identified. Diffuse fatty marrow replacement reflects previous radiation treatment. The anterior-superior corner of the vertebral bodies at T12, L1, L2 show focal T2 hyperintensity with increased contrast enhancement, likely degenerative/benign reactive in etiology. No new osseous metastatic disease is identified. The spinal canal is capacious. The thoracic spinal cord is of normal course, caliber and signal intensity. Right pleural enhancing thickening is redemonstrated. IMPRESSION: 1. Residual right anterior paraspinal mass at T10. 2. No evidence of osseous metastatic disease.
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FINDINGS: T11-T12 right hemilaminectomy/facetectomy and T10-L1 posterior fusion remain stable in appearance. Residual right anterior paraspinal mass measures approximately 2.7 x 1.0 cm at T10 level. No intraspinal enhancing abnormality is identified. Diffuse fatty marrow replacement reflects previous radiation treatment. The anterior-superior corner of the vertebral bodies at T12, L1, L2 show focal T2 hyperintensity with increased contrast enhancement, likely degenerative/benign reactive in etiology. No new osseous metastatic disease is identified. The spinal canal is capacious. The thoracic spinal cord is of normal course, caliber and signal intensity. Right pleural enhancing thickening is redemonstrated.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Extensive left-sided predominant soft tissue emphysema. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube distal tip projects 4.3 cm superior to the carina. Extensive contusion and consolidation of the posterior aspect of the right lung. There is near-complete collapse of the right upper lobe with multiple traumatic pneumatoceles. Trace anterior right pneumothorax. The left chest tube distal tip terminates in the left chest wall. Moderate size anterior left pneumothorax with hemothorax component posteriorly. Left basilar atelectasis. Patchy opacities in the lingula likely contusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Extensive pneumomediastinum tracking along the course of the esophagus. DIAPHRAGM: No definitive diaphragmatic defect although the diaphragm is now well-visualized along the posterior/superior dome of the liver. LYMPH NODES: None enlarged. CHEST WALL: Extensive left chest wall emphysema extending inferiorly along the left anterior abdominal wall. ABDOMEN and PELVIS: LIVER: Ill-defined central predominant liver laceration with associated extensive surgical material posteriorly. There is also extensive packing material anterior and inferior to the liver. Focal area of hyperenhancement in the right hepatic lobe could be related to a THAD. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube distal tip terminates within the stomach. Small bowel is normal in caliber. COLON / APPENDIX: The appendix is normal. The colon is unremarkable. PERITONEUM / MESENTERY: Small volume hemoperitoneum is noted in the deep pelvis. Scattered foci of intraperitoneal free air are noted, likely postsurgical. Extensive packing material seen in around the liver. RETROPERITONEUM: Normal. VESSELS: Right inferior approach central venous and arterial lines are noted. Intrahepatic portions of the right portal vein are difficult to identify. URINARY BLADDER: Collapsed around a Foley balloon. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Anterior abdominal wall was left in discontinuity/open. Extensive anterior body wall emphysema, left greater than right. MUSCULOSKELETAL: The left femoral head is dislocated superiorly and posteriorly with associated comminuted and displaced femoral head fractures. The largest fracture fragment remains within the joint space. No significant associated acetabular fracture. Minimally displaced superior/left manubrial fracture. Mildly displaced right lateral rib fractures involving the first through 12th ribs and segmentally at the first rib. There are also mildly displaced left lateral and posterior rib fractures involving the first through 11th ribs, segmentally at 2-9. Comminuted fracture of the right talar neck with associated distal fibular fracture. Posterior subluxation of the right tibia with respect to the femur. Associated lipohemarthrosis and comminuted osseous fragments are noted both posteriorly and anteriorly to the joint space. Gas is also noted within the joint. Comminution involving the medial condyle of the right distal femur. Questionable compression of the medial tibial plateau on the right. Fracture of the inferior pole of the right patella. THORACIC: VERTEBRA: Minimally displaced left transverse process fractures involving the first, third, fourth, sixth, and seventh vertebral bodies. No compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: Grade 1 anterolisthesis of L5 on S1. DISC SPACES AND FACET JOINTS: No acute injury. Bilateral L5 pars defects. PREVERTEBRAL SOFT TISSUES: Unremarkable. RIGHT LOWER EXTREMITY RUNOFF: Right Common Iliac artery: No aneurysm, dissection, or stenosis. Right External Iliac artery: No aneurysm, dissection, or stenosis. Right Internal Iliac artery: No aneurysm, dissection, or stenosis. Proximal Right Femoral arteries: No aneurysm, dissection, or stenosis. Right Common Femoral artery: No aneurysm, dissection, or stenosis. Right Deep Femoral artery: No aneurysm, dissection, or stenosis. Right Superficial Femoral artery: No aneurysm, dissection, or stenosis. Right Popliteal artery: No aneurysm, dissection, or stenosis. Right Anterior Tibial artery: No aneurysm, dissection, or stenosis. Patent into the foot. Right Posterior Tibial artery: No aneurysm, dissection, or stenosis. Patent into the foot. Right Peroneal artery: No aneurysm, dissection, or stenosis. Patent to the level of the ankle. Right Foot Arteries: The foot is supplied by patent anterior and posterior tibial arteries.
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15,151 |
MR Thoracic Spine wo+w contrast, MR Lumbar Spine wo+w contrast 1/21/2022 12:48 PM CLINICAL INFORMATION: Metastatic thymoma sp T10-T12 laminectomy at MDACC. Post-surgery and post-RT surveillance, C79.49 Secondary malignant neoplasm of other parts of nervous system, D49.89 Neoplasm of unspecified behavior of other specified sites Spec Inst: Please schedule in 3 months with RET to follow COMPARISON: MRI of the thoracic spine dated 9/28/2021. TECHNIQUE: MRI of thoracic and lumbar spine including axial T1/T2 and sagittal T1/T2/STIR and postcontrast axial and sagittal fat-sat T1-weighted images. . Patient weight: 198 lbs. IV contrast: ProHance, 19 ml, per protocol. FINDINGS: T11-T12 right hemilaminectomy/facetectomy and T10-L1 posterior fusion remain stable in appearance. Residual right anterior paraspinal mass measures approximately 2.7 x 1.0 cm at T10 level. No intraspinal enhancing abnormality is identified. Diffuse fatty marrow replacement reflects previous radiation treatment. The anterior-superior corner of the vertebral bodies at T12, L1, L2 show focal T2 hyperintensity with increased contrast enhancement, likely degenerative/benign reactive in etiology. No new osseous metastatic disease is identified. The spinal canal is capacious. The thoracic spinal cord is of normal course, caliber and signal intensity. Right pleural enhancing thickening is redemonstrated. IMPRESSION: 1. Residual right anterior paraspinal mass at T10. 2. No evidence of osseous metastatic disease.
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FINDINGS: T11-T12 right hemilaminectomy/facetectomy and T10-L1 posterior fusion remain stable in appearance. Residual right anterior paraspinal mass measures approximately 2.7 x 1.0 cm at T10 level. No intraspinal enhancing abnormality is identified. Diffuse fatty marrow replacement reflects previous radiation treatment. The anterior-superior corner of the vertebral bodies at T12, L1, L2 show focal T2 hyperintensity with increased contrast enhancement, likely degenerative/benign reactive in etiology. No new osseous metastatic disease is identified. The spinal canal is capacious. The thoracic spinal cord is of normal course, caliber and signal intensity. Right pleural enhancing thickening is redemonstrated.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Extensive left-sided predominant soft tissue emphysema. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube distal tip projects 4.3 cm superior to the carina. Extensive contusion and consolidation of the posterior aspect of the right lung. There is near-complete collapse of the right upper lobe with multiple traumatic pneumatoceles. Trace anterior right pneumothorax. The left chest tube distal tip terminates in the left chest wall. Moderate size anterior left pneumothorax with hemothorax component posteriorly. Left basilar atelectasis. Patchy opacities in the lingula likely contusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Extensive pneumomediastinum tracking along the course of the esophagus. DIAPHRAGM: No definitive diaphragmatic defect although the diaphragm is now well-visualized along the posterior/superior dome of the liver. LYMPH NODES: None enlarged. CHEST WALL: Extensive left chest wall emphysema extending inferiorly along the left anterior abdominal wall. ABDOMEN and PELVIS: LIVER: Ill-defined central predominant liver laceration with associated extensive surgical material posteriorly. There is also extensive packing material anterior and inferior to the liver. Focal area of hyperenhancement in the right hepatic lobe could be related to a THAD. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube distal tip terminates within the stomach. Small bowel is normal in caliber. COLON / APPENDIX: The appendix is normal. The colon is unremarkable. PERITONEUM / MESENTERY: Small volume hemoperitoneum is noted in the deep pelvis. Scattered foci of intraperitoneal free air are noted, likely postsurgical. Extensive packing material seen in around the liver. RETROPERITONEUM: Normal. VESSELS: Right inferior approach central venous and arterial lines are noted. Intrahepatic portions of the right portal vein are difficult to identify. URINARY BLADDER: Collapsed around a Foley balloon. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Anterior abdominal wall was left in discontinuity/open. Extensive anterior body wall emphysema, left greater than right. MUSCULOSKELETAL: The left femoral head is dislocated superiorly and posteriorly with associated comminuted and displaced femoral head fractures. The largest fracture fragment remains within the joint space. No significant associated acetabular fracture. Minimally displaced superior/left manubrial fracture. Mildly displaced right lateral rib fractures involving the first through 12th ribs and segmentally at the first rib. There are also mildly displaced left lateral and posterior rib fractures involving the first through 11th ribs, segmentally at 2-9. Comminuted fracture of the right talar neck with associated distal fibular fracture. Posterior subluxation of the right tibia with respect to the femur. Associated lipohemarthrosis and comminuted osseous fragments are noted both posteriorly and anteriorly to the joint space. Gas is also noted within the joint. Comminution involving the medial condyle of the right distal femur. Questionable compression of the medial tibial plateau on the right. Fracture of the inferior pole of the right patella. THORACIC: VERTEBRA: Minimally displaced left transverse process fractures involving the first, third, fourth, sixth, and seventh vertebral bodies. No compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: Grade 1 anterolisthesis of L5 on S1. DISC SPACES AND FACET JOINTS: No acute injury. Bilateral L5 pars defects. PREVERTEBRAL SOFT TISSUES: Unremarkable. RIGHT LOWER EXTREMITY RUNOFF: Right Common Iliac artery: No aneurysm, dissection, or stenosis. Right External Iliac artery: No aneurysm, dissection, or stenosis. Right Internal Iliac artery: No aneurysm, dissection, or stenosis. Proximal Right Femoral arteries: No aneurysm, dissection, or stenosis. Right Common Femoral artery: No aneurysm, dissection, or stenosis. Right Deep Femoral artery: No aneurysm, dissection, or stenosis. Right Superficial Femoral artery: No aneurysm, dissection, or stenosis. Right Popliteal artery: No aneurysm, dissection, or stenosis. Right Anterior Tibial artery: No aneurysm, dissection, or stenosis. Patent into the foot. Right Posterior Tibial artery: No aneurysm, dissection, or stenosis. Patent into the foot. Right Peroneal artery: No aneurysm, dissection, or stenosis. Patent to the level of the ankle. Right Foot Arteries: The foot is supplied by patent anterior and posterior tibial arteries.
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15,152 |
EXAM: MR Knee Right wo contrast CLINICAL INFORMATION: Right knee pain COMPARISON: 11/18/2021 TECHNIQUE: Multiplanar and multisequence MRI of the right knee was obtained without contrast contrast. FINDINGS: BONES:No fracture, marrow replacement, or aggressive osseous lesion. ARTICULATIONS: Effusion:None. Patellofemoral compartment:No cartilage defect. 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. Tiny popliteal cyst. There is an anomalous origin of the proximal lateral gastrocnemius, at the femoral attachment of the fibular collateral ligament. CONCLUSION: 1. Tiny popliteal cyst. 2. Anomalous femoral attachment of the lateral gastrocnemius. 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.
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FINDINGS: BONES:No fracture, marrow replacement, or aggressive osseous lesion. ARTICULATIONS: Effusion:None. Patellofemoral compartment:No cartilage defect. 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. Tiny popliteal cyst. There is an anomalous origin of the proximal lateral gastrocnemius, at the femoral attachment of the fibular collateral ligament.
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Findings: The patient is intubated. There or also oral and nasogastric tubes. There is extensive soft tissue emphysema, worse on the left side, extending into the chest wall. There is also pneumomediastinum. These findings are better assessed on the dedicated CT chest. There are multiple bilateral rib fractures. There is small avulsion fracture of the right occipital condyle. Also widening of the right lateral atlantoaxial joint. There is asymmetry in the alignment of the right and left occipital atlas joints (series 3 image 287).Left parasymphyseal mandibular fractures Comminuted fracture of the left mandibular condyle There is mild straightening of the cervical spine lordotic curvature .Vertebral body heights are maintained. No compression deformities or other fractures are evident. The disc spaces are well-maintained. There is no spinal canal or neural foraminal stenosis.
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15,153 |
EXAM: MR Brain wo contrast 1/21/2022 1:46 PM CLINICAL INFORMATION: Memory Disorders Protocol, eval for PD, v. NPH v. vascular parkinsonism v. MSA. COMPARISON: None available. TECHNIQUE: Multiplanar, multisequence MRI of the brain was performed without intravenous contrast. FINDINGS: INTRACRANIAL FINDINGS: The brain parenchyma appears normal without evidence for acute ischemia, hemorrhage, or mass lesion. Age-appropriate cerebral volume. The ventricles are normal in size. There is no abnormal extra-axial collection. Minimal periventricular and single punctate superior left frontal lobe T2/FLAIR hyperintense foci, likely mild chronic microangiopathic changes. The flow voids at the skull base are normal. The cerebellar tonsils are normal in position. EXTRACRANIAL FINDINGS: Bilateral ocular lens replacements. Mild left greater than right maxillary sinus floor and anterior ethmoid sinus mucosal thickening bilaterally. Visualized paranasal sinuses and mastoid air cells are otherwise well aerated. _________________________ CONCLUSION 1. No acute intracranial process. 2. No MRI evidence to suggest neurodegenerative 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.
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FINDINGS: INTRACRANIAL FINDINGS: The brain parenchyma appears normal without evidence for acute ischemia, hemorrhage, or mass lesion. Age-appropriate cerebral volume. The ventricles are normal in size. There is no abnormal extra-axial collection. Minimal periventricular and single punctate superior left frontal lobe T2/FLAIR hyperintense foci, likely mild chronic microangiopathic changes. The flow voids at the skull base are normal. The cerebellar tonsils are normal in position. EXTRACRANIAL FINDINGS: Bilateral ocular lens replacements. Mild left greater than right maxillary sinus floor and anterior ethmoid sinus mucosal thickening bilaterally. Visualized paranasal sinuses and mastoid air cells are otherwise well aerated. _________________________
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Extensive left-sided predominant soft tissue emphysema. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube distal tip projects 4.3 cm superior to the carina. Extensive contusion and consolidation of the posterior aspect of the right lung. There is near-complete collapse of the right upper lobe with multiple traumatic pneumatoceles. Trace anterior right pneumothorax. The left chest tube distal tip terminates in the left chest wall. Moderate size anterior left pneumothorax with hemothorax component posteriorly. Left basilar atelectasis. Patchy opacities in the lingula likely contusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Extensive pneumomediastinum tracking along the course of the esophagus. DIAPHRAGM: No definitive diaphragmatic defect although the diaphragm is now well-visualized along the posterior/superior dome of the liver. LYMPH NODES: None enlarged. CHEST WALL: Extensive left chest wall emphysema extending inferiorly along the left anterior abdominal wall. ABDOMEN and PELVIS: LIVER: Ill-defined central predominant liver laceration with associated extensive surgical material posteriorly. There is also extensive packing material anterior and inferior to the liver. Focal area of hyperenhancement in the right hepatic lobe could be related to a THAD. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube distal tip terminates within the stomach. Small bowel is normal in caliber. COLON / APPENDIX: The appendix is normal. The colon is unremarkable. PERITONEUM / MESENTERY: Small volume hemoperitoneum is noted in the deep pelvis. Scattered foci of intraperitoneal free air are noted, likely postsurgical. Extensive packing material seen in around the liver. RETROPERITONEUM: Normal. VESSELS: Right inferior approach central venous and arterial lines are noted. Intrahepatic portions of the right portal vein are difficult to identify. URINARY BLADDER: Collapsed around a Foley balloon. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Anterior abdominal wall was left in discontinuity/open. Extensive anterior body wall emphysema, left greater than right. MUSCULOSKELETAL: The left femoral head is dislocated superiorly and posteriorly with associated comminuted and displaced femoral head fractures. The largest fracture fragment remains within the joint space. No significant associated acetabular fracture. Minimally displaced superior/left manubrial fracture. Mildly displaced right lateral rib fractures involving the first through 12th ribs and segmentally at the first rib. There are also mildly displaced left lateral and posterior rib fractures involving the first through 11th ribs, segmentally at 2-9. Comminuted fracture of the right talar neck with associated distal fibular fracture. Posterior subluxation of the right tibia with respect to the femur. Associated lipohemarthrosis and comminuted osseous fragments are noted both posteriorly and anteriorly to the joint space. Gas is also noted within the joint. Comminution involving the medial condyle of the right distal femur. Questionable compression of the medial tibial plateau on the right. Fracture of the inferior pole of the right patella. THORACIC: VERTEBRA: Minimally displaced left transverse process fractures involving the first, third, fourth, sixth, and seventh vertebral bodies. No compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: Grade 1 anterolisthesis of L5 on S1. DISC SPACES AND FACET JOINTS: No acute injury. Bilateral L5 pars defects. PREVERTEBRAL SOFT TISSUES: Unremarkable. RIGHT LOWER EXTREMITY RUNOFF: Right Common Iliac artery: No aneurysm, dissection, or stenosis. Right External Iliac artery: No aneurysm, dissection, or stenosis. Right Internal Iliac artery: No aneurysm, dissection, or stenosis. Proximal Right Femoral arteries: No aneurysm, dissection, or stenosis. Right Common Femoral artery: No aneurysm, dissection, or stenosis. Right Deep Femoral artery: No aneurysm, dissection, or stenosis. Right Superficial Femoral artery: No aneurysm, dissection, or stenosis. Right Popliteal artery: No aneurysm, dissection, or stenosis. Right Anterior Tibial artery: No aneurysm, dissection, or stenosis. Patent into the foot. Right Posterior Tibial artery: No aneurysm, dissection, or stenosis. Patent into the foot. Right Peroneal artery: No aneurysm, dissection, or stenosis. Patent to the level of the ankle. Right Foot Arteries: The foot is supplied by patent anterior and posterior tibial arteries.
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15,154 |
MR Brain wo+w contrast Clinical Information: 68-year-old with with metastatic melanoma. Comparison: MR brain dated 1/13/2022. Technique: Multiplanar, multisequence MR images of the brain with and without contrast. Patient weight: 204 lbs. IV contrast: ProHance, 20 ml, per protocol. Findings: Post right parietooccipital craniotomy with occipital tumor resection changes are noted. The tumor resection bed measuring 1.9 x 2.3 x 2.2 cm shows no nodular enhancing residual mass. Mild rim enhancement and surrounding diffusion restriction are postsurgical reactive. Small postsurgical pneumocephalus is seen over the right anterior frontal convexity. There is no evidence of acute cerebral infarction. Age-appropriate brain atrophy with mild microangiopathic disease. No acute infarct, hemorrhage, or midline shift. Orbits appear normal. Mild mucosal thickening in the right maxillary and anterior ethmoid sinuses. Remaining paranasal sinuses and mastoid air cells are clear. Major proximal intracranial flow voids are intact. No aggressive osseous lesion. Conclusion: 1. Interval gross total resection of the right occipital tumor. 2. No evidence of new intracranial metastasis or other 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.
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Findings: Post right parietooccipital craniotomy with occipital tumor resection changes are noted. The tumor resection bed measuring 1.9 x 2.3 x 2.2 cm shows no nodular enhancing residual mass. Mild rim enhancement and surrounding diffusion restriction are postsurgical reactive. Small postsurgical pneumocephalus is seen over the right anterior frontal convexity. There is no evidence of acute cerebral infarction. Age-appropriate brain atrophy with mild microangiopathic disease. No acute infarct, hemorrhage, or midline shift. Orbits appear normal. Mild mucosal thickening in the right maxillary and anterior ethmoid sinuses. Remaining paranasal sinuses and mastoid air cells are clear. Major proximal intracranial flow voids are intact. No aggressive osseous lesion.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Extensive left-sided predominant soft tissue emphysema. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube distal tip projects 4.3 cm superior to the carina. Extensive contusion and consolidation of the posterior aspect of the right lung. There is near-complete collapse of the right upper lobe with multiple traumatic pneumatoceles. Trace anterior right pneumothorax. The left chest tube distal tip terminates in the left chest wall. Moderate size anterior left pneumothorax with hemothorax component posteriorly. Left basilar atelectasis. Patchy opacities in the lingula likely contusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Extensive pneumomediastinum tracking along the course of the esophagus. DIAPHRAGM: No definitive diaphragmatic defect although the diaphragm is now well-visualized along the posterior/superior dome of the liver. LYMPH NODES: None enlarged. CHEST WALL: Extensive left chest wall emphysema extending inferiorly along the left anterior abdominal wall. ABDOMEN and PELVIS: LIVER: Ill-defined central predominant liver laceration with associated extensive surgical material posteriorly. There is also extensive packing material anterior and inferior to the liver. Focal area of hyperenhancement in the right hepatic lobe could be related to a THAD. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube distal tip terminates within the stomach. Small bowel is normal in caliber. COLON / APPENDIX: The appendix is normal. The colon is unremarkable. PERITONEUM / MESENTERY: Small volume hemoperitoneum is noted in the deep pelvis. Scattered foci of intraperitoneal free air are noted, likely postsurgical. Extensive packing material seen in around the liver. RETROPERITONEUM: Normal. VESSELS: Right inferior approach central venous and arterial lines are noted. Intrahepatic portions of the right portal vein are difficult to identify. URINARY BLADDER: Collapsed around a Foley balloon. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Anterior abdominal wall was left in discontinuity/open. Extensive anterior body wall emphysema, left greater than right. MUSCULOSKELETAL: The left femoral head is dislocated superiorly and posteriorly with associated comminuted and displaced femoral head fractures. The largest fracture fragment remains within the joint space. No significant associated acetabular fracture. Minimally displaced superior/left manubrial fracture. Mildly displaced right lateral rib fractures involving the first through 12th ribs and segmentally at the first rib. There are also mildly displaced left lateral and posterior rib fractures involving the first through 11th ribs, segmentally at 2-9. Comminuted fracture of the right talar neck with associated distal fibular fracture. Posterior subluxation of the right tibia with respect to the femur. Associated lipohemarthrosis and comminuted osseous fragments are noted both posteriorly and anteriorly to the joint space. Gas is also noted within the joint. Comminution involving the medial condyle of the right distal femur. Questionable compression of the medial tibial plateau on the right. Fracture of the inferior pole of the right patella. THORACIC: VERTEBRA: Minimally displaced left transverse process fractures involving the first, third, fourth, sixth, and seventh vertebral bodies. No compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: Grade 1 anterolisthesis of L5 on S1. DISC SPACES AND FACET JOINTS: No acute injury. Bilateral L5 pars defects. PREVERTEBRAL SOFT TISSUES: Unremarkable. RIGHT LOWER EXTREMITY RUNOFF: Right Common Iliac artery: No aneurysm, dissection, or stenosis. Right External Iliac artery: No aneurysm, dissection, or stenosis. Right Internal Iliac artery: No aneurysm, dissection, or stenosis. Proximal Right Femoral arteries: No aneurysm, dissection, or stenosis. Right Common Femoral artery: No aneurysm, dissection, or stenosis. Right Deep Femoral artery: No aneurysm, dissection, or stenosis. Right Superficial Femoral artery: No aneurysm, dissection, or stenosis. Right Popliteal artery: No aneurysm, dissection, or stenosis. Right Anterior Tibial artery: No aneurysm, dissection, or stenosis. Patent into the foot. Right Posterior Tibial artery: No aneurysm, dissection, or stenosis. Patent into the foot. Right Peroneal artery: No aneurysm, dissection, or stenosis. Patent to the level of the ankle. Right Foot Arteries: The foot is supplied by patent anterior and posterior tibial arteries.
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15,155 |
MR Brain wo contrast 1/21/2022 12:40 PM Clinical Information: Neuro deficit, acute, stroke suspected, R25.1 Tremor, unspecified, R15.9 Full incontinence of feces, R68.2 Dry mouth, unspecified, R26.89 Other abnormalities of gait and mobility Comparison: None. Technique: Sagittal T1, axial T2, FLAIR, DWI with ADC map and SWI. Findings: Diffusion-weighted imaging is negative for acute cortical infarct or vascular territory cerebral ischemia. Mild grade of chronic small vessel ischemic changes are seen around the bilateral periventricular white matter. The cortical sulci, subarachnoid cisterns and ventricles are symmetric and age-appropriate. The brainstem and cerebellum are unremarkable. The major intracranial vascular flow voids are normally seen. No cerebral hemorrhage or extra-axial collection is noted. Impression: No acute intracranial abnormality.
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Findings: Diffusion-weighted imaging is negative for acute cortical infarct or vascular territory cerebral ischemia. Mild grade of chronic small vessel ischemic changes are seen around the bilateral periventricular white matter. The cortical sulci, subarachnoid cisterns and ventricles are symmetric and age-appropriate. The brainstem and cerebellum are unremarkable. The major intracranial vascular flow voids are normally seen. No cerebral hemorrhage or extra-axial collection is noted.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is normal. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Upper normal limits ventricular size ORBITS: Globes are intact. No fracture. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. Left frontal scalp contusion. Extensive soft tissue emphysema in the left upper neck and retropharyngeal soft tissues. Small avulsion fracture of the right occipital condyle. Asymmetry in the appearance of the right and left atlantooccipital joints. FACIAL BONES: No fracture. Pterygoid plates are intact. MANDIBLE: Acute displaced fracture of the left mandibular condyle near the ramus. Acute comminuted and mildly displaced fracture of the symphyseal/left parasymphyseal hemimandible alveolar processes of the mandibular central incisors. SINONASAL CAVITIES: Mild mucosal thickening of the bilateral ethmoid, sphenoid, and bilateral maxillary sinuses.
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15,156 |
MRI brain with and without Indication: Metastatic evaluation 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: 98 lbs. IV contrast: ProHance, 9 ml, per protocol. Findings: There is no restricted diffusion. There is moderate diffuse cerebral atrophy and prominent CSF spaces. There is no hydrocephalus. There are small foci of increased susceptibility in the left frontal corona radiata, likely chronic microhemorrhages. There is no abnormal enhancing lesion in the brain parenchyma. No definite abnormal enhancement along the cranial nerves. Posterior fossa and midline structures are within normal limits. Impression: No acute intracranial process. Moderate diffuse cerebral atrophy without hydrocephalus. No definite MRI evidence of intracranial metastasis.
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Findings: There is no restricted diffusion. There is moderate diffuse cerebral atrophy and prominent CSF spaces. There is no hydrocephalus. There are small foci of increased susceptibility in the left frontal corona radiata, likely chronic microhemorrhages. There is no abnormal enhancing lesion in the brain parenchyma. No definite abnormal enhancement along the cranial nerves. Posterior fossa and midline structures are within normal limits.
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FINDINGS: AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. LEFT CAROTID: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. RIGHT VERTEBRAL ARTERY: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. LEFT VERTEBRAL ARTERY: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. No contrast extravasation or pseudoaneurysm is identified. Mildly displaced fracture of the left manubrium. Displaced fractures of all visualized ribs bilaterally. Mildly displaced fracture of the 123. Bilateral upper lobe pulmonary contusions. Partially visualized left pneumothorax. Extensive subcutaneous emphysema, predominantly along the left chest, back and neck. This soft tissue gas extends along the prevertebral and bilateral carotid spaces. Small amount of soft tissue gas is seen within the spinal canal in the epidural space. Chin laceration with underlying displaced mandibular body fracture. Displaced fracture of the right occipital condyle.
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15,157 |
MR Breast Diagnostic Bil wo+w contrast CLINICAL INFORMATION: 59-year-old woman with left invasive ductal carcinoma, grade 2 with associated high-grade DCIS. Left axillary node biopsy was benign but discordant.. 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: 155 lbs. IV contrast: ProHance, 15 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: Most recent breast MRI: 10/15/2021. Most recent mammogram: 1/21/2022. MRI FINDINGS: This bilateral breast MRI exam demonstrates mild background enhancement. There is scattered fibroglandular tissue. RIGHT BREAST:No suspicious enhancing mass or nonmass enhancement. No architectural distortion. LEFT BREAST:There is susceptibility artifact in the central breast, posterior depth corresponding to the HIDA mark biopsy marker. No residual enhancement identified. LYMPH NODES:No axillary adenopathy identified. Susceptibility artifact is seen in the left axilla consistent with biopsy marker. ADDITIONAL FINDINGS: MediPort is seen in the upper inner quadrant of the right breast. IMPRESSION AND RECOMMENDATIONS: RIGHT BREAST: No MRI evidence of occult breast malignancy.. BI-RADS 1: Negative. LEFT BREAST: No residual enhancement consistent with complete imaging response to therapy. Biopsy marker identified.. BI-RADS 6: Biopsy proven malignancy. Recommend surgical excision when clinically appropriate. LYMPH NODES: Left axillary lymph node benign and discordant. Surgical excision when clinically appropriate. OVERALL BI-RADS ASSESSMENT:BI-RADS 6: Biopsy proven malignancy. Recommend surgical excision when clinically appropriate.
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FINDINGS: This bilateral breast MRI exam demonstrates mild background enhancement. There is scattered fibroglandular tissue. RIGHT BREAST:No suspicious enhancing mass or nonmass enhancement. No architectural distortion. LEFT BREAST:There is susceptibility artifact in the central breast, posterior depth corresponding to the HIDA mark biopsy marker. No residual enhancement identified. LYMPH NODES:No axillary adenopathy identified. Susceptibility artifact is seen in the left axilla consistent with biopsy marker. ADDITIONAL FINDINGS: MediPort is seen in the upper inner quadrant of the right breast. IMPRESSION AND RECOMMENDATIONS: RIGHT BREAST: No MRI evidence of occult breast malignancy.. BI-RADS 1: Negative. LEFT BREAST: No residual enhancement consistent with complete imaging response to therapy. Biopsy marker identified.. BI-RADS 6: Biopsy proven malignancy. Recommend surgical excision when clinically appropriate. LYMPH NODES: Left axillary lymph node benign and discordant. Surgical excision when clinically appropriate. OVERALL BI-RADS ASSESSMENT:BI-RADS 6: Biopsy proven malignancy. Recommend surgical excision when clinically appropriate.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Extensive left-sided predominant soft tissue emphysema. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube distal tip projects 4.3 cm superior to the carina. Extensive contusion and consolidation of the posterior aspect of the right lung. There is near-complete collapse of the right upper lobe with multiple traumatic pneumatoceles. Trace anterior right pneumothorax. The left chest tube distal tip terminates in the left chest wall. Moderate size anterior left pneumothorax with hemothorax component posteriorly. Left basilar atelectasis. Patchy opacities in the lingula likely contusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Extensive pneumomediastinum tracking along the course of the esophagus. DIAPHRAGM: No definitive diaphragmatic defect although the diaphragm is now well-visualized along the posterior/superior dome of the liver. LYMPH NODES: None enlarged. CHEST WALL: Extensive left chest wall emphysema extending inferiorly along the left anterior abdominal wall. ABDOMEN and PELVIS: LIVER: Ill-defined central predominant liver laceration with associated extensive surgical material posteriorly. There is also extensive packing material anterior and inferior to the liver. Focal area of hyperenhancement in the right hepatic lobe could be related to a THAD. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube distal tip terminates within the stomach. Small bowel is normal in caliber. COLON / APPENDIX: The appendix is normal. The colon is unremarkable. PERITONEUM / MESENTERY: Small volume hemoperitoneum is noted in the deep pelvis. Scattered foci of intraperitoneal free air are noted, likely postsurgical. Extensive packing material seen in around the liver. RETROPERITONEUM: Normal. VESSELS: Right inferior approach central venous and arterial lines are noted. Intrahepatic portions of the right portal vein are difficult to identify. URINARY BLADDER: Collapsed around a Foley balloon. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Anterior abdominal wall was left in discontinuity/open. Extensive anterior body wall emphysema, left greater than right. MUSCULOSKELETAL: The left femoral head is dislocated superiorly and posteriorly with associated comminuted and displaced femoral head fractures. The largest fracture fragment remains within the joint space. No significant associated acetabular fracture. Minimally displaced superior/left manubrial fracture. Mildly displaced right lateral rib fractures involving the first through 12th ribs and segmentally at the first rib. There are also mildly displaced left lateral and posterior rib fractures involving the first through 11th ribs, segmentally at 2-9. Comminuted fracture of the right talar neck with associated distal fibular fracture. Posterior subluxation of the right tibia with respect to the femur. Associated lipohemarthrosis and comminuted osseous fragments are noted both posteriorly and anteriorly to the joint space. Gas is also noted within the joint. Comminution involving the medial condyle of the right distal femur. Questionable compression of the medial tibial plateau on the right. Fracture of the inferior pole of the right patella. THORACIC: VERTEBRA: Minimally displaced left transverse process fractures involving the first, third, fourth, sixth, and seventh vertebral bodies. No compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: Grade 1 anterolisthesis of L5 on S1. DISC SPACES AND FACET JOINTS: No acute injury. Bilateral L5 pars defects. PREVERTEBRAL SOFT TISSUES: Unremarkable. RIGHT LOWER EXTREMITY RUNOFF: Right Common Iliac artery: No aneurysm, dissection, or stenosis. Right External Iliac artery: No aneurysm, dissection, or stenosis. Right Internal Iliac artery: No aneurysm, dissection, or stenosis. Proximal Right Femoral arteries: No aneurysm, dissection, or stenosis. Right Common Femoral artery: No aneurysm, dissection, or stenosis. Right Deep Femoral artery: No aneurysm, dissection, or stenosis. Right Superficial Femoral artery: No aneurysm, dissection, or stenosis. Right Popliteal artery: No aneurysm, dissection, or stenosis. Right Anterior Tibial artery: No aneurysm, dissection, or stenosis. Patent into the foot. Right Posterior Tibial artery: No aneurysm, dissection, or stenosis. Patent into the foot. Right Peroneal artery: No aneurysm, dissection, or stenosis. Patent to the level of the ankle. Right Foot Arteries: The foot is supplied by patent anterior and posterior tibial arteries.
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15,158 |
MRI brain with and without, Indication: Ataxia, nontraumatic, stroke excluded, R53.1 Weakness, U09.9 Post COVID-19 condition, unspecified, R53.83 Other fatigue 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. T2 sagittal and axial fast spin spin echo, T1 sagittal spin echo, sagittal STIR, axial T2* gradient echo of the cervical spine. Post contrast T1 sagittal and axial images as per departmental protocol. Patient weight: 154 lbs. IV contrast: ProHance, 15 ml, per protocol. IV contrast injection rate: 0.50 ml per sec. Findings: Brain: Echoplanar diffusion-weighted imaging demonstrates no evidence of restricted diffusion at this time. Whole brain T2 and FLAIR imaging demonstrate no midline shift, mass effect, or other space-occupying lesion. There are no significant white matter FLAIR hyperintensities . The ventricular system is of normal morphology. The basal cisterns are clear. The visualized vascular flow voids appear normal. Post administration of contrast material, there is no other abnormal enhancement. The remaining visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Prominent adenoid. Cervical spine: There is loss of normal cervical lordotic curvature with mild reversal. Multilevel degenerative changes with disc desiccation. Anterior and posterior osteophytes at C5-6 and C6-7 with mild disc height loss. Vertebral body heights are preserved. There are no suspicious bone marrow signal abnormalities. The cranial vertebral junction appears unremarkable. No definite cord signal abnormality is identified. Degenerative findings are discussed on a level by level basis: C2-3: No disc bulge. No central canal or neuroforaminal stenosis. C3-4: Mild bulge indenting the ventral thecal sac. No central canal or neuroforaminal stenosis. C4-5: No significant disc bulge. No central canal or neuroforaminal stenosis. C5-6: Mild to moderate disc protrusion/extrusion indenting the ventral cord surface. With no definite cord signal abnormality. Both neuroforamina patent. C6-7: Mild to moderate disc protrusion asymmetric to the left with extension into the left neural foramen and compression of the exiting C7 nerve root. Mild cord surface deformity with no definite cord signal abnormality.. Right neural foramen. C7-T1: Unremarkable. No abnormal postcontrast enhancement identified. Impression: No acute intracranial process. No pathologic enhancement is appreciated. Disc protrusion/extrusion at C5-6 with ventral cord surface indentation. No cord signal abnormality. Left foraminal disc protrusion/extrusion at C6-7 with compression of the exiting left C7 nerve root.
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Findings: Brain: Echoplanar diffusion-weighted imaging demonstrates no evidence of restricted diffusion at this time. Whole brain T2 and FLAIR imaging demonstrate no midline shift, mass effect, or other space-occupying lesion. There are no significant white matter FLAIR hyperintensities . The ventricular system is of normal morphology. The basal cisterns are clear. The visualized vascular flow voids appear normal. Post administration of contrast material, there is no other abnormal enhancement. The remaining visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Prominent adenoid. Cervical spine: There is loss of normal cervical lordotic curvature with mild reversal. Multilevel degenerative changes with disc desiccation. Anterior and posterior osteophytes at C5-6 and C6-7 with mild disc height loss. Vertebral body heights are preserved. There are no suspicious bone marrow signal abnormalities. The cranial vertebral junction appears unremarkable. No definite cord signal abnormality is identified. Degenerative findings are discussed on a level by level basis: C2-3: No disc bulge. No central canal or neuroforaminal stenosis. C3-4: Mild bulge indenting the ventral thecal sac. No central canal or neuroforaminal stenosis. C4-5: No significant disc bulge. No central canal or neuroforaminal stenosis. C5-6: Mild to moderate disc protrusion/extrusion indenting the ventral cord surface. With no definite cord signal abnormality. Both neuroforamina patent. C6-7: Mild to moderate disc protrusion asymmetric to the left with extension into the left neural foramen and compression of the exiting C7 nerve root. Mild cord surface deformity with no definite cord signal abnormality.. Right neural foramen. C7-T1: Unremarkable. No abnormal postcontrast enhancement identified.
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FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Mild diffuse cerebral volume loss. Gray-white differentiation is maintained. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. SOFT TISSUES: Normal. FACE: FACIAL BONES: No acute facial or mandibular fracture identified. ORBITS: Normal. SINUSES: Normal. SOFT TISSUES: Mild left periorbital soft tissue swelling.
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15,159 |
MRI brain with and without, Indication: Ataxia, nontraumatic, stroke excluded, R53.1 Weakness, U09.9 Post COVID-19 condition, unspecified, R53.83 Other fatigue 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. T2 sagittal and axial fast spin spin echo, T1 sagittal spin echo, sagittal STIR, axial T2* gradient echo of the cervical spine. Post contrast T1 sagittal and axial images as per departmental protocol. Patient weight: 154 lbs. IV contrast: ProHance, 15 ml, per protocol. IV contrast injection rate: 0.50 ml per sec. Findings: Brain: Echoplanar diffusion-weighted imaging demonstrates no evidence of restricted diffusion at this time. Whole brain T2 and FLAIR imaging demonstrate no midline shift, mass effect, or other space-occupying lesion. There are no significant white matter FLAIR hyperintensities . The ventricular system is of normal morphology. The basal cisterns are clear. The visualized vascular flow voids appear normal. Post administration of contrast material, there is no other abnormal enhancement. The remaining visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Prominent adenoid. Cervical spine: There is loss of normal cervical lordotic curvature with mild reversal. Multilevel degenerative changes with disc desiccation. Anterior and posterior osteophytes at C5-6 and C6-7 with mild disc height loss. Vertebral body heights are preserved. There are no suspicious bone marrow signal abnormalities. The cranial vertebral junction appears unremarkable. No definite cord signal abnormality is identified. Degenerative findings are discussed on a level by level basis: C2-3: No disc bulge. No central canal or neuroforaminal stenosis. C3-4: Mild bulge indenting the ventral thecal sac. No central canal or neuroforaminal stenosis. C4-5: No significant disc bulge. No central canal or neuroforaminal stenosis. C5-6: Mild to moderate disc protrusion/extrusion indenting the ventral cord surface. With no definite cord signal abnormality. Both neuroforamina patent. C6-7: Mild to moderate disc protrusion asymmetric to the left with extension into the left neural foramen and compression of the exiting C7 nerve root. Mild cord surface deformity with no definite cord signal abnormality.. Right neural foramen. C7-T1: Unremarkable. No abnormal postcontrast enhancement identified. Impression: No acute intracranial process. No pathologic enhancement is appreciated. Disc protrusion/extrusion at C5-6 with ventral cord surface indentation. No cord signal abnormality. Left foraminal disc protrusion/extrusion at C6-7 with compression of the exiting left C7 nerve root.
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Findings: Brain: Echoplanar diffusion-weighted imaging demonstrates no evidence of restricted diffusion at this time. Whole brain T2 and FLAIR imaging demonstrate no midline shift, mass effect, or other space-occupying lesion. There are no significant white matter FLAIR hyperintensities . The ventricular system is of normal morphology. The basal cisterns are clear. The visualized vascular flow voids appear normal. Post administration of contrast material, there is no other abnormal enhancement. The remaining visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Prominent adenoid. Cervical spine: There is loss of normal cervical lordotic curvature with mild reversal. Multilevel degenerative changes with disc desiccation. Anterior and posterior osteophytes at C5-6 and C6-7 with mild disc height loss. Vertebral body heights are preserved. There are no suspicious bone marrow signal abnormalities. The cranial vertebral junction appears unremarkable. No definite cord signal abnormality is identified. Degenerative findings are discussed on a level by level basis: C2-3: No disc bulge. No central canal or neuroforaminal stenosis. C3-4: Mild bulge indenting the ventral thecal sac. No central canal or neuroforaminal stenosis. C4-5: No significant disc bulge. No central canal or neuroforaminal stenosis. C5-6: Mild to moderate disc protrusion/extrusion indenting the ventral cord surface. With no definite cord signal abnormality. Both neuroforamina patent. C6-7: Mild to moderate disc protrusion asymmetric to the left with extension into the left neural foramen and compression of the exiting C7 nerve root. Mild cord surface deformity with no definite cord signal abnormality.. Right neural foramen. C7-T1: Unremarkable. No abnormal postcontrast enhancement identified.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The trachea and central airways are patent. Diffuse bronchial wall thickening most pronounced at the bilateral bases. There is mild associated septal thickening at the bases. Tree-in-bud nodularity is present throughout the lungs. No significant pleural effusion or pneumothorax. Scattered calcified granulomas. HEART / VESSELS: The heart is mildly enlarged. Trace pericardial effusion. Extensive vascular calcifications. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: Innumerable mediastinal and hilar calcified lymph nodes. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral simple cysts. There is a small amount of bilateral and symmetric perinephric fluid/stranding. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix and colon are normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered vascular calcifications. URINARY BLADDER: Distended. REPRODUCTIVE ORGANS: The uterus is absent. No adnexal mass. BODY WALL: Scattered body wall edema. MUSCULOSKELETAL: Advanced degenerative change of both glenohumeral joints with joint capsular hypertrophy. There is also bilateral high riding humeral heads with pseudoarthrosis in the humeral head and the acromium which can suggest rotator cuff insufficiency. Advanced degenerative change of the SI joints. Prominent chondrocalcinosis in the shoulder joints, sternoclavicular joint and hip joints. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: Grade 1 anterolisthesis of L4 on L5. DISC SPACES AND FACET JOINTS: No acute injury. Advanced degenerative change with lower lumbar spine facet arthropathy. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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15,160 |
Lumbar MRI without contrast - Clinical indication: back pain, M54.40 Lumbago with sciatica, unspecified side Spec Inst: Outside order fax report to .br (205) 521-5523. - Technique: Multiple T1 and T2 weighted MR sequence images of the lumbar spine were obtained in the axial and sagittal plane without the use of intravenous contrast per departmental cervical spine protocol. Patient weight: 200 lbs. - Comparison: No previous similar studies are presented for comparison.. - Findings: Sagittal imaging demonstrates the intervertebral disc spaces, vertebral body heights, and alignment to be maintained. The marrow signal appears maintained. Axial imaging demonstrates no significant disc degenerative changes. The conus terminates at L1-2 Axial images are evaluated on a level by level basis: - T12-L1: Normal. - L1-2: Normal. - L2-3: Normal. - L3-4: No disc bulge. No canal or neuroforaminal stenosis. Right-sided facet arthropathy and ligamentum flavum thickening.. - L4-5: Mild bulge. Mild right neural foraminal narrowing. No central stenosis. Bilateral facet arthropathy.. - L5-S1: Mild bulge no central or neuroforaminal stenosis. Lateral facet arthropathy.. - The visualized paraspinal structures appear otherwise within normal limits. The remaining visualized osseous and soft tissue structures demonstrate normal MR signal characteristics. - Impression: Mild degenerative changes in the lumbar spine as described. -
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Findings: Sagittal imaging demonstrates the intervertebral disc spaces, vertebral body heights, and alignment to be maintained. The marrow signal appears maintained. Axial imaging demonstrates no significant disc degenerative changes. The conus terminates at L1-2 Axial images are evaluated on a level by level basis: - T12-L1: Normal. - L1-2: Normal. - L2-3: Normal. - L3-4: No disc bulge. No canal or neuroforaminal stenosis. Right-sided facet arthropathy and ligamentum flavum thickening.. - L4-5: Mild bulge. Mild right neural foraminal narrowing. No central stenosis. Bilateral facet arthropathy.. - L5-S1: Mild bulge no central or neuroforaminal stenosis. Lateral facet arthropathy.. - The visualized paraspinal structures appear otherwise within normal limits. The remaining visualized osseous and soft tissue structures demonstrate normal MR signal characteristics. -
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The trachea and central airways are patent. Diffuse bronchial wall thickening most pronounced at the bilateral bases. There is mild associated septal thickening at the bases. Tree-in-bud nodularity is present throughout the lungs. No significant pleural effusion or pneumothorax. Scattered calcified granulomas. HEART / VESSELS: The heart is mildly enlarged. Trace pericardial effusion. Extensive vascular calcifications. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: Innumerable mediastinal and hilar calcified lymph nodes. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral simple cysts. There is a small amount of bilateral and symmetric perinephric fluid/stranding. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix and colon are normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered vascular calcifications. URINARY BLADDER: Distended. REPRODUCTIVE ORGANS: The uterus is absent. No adnexal mass. BODY WALL: Scattered body wall edema. MUSCULOSKELETAL: Advanced degenerative change of both glenohumeral joints with joint capsular hypertrophy. There is also bilateral high riding humeral heads with pseudoarthrosis in the humeral head and the acromium which can suggest rotator cuff insufficiency. Advanced degenerative change of the SI joints. Prominent chondrocalcinosis in the shoulder joints, sternoclavicular joint and hip joints. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: Grade 1 anterolisthesis of L4 on L5. DISC SPACES AND FACET JOINTS: No acute injury. Advanced degenerative change with lower lumbar spine facet arthropathy. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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15,161 |
MR Breast Screening wo+w contrast CLINICAL INFORMATION: 62-year-old woman with a personal history of breast cancer and dense breast tissue. This is a screening exam.. 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: 167 lbs. IV contrast: ProHance, 16 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: Most recent breast MRI: None. Most recent mammogram: 9/9/2021. MRI FINDINGS: This bilateral breast MRI exam demonstrates minimal background enhancement. There is heterogeneous fibroglandular tissue. RIGHT BREAST:No suspicious enhancing mass or nonmass enhancement. No architectural distortion. LEFT BREAST:Postsurgical changes of breast conservation therapy. No suspicious enhancing mass or nonmass enhancement LYMPH NODES:No axillary adenopathy. No internal mammary chain adenopathy ADDITIONAL FINDINGS: No marrow signal abnormality IMPRESSION AND RECOMMENDATIONS: RIGHT BREAST: No MRI evidence of occult breast malignancy.. BI-RADS 1: Negative. LEFT BREAST: Post breast conservation therapy change without MR evidence of malignancy. BI-RADS 2: Benign OVERALL BI-RADS ASSESSMENT:BI-RADS 2: Benign. Annual mammography is due in September 2022.
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FINDINGS: This bilateral breast MRI exam demonstrates minimal background enhancement. There is heterogeneous fibroglandular tissue. RIGHT BREAST:No suspicious enhancing mass or nonmass enhancement. No architectural distortion. LEFT BREAST:Postsurgical changes of breast conservation therapy. No suspicious enhancing mass or nonmass enhancement LYMPH NODES:No axillary adenopathy. No internal mammary chain adenopathy ADDITIONAL FINDINGS: No marrow signal abnormality IMPRESSION AND RECOMMENDATIONS: RIGHT BREAST: No MRI evidence of occult breast malignancy.. BI-RADS 1: Negative. LEFT BREAST: Post breast conservation therapy change without MR evidence of malignancy. BI-RADS 2: Benign OVERALL BI-RADS ASSESSMENT:BI-RADS 2: Benign. Annual mammography is due in September 2022.
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FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Mild diffuse cerebral volume loss. Gray-white differentiation is maintained. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. SOFT TISSUES: Normal. FACE: FACIAL BONES: No acute facial or mandibular fracture identified. ORBITS: Normal. SINUSES: Normal. SOFT TISSUES: Mild left periorbital soft tissue swelling.
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15,162 |
MRI brain with and without contrast Clinical Information: Female aged 55 years. Per chart review patient with history of left breast cancer and colon cancer. Patient reports worsening headaches. Comparison: MR 7/18/2019 Technique: Multiplanar, multisequence MRI of the brain were obtained in multiple planes pre-and post administration of intravenous contrast per departmental protocol. Patient weight: 215 lbs. IV contrast: ProHance, 20 ml, per protocol. Findings: No acute infarct or intracranial hemorrhage. No midline shift, hydrocephalus, mass effect, or other space-occupying lesion. No abnormal parenchymal or leptomeningeal enhancement. Cortical encephalomalacia and subcortical gliosis are seen in the left parieto-occipital region. No corresponding enhancement on postcontrast images. Small foci of T2/FLAIR hyperintensities in the deep white/periventricular white matter, likely reflecting chronic microangiopathic changes. No significant abnormality of the extracranial osseous and soft tissue structures. Conclusion: 1. No evidence of intracranial metastatic disease. 2. Left parietooccipital encephalomalacia and microangiopathic changes 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.
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Findings: No acute infarct or intracranial hemorrhage. No midline shift, hydrocephalus, mass effect, or other space-occupying lesion. No abnormal parenchymal or leptomeningeal enhancement. Cortical encephalomalacia and subcortical gliosis are seen in the left parieto-occipital region. No corresponding enhancement on postcontrast images. Small foci of T2/FLAIR hyperintensities in the deep white/periventricular white matter, likely reflecting chronic microangiopathic changes. No significant abnormality of the extracranial osseous and soft tissue structures.
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FINDINGS: CT of the head with and without contrast: Please see separately reported same day noncontrast CT head for intracranial findings including multi compartmental hemorrhage, subfalcine and left uncal herniation, and hydrocephalus. No abnormal intracranial enhancement within the limitations of arterial phase exam. CT angiogram of the brain: RIGHT CAROTID: Mild atherosclerosis of the carotid siphon without flow-limiting stenosis. No evidence of occlusion or aneurysmal dilation. LEFT CAROTID: Moderate atherosclerosis of the carotid siphon without flow-limiting stenosis. No evidence of occlusion or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Mild diffuse irregularity of the bilateral PCAs, likely vasospasm. Fetal predominant circulation of the left PCA. Unremarkable appearance of the bilateral ACAs and MCAs. VERTEBROBASILAR ARTERIES: Mild luminal irregularity of the basilar artery. There is no evidence of stenosis, occlusion, or aneurysmal dilation. Tiny focus of hyperdensity within the left frontotemporal intraparenchymal hemorrhage (image 246, series #407) representing contrast extravasation. No definite feeding vessel identified. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: Mild atherosclerosis of the proximal ICA without flow-limiting stenosis. No evidence of occlusion or aneurysmal dilation. LEFT CAROTID: Moderate atherosclerosis of the proximal ICA without flow-limiting stenosis. No evidence of occlusion or aneurysmal dilation. RIGHT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT VERTEBRAL ARTERY: Greater than 70% narrowing at the level of C5-C6 secondary to uncovertebral/facet hypertrophy. Mild atherosclerosis at the origin without flow-limiting stenosis. No evidence of occlusion or aneurysmal dilation. SOFT TISSUES: No soft tissue abnormality within the neck. Bilateral dependent atelectasis, right greater than left. Bulky calcified right paratracheal lymph node. Endotracheal tube is present terminating in the mid trachea. Esophagogastric tube is partially imaged and courses below the field-of-view. CERVICAL SPINE: Advanced multilevel discogenic degenerative changes of the cervical spine with partial fusion of the C6 and C7 vertebral bodies. Calcification of the posterior longitudinal ligament at C6-C7. Moderate multilevel spinal canal narrowing at C4-C5, C5-C6, and C6-C7 due to posterior disc osteophyte complexes. Severe bilateral C4-C5 and C5-C6 neuroforaminal narrowing.
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15,163 |
MRI brain without Indication: Dementia, Alzheimer s suspected, G31.84 Mild cognitive impairment, so stated Spec Inst: Memory Disorders 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 without the use of intravenous contrast per departmental protocol. Findings: Echoplanar diffusion-weighted imaging demonstrates no evidence of restrained diffusion at this time. Whole brain T2 and FLAIR imaging demonstrate no midline shift, mass effect, or other space-occupying lesion. There is no significant white matter hyperintensities. The ventricular system is of normal morphology. The basal cisterns are clear. The visualized vascular flow voids appear normal. The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. MTA 2 bilaterally. Impression: No acute intracranial process.
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Findings: Echoplanar diffusion-weighted imaging demonstrates no evidence of restrained diffusion at this time. Whole brain T2 and FLAIR imaging demonstrate no midline shift, mass effect, or other space-occupying lesion. There is no significant white matter hyperintensities. The ventricular system is of normal morphology. The basal cisterns are clear. The visualized vascular flow voids appear normal. The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. MTA 2 bilaterally.
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FINDINGS: CT of the head with and without contrast: Please see separately reported same day noncontrast CT head for intracranial findings including multi compartmental hemorrhage, subfalcine and left uncal herniation, and hydrocephalus. No abnormal intracranial enhancement within the limitations of arterial phase exam. CT angiogram of the brain: RIGHT CAROTID: Mild atherosclerosis of the carotid siphon without flow-limiting stenosis. No evidence of occlusion or aneurysmal dilation. LEFT CAROTID: Moderate atherosclerosis of the carotid siphon without flow-limiting stenosis. No evidence of occlusion or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Mild diffuse irregularity of the bilateral PCAs, likely vasospasm. Fetal predominant circulation of the left PCA. Unremarkable appearance of the bilateral ACAs and MCAs. VERTEBROBASILAR ARTERIES: Mild luminal irregularity of the basilar artery. There is no evidence of stenosis, occlusion, or aneurysmal dilation. Tiny focus of hyperdensity within the left frontotemporal intraparenchymal hemorrhage (image 246, series #407) representing contrast extravasation. No definite feeding vessel identified. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: Mild atherosclerosis of the proximal ICA without flow-limiting stenosis. No evidence of occlusion or aneurysmal dilation. LEFT CAROTID: Moderate atherosclerosis of the proximal ICA without flow-limiting stenosis. No evidence of occlusion or aneurysmal dilation. RIGHT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT VERTEBRAL ARTERY: Greater than 70% narrowing at the level of C5-C6 secondary to uncovertebral/facet hypertrophy. Mild atherosclerosis at the origin without flow-limiting stenosis. No evidence of occlusion or aneurysmal dilation. SOFT TISSUES: No soft tissue abnormality within the neck. Bilateral dependent atelectasis, right greater than left. Bulky calcified right paratracheal lymph node. Endotracheal tube is present terminating in the mid trachea. Esophagogastric tube is partially imaged and courses below the field-of-view. CERVICAL SPINE: Advanced multilevel discogenic degenerative changes of the cervical spine with partial fusion of the C6 and C7 vertebral bodies. Calcification of the posterior longitudinal ligament at C6-C7. Moderate multilevel spinal canal narrowing at C4-C5, C5-C6, and C6-C7 due to posterior disc osteophyte complexes. Severe bilateral C4-C5 and C5-C6 neuroforaminal narrowing.
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MRI brain with and without, MRA head without Indication: Headache, new or worsening, R51.9 Headache, unspecified 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. MR angiogram of the head without contrast per protocol. 3-D reconstructions were generated per the ordering physician's request and reviewed by the interpreting physician Patient weight: 241 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 2 ml per sec. Findings: Echoplanar diffusion-weighted imaging demonstrates no evidence of restricted diffusion at this time. Whole brain T2 and FLAIR imaging demonstrate no midline shift, mass effect, or other space-occupying lesion. There are a few scattered white matter FLAIR hyperintensitiesin the bilateral cerebral white matter. The ventricular system is of normal morphology. The basal cisterns are clear. The visualized vascular flow voids appear normal. Post administration of contrast material, there is no other abnormal enhancement. The remaining visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. MRA head without: There is no evidence of intracranial arterial stenosis/occlusion. Attenuation of the flow signal secondary to in plane artifacts. There is no aneurysm or arteriovenous malformation. Impression: 1. A few scattered nonenhancing T2/FLAIR white matter hyperintensities nonspecific, most likely secondary to chronic microvascular ischemic disease but may be seen in patient's with headache/migraine. 2. No evidence of acute infarct or hemorrhage. No pathologic enhancement is appreciated. 3. On MRA of the head no evidence of flow-limiting stenosis or occlusion of the intracranial arteries. No aneurysms or arteriovenous malformations.
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Findings: Echoplanar diffusion-weighted imaging demonstrates no evidence of restricted diffusion at this time. Whole brain T2 and FLAIR imaging demonstrate no midline shift, mass effect, or other space-occupying lesion. There are a few scattered white matter FLAIR hyperintensitiesin the bilateral cerebral white matter. The ventricular system is of normal morphology. The basal cisterns are clear. The visualized vascular flow voids appear normal. Post administration of contrast material, there is no other abnormal enhancement. The remaining visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. MRA head without: There is no evidence of intracranial arterial stenosis/occlusion. Attenuation of the flow signal secondary to in plane artifacts. There is no aneurysm or arteriovenous malformation.
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FINDINGS: BRAIN PARENCHYMA: Acute intraparenchymal hemorrhage in the left frontal and anterior temporal lobes measuring up to 4.7 x 4.6 cm with intraventricular extension as below. Moderate surrounding edema with approximately 7 mm of left to right midline shift. Effacement of the left basal cisterns with left uncal herniation. Gray-white matter differentiation is maintained. 7 mm hyperdense focus adjacent to the body of the right lateral ventricle, indeterminate. Periventricular white matter hypoattenuation consistent with chronic microangiopathic changes and transependymal CSF flow. Mild diffuse age-appropriate parenchymal volume loss. EXTRA-AXIAL SPACES: Small subarachnoid hemorrhage layering in the temporal cortical sulci adjacent to the left anterior temporal intraparenchymal hemorrhage. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. VENTRICULAR SYSTEM: Diffuse large volume intraventricular hemorrhage in the left greater than right lateral, third, and fourth ventricles extending from the left frontotemporal intraparenchymal hemorrhage. Intraventricular hemorrhage also extends to the lateral apertures. Severe associated diffuse hydrocephalus. ORBITS: Bilateral pseudophakia. SINUSES: Paranasal sinuses are clear. VESSELS: Mild scattered atherosclerosis of the carotid siphons.
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MRI brain with and without, MRA head without Indication: Headache, new or worsening, R51.9 Headache, unspecified 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. MR angiogram of the head without contrast per protocol. 3-D reconstructions were generated per the ordering physician's request and reviewed by the interpreting physician Patient weight: 241 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 2 ml per sec. Findings: Echoplanar diffusion-weighted imaging demonstrates no evidence of restricted diffusion at this time. Whole brain T2 and FLAIR imaging demonstrate no midline shift, mass effect, or other space-occupying lesion. There are a few scattered white matter FLAIR hyperintensitiesin the bilateral cerebral white matter. The ventricular system is of normal morphology. The basal cisterns are clear. The visualized vascular flow voids appear normal. Post administration of contrast material, there is no other abnormal enhancement. The remaining visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. MRA head without: There is no evidence of intracranial arterial stenosis/occlusion. Attenuation of the flow signal secondary to in plane artifacts. There is no aneurysm or arteriovenous malformation. Impression: 1. A few scattered nonenhancing T2/FLAIR white matter hyperintensities nonspecific, most likely secondary to chronic microvascular ischemic disease but may be seen in patient's with headache/migraine. 2. No evidence of acute infarct or hemorrhage. No pathologic enhancement is appreciated. 3. On MRA of the head no evidence of flow-limiting stenosis or occlusion of the intracranial arteries. No aneurysms or arteriovenous malformations.
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Findings: Echoplanar diffusion-weighted imaging demonstrates no evidence of restricted diffusion at this time. Whole brain T2 and FLAIR imaging demonstrate no midline shift, mass effect, or other space-occupying lesion. There are a few scattered white matter FLAIR hyperintensitiesin the bilateral cerebral white matter. The ventricular system is of normal morphology. The basal cisterns are clear. The visualized vascular flow voids appear normal. Post administration of contrast material, there is no other abnormal enhancement. The remaining visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. MRA head without: There is no evidence of intracranial arterial stenosis/occlusion. Attenuation of the flow signal secondary to in plane artifacts. There is no aneurysm or arteriovenous malformation.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Small pneumatocele of the medial segment middle lobe, unchanged. Lung bases otherwise clear DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. Otherwise unremarkable. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Atrophic SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Tiny hypoattenuating foci bilaterally, most are too small to characterize. At least one of these in the posterior left kidney on image 131 is likely to be an angiomyolipoma. Slightly heterogeneous enhancement right upper pole. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach appears normal. Mildly prominent fluid-filled small bowel within the left hemiabdomen adjacent to left end colostomy. There is normal caliber small bowel seen distally. COLON / APPENDIX: Postsurgical changes of partial transverse colectomy and creation of end colostomy in the left hemiabdomen. The colon extending to the ostomy appears mildly thickened. PERITONEUM / MESENTERY: Some small, peripherally enhancing, gas containing collection within the peritoneum, closely abutting the left anterior abdominal wall. This collection measures approximately 3.2 x 1.2 cm (series 201 image 106). There is mild left paramedian mid mesenteric stranding adjacent to the end colostomy. Smaller gas containing, circumscribed collections are also seen within the anterior abdomen (series 201 image is 117, 141, and 162). Additional areas of nonorganized fluid are seen in the inferior left paramedian abdomen (series 201 image 204) and adjacent to a loop of small bowel (series 201 image 153).. Tiny foci of free intraperitoneal air within the left hemiabdomen, for example series 201 image 98. RETROPERITONEUM: Normal. VESSELS: Scattered atherosclerosis. URINARY BLADDER: Underdistended, mildly thickened. REPRODUCTIVE ORGANS: Prior hysterectomy. BODY WALL: Postsurgical changes of prior midline laparotomy with soft tissue edema of the anterior abdominal wall. MUSCULOSKELETAL: No aggressive osseous lesion or acute fracture. Severe intervertebral disc space narrowing at T8-T9 with reactive sclerosis at the endplates. Chronic, remote fractures of the right L1 and L2 transverse processes. There is severe bilateral facet arthropathy at spanning L2-S1.
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MR Breast Diagnostic Bil wo+w contrast CLINICAL INFORMATION: 42-year-old woman with the personal history of left breast DCIS. She's undergone bilateral mastectomy with TRAM flap reconstruction. Patient presents for evaluation for malignancy. 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: 250 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: Most recent breast MRI: 1/19/2021. Most recent mammogram: Not available. MRI FINDINGS: Postsurgical change of bilateral mastectomy with bilateral TRAM reconstruction. RIGHT BREAST:No suspicious enhancing mass or nonmass enhancement. LEFT BREAST:No suspicious enhancing mass or nonmass enhancement. LYMPH NODES:No axillary or internal mammary chain adenopathy ADDITIONAL FINDINGS: No marrow signal abnormality IMPRESSION AND RECOMMENDATIONS: RIGHT BREAST: Postsurgical change of mastectomy with TRAM reconstruction. No evidence of malignancy. BI-RADS 2: Benign LEFT BREAST: Postsurgical change of mastectomy with TRAM reconstruction. No evidence of malignancy. BI-RADS 2: Benign OVERALL BI-RADS ASSESSMENT:BI-RADS 2: Benign
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FINDINGS: Postsurgical change of bilateral mastectomy with bilateral TRAM reconstruction. RIGHT BREAST:No suspicious enhancing mass or nonmass enhancement. LEFT BREAST:No suspicious enhancing mass or nonmass enhancement. LYMPH NODES:No axillary or internal mammary chain adenopathy ADDITIONAL FINDINGS: No marrow signal abnormality IMPRESSION AND RECOMMENDATIONS: RIGHT BREAST: Postsurgical change of mastectomy with TRAM reconstruction. No evidence of malignancy. BI-RADS 2: Benign LEFT BREAST: Postsurgical change of mastectomy with TRAM reconstruction. No evidence of malignancy. BI-RADS 2: Benign OVERALL BI-RADS ASSESSMENT:BI-RADS 2: Benign
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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: 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: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral renal sinus cysts. No other significant abnormality LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No free fluid or free intraperitoneal air. A few areas of fat necrosis in the anterior lower abdomen RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is present. No adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Bilateral hip degenerative change. Mild multilevel discogenic degenerative change.
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EXAM: MR Knee Left wo contrast CLINICAL INFORMATION: Chronic left knee pain COMPARISON: MRI dated April 9, 2021 TECHNIQUE: Multiplanar and multisequence MRI of the left knee was obtained without intravenous contrast. FINDINGS: BONES:No fracture, marrow replacement, or aggressive osseous lesion. ARTICULATIONS: Effusion:None. Patellofemoral compartment:Full-thickness fissure of the midsagittal trochlear groove. The patellar cartilage is unremarkable. Medial compartment:Articular cartilage thinning without full thickness defect. Lateral compartment:Full-thickness articular cartilage defect of the lateral femoral condyle. MENISCI: Medial meniscus: Complex signal of the posterior horn extending to the undersurface and free edge. Susceptibility artifact is noted within the medial femorotibial compartment adjacent to the meniscus likely representing prior surgery. There is mild medial extrusion of the body. Additionally, there is truncation of the free edge of the body suggesting postsurgical change. 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. There is fluid surrounding the distal pes anserine tendon insertion. Postsurgical changes are noted in Hoffa's with likely artifact within the knee, predominantly involving the medial patellofemoral compartment. Small amount of prepatellar edema. Small popliteal cyst. CONCLUSION: 1. Increased signal throughout the body and posterior horn of the medial meniscus. Findings either represent surgical changes or recurrent tearing, however, without arthrography, these two cannot be differentiated on MRI. 2. Tricompartmental degenerative changes most prominent in the medial femorotibial compartment. 3. Pes anserine bursitis. 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.
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FINDINGS: BONES:No fracture, marrow replacement, or aggressive osseous lesion. ARTICULATIONS: Effusion:None. Patellofemoral compartment:Full-thickness fissure of the midsagittal trochlear groove. The patellar cartilage is unremarkable. Medial compartment:Articular cartilage thinning without full thickness defect. Lateral compartment:Full-thickness articular cartilage defect of the lateral femoral condyle. MENISCI: Medial meniscus: Complex signal of the posterior horn extending to the undersurface and free edge. Susceptibility artifact is noted within the medial femorotibial compartment adjacent to the meniscus likely representing prior surgery. There is mild medial extrusion of the body. Additionally, there is truncation of the free edge of the body suggesting postsurgical change. 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. There is fluid surrounding the distal pes anserine tendon insertion. Postsurgical changes are noted in Hoffa's with likely artifact within the knee, predominantly involving the medial patellofemoral compartment. Small amount of prepatellar edema. Small popliteal cyst.
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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: 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: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral renal sinus cysts. No other significant abnormality LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No free fluid or free intraperitoneal air. A few areas of fat necrosis in the anterior lower abdomen RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is present. No adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Bilateral hip degenerative change. Mild multilevel discogenic degenerative change.
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Lumbar MRI without contrast - Clinical indication: radiculopathy lumbar region, M54.16 Radiculopathy, lumbar region Spec Inst: outside order fx report 205-731-8479. - Technique: Multiple T1 and T2 weighted MR sequence images of the lumbar spine were obtained in the axial and sagittal plane without the use of intravenous contrast per departmental cervical spine protocol. Patient weight: 200 lbs. - Comparison: Multiple priors, most recent MR lumbar spine without contrast 12/20/2019.. - Findings: Interval mid wedge compression fracture of the L5 vertebral body with disruption of the superior endplate. Some endplate trabecular impaction and vertebral marrow edema are seen. There is mild exaggeration of the lumbar lordotic curvature. The liver degenerative changes with anterior and posterior artifacts irregular multilevel Modic type II endplate changes. Focal fatty change/hemangioma T10 and T11 vertebral bodies. Laminectomy changes at L5-S1. The conus terminates at L1 Right-sided ligamentum flavum thickening at T10-11. No cord compression or cord signal noted. Axial images are evaluated on a level by level basis: -T11-T12: Bilateral facet arthropathy and left-sided ligamentum flavum thickening. No cord compression or cord signal noted. T12-L1: Mild bulge. No central canal narrowing.. - L1-2: Mild diffuse bulge indenting the ventral thecal sac. Mild canal narrowing. No compression of the cauda equina nerve roots. No significant neuroforaminal narrowing.. - L2-3: Mild bulge with no significant central neuroforaminal stenosis. Bilateral ligamentum flavum thickening.. - L3-4: Mild bulge, bilateral ligamentum flavum thickening causing mild central narrowing and mild bilateral neural foraminal narrowing, right greater than left. - L4-5: Diffuse bulge severe bilateral facet arthropathy and ligamentum flavum thickening causing severe central stenosis. Mild bilateral neural foraminal narrowing. Right facet effusion.. - L5-S1: Mild bulge and severe left facet hypertrophy asymmetric left-sided lateral recess narrowing and left neuroforaminal stenosis. The right neural foramen is patent. - The visualized paraspinal structures appear otherwise within normal limits. The remaining visualized osseous and soft tissue structures demonstrate normal MR signal characteristics. Lower lumbar posterior paraspinal muscle fatty atrophy. The bilateral SI joints are unremarkable. Subcentimeter right renal cyst. - Impression: 1. Interval mid wedge compression fracture of the L4 vertebral body with mild marrow edema. 2. Multilevel degenerative changes with multilevel canal narrowing at L3-4 L4-L5 S1 as described. - The first line of findings should read: Interval mid wedge compression fracture of the L4 vertebral body with disruption of the superior endplate.
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Findings: Interval mid wedge compression fracture of the L5 vertebral body with disruption of the superior endplate. Some endplate trabecular impaction and vertebral marrow edema are seen. There is mild exaggeration of the lumbar lordotic curvature. The liver degenerative changes with anterior and posterior artifacts irregular multilevel Modic type II endplate changes. Focal fatty change/hemangioma T10 and T11 vertebral bodies. Laminectomy changes at L5-S1. The conus terminates at L1 Right-sided ligamentum flavum thickening at T10-11. No cord compression or cord signal noted. Axial images are evaluated on a level by level basis: -T11-T12: Bilateral facet arthropathy and left-sided ligamentum flavum thickening. No cord compression or cord signal noted. T12-L1: Mild bulge. No central canal narrowing.. - L1-2: Mild diffuse bulge indenting the ventral thecal sac. Mild canal narrowing. No compression of the cauda equina nerve roots. No significant neuroforaminal narrowing.. - L2-3: Mild bulge with no significant central neuroforaminal stenosis. Bilateral ligamentum flavum thickening.. - L3-4: Mild bulge, bilateral ligamentum flavum thickening causing mild central narrowing and mild bilateral neural foraminal narrowing, right greater than left. - L4-5: Diffuse bulge severe bilateral facet arthropathy and ligamentum flavum thickening causing severe central stenosis. Mild bilateral neural foraminal narrowing. Right facet effusion.. - L5-S1: Mild bulge and severe left facet hypertrophy asymmetric left-sided lateral recess narrowing and left neuroforaminal stenosis. The right neural foramen is patent. - The visualized paraspinal structures appear otherwise within normal limits. The remaining visualized osseous and soft tissue structures demonstrate normal MR signal characteristics. Lower lumbar posterior paraspinal muscle fatty atrophy. The bilateral SI joints are unremarkable. Subcentimeter right renal cyst. -
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Bibasilar atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Diffuse periportal edema. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: Mildly prominent left upper quadrant mesenteric lymph nodes. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The distal appendix/appendiceal tip is fluid-filled and mildly dilated with a small amount of adjacent stranding. The proximal aspect of the appendix is more decompressed and shows small foci of gas. PERITONEUM / MESENTERY: Trace free fluid in the pelvis surrounding the tip of the appendix. RETROPERITONEUM: Normal. VESSELS: Circumaortic left renal vein. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is present. No adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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MR Chest MSK wo+w contrast TECHNIQUE: Multiplanar multisequence MRI of the chest was obtained without and with intravenous contrast. Patient weight: 245 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 1 ml per sec. CLINICAL INFORMATION: Soft tissue mass, chest. Patient reports having a similar mass within this area approximately 15 years ago which revealed benign pathology. COMPARISON: 11/19/2021 FINDINGS: There is a round, well-circumscribed T2 hyperintense and T1 hyperintense mass in the anterior left axillary subcutaneous soft tissues measuring 3.5 x 3.2 x 3.2 cm (AP, transverse, CC) (image 10, series 301; image 11, series 701). This lesion demonstrates faint peripheral enhancement. No surrounding soft tissue edema. There are several benign-appearing left axillary lymph nodes. Mild bilateral axillary cutaneous thickening with increased T2 signal, left greater than right, with associated postcontrast enhancement. No abnormal bone marrow signal to suggest acute fracture or aggressive osseous lesion. The visualized portions of the intrathoracic chest and abdomen are unremarkable. CONCLUSION: 1. Well-circumscribed cystic lesion within the subcutaneous soft tissues of the left axilla is favored to represent a sebaceous cyst. A less likely differential consideration is a soft tissue myxoma. 2. Mild cutaneous thickening of the bilateral axilla with postcontrast enhancement, left greater than right, may represent hidradenitis suppurativa. Correlate clinically. 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.
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FINDINGS: There is a round, well-circumscribed T2 hyperintense and T1 hyperintense mass in the anterior left axillary subcutaneous soft tissues measuring 3.5 x 3.2 x 3.2 cm (AP, transverse, CC) (image 10, series 301; image 11, series 701). This lesion demonstrates faint peripheral enhancement. No surrounding soft tissue edema. There are several benign-appearing left axillary lymph nodes. Mild bilateral axillary cutaneous thickening with increased T2 signal, left greater than right, with associated postcontrast enhancement. No abnormal bone marrow signal to suggest acute fracture or aggressive osseous lesion. The visualized portions of the intrathoracic chest and abdomen are unremarkable.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The trachea and central airways are patent. Diffuse bronchial wall thickening most pronounced at the bilateral bases. There is mild associated septal thickening at the bases. Tree-in-bud nodularity is present throughout the lungs. No significant pleural effusion or pneumothorax. Scattered calcified granulomas. HEART / VESSELS: The heart is mildly enlarged. Trace pericardial effusion. Extensive vascular calcifications. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: Innumerable mediastinal and hilar calcified lymph nodes. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral simple cysts. There is a small amount of bilateral and symmetric perinephric fluid/stranding. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix and colon are normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered vascular calcifications. URINARY BLADDER: Distended. REPRODUCTIVE ORGANS: The uterus is absent. No adnexal mass. BODY WALL: Scattered body wall edema. MUSCULOSKELETAL: Advanced degenerative change of both glenohumeral joints with joint capsular hypertrophy. There is also bilateral high riding humeral heads with pseudoarthrosis in the humeral head and the acromium which can suggest rotator cuff insufficiency. Advanced degenerative change of the SI joints. Prominent chondrocalcinosis in the shoulder joints, sternoclavicular joint and hip joints. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: Grade 1 anterolisthesis of L4 on L5. DISC SPACES AND FACET JOINTS: No acute injury. Advanced degenerative change with lower lumbar spine facet arthropathy. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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MR Lumbar Spine wo+w contrast, MR Thoracic Spine wo+w contrast 1/23/2022 12:24 PM Clinical Information: urinary retention and weakness Spec Inst: metastatic prostate cancer; eval for mets causing spinal cord compression, in setting of urinary retention and weakness Comparison: CT lumbar spine dated 12/30/2021. Technique: MRI of the thoracic and lumbar spine including axial T1/T2 and sagittal T1/T2/STIR and postcontrast axial and sagittal fat-sat T1-weighted images. Patient weight: 235 lbs. IV contrast: ProHance, 10 ml, per protocol. Findings: Diffusely disseminated osteoblastic metastatic disease throughout the entire levels of the thoracic and lumbar spine and pelvic bones is redemonstrated. The vertebral body height and alignment are maintained. There is no evidence of acute pathologic fracture or epidural mass formation. Spondylotic severe spinal canal stenoses at L2-L3 and L3-L4 are again noted. The thoracic spinal canal is capacious. The thoracic spinal cord is of normal course, caliber and signal intensity. The conus medullaris is free from compressive pathology. There is a 3 mm intradural nodular enhancing lesion at L4 level. The cauda equina at other levels is unremarkable. No nerve root edema is appreciated. The left pelvic fossa shows 2.5 cm iliac lymphadenopathy. Large bilateral adrenal masses are also noted. Impression: 1. Disseminated osteoblastic metastatic disease without acute pathologic fracture or epidural mass formation. 2. 3 mm intradural nodular enhancing lesion at L4 level concerning for leptomeningeal metastatic disease involving the cauda equina nerve root. 3. Left iliac lymphadenopathy and large bilateral adrenal masses.
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Findings: Diffusely disseminated osteoblastic metastatic disease throughout the entire levels of the thoracic and lumbar spine and pelvic bones is redemonstrated. The vertebral body height and alignment are maintained. There is no evidence of acute pathologic fracture or epidural mass formation. Spondylotic severe spinal canal stenoses at L2-L3 and L3-L4 are again noted. The thoracic spinal canal is capacious. The thoracic spinal cord is of normal course, caliber and signal intensity. The conus medullaris is free from compressive pathology. There is a 3 mm intradural nodular enhancing lesion at L4 level. The cauda equina at other levels is unremarkable. No nerve root edema is appreciated. The left pelvic fossa shows 2.5 cm iliac lymphadenopathy. Large bilateral adrenal masses are also noted.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The trachea and central airways are patent. Diffuse bronchial wall thickening most pronounced at the bilateral bases. There is mild associated septal thickening at the bases. Tree-in-bud nodularity is present throughout the lungs. No significant pleural effusion or pneumothorax. Scattered calcified granulomas. HEART / VESSELS: The heart is mildly enlarged. Trace pericardial effusion. Extensive vascular calcifications. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: Innumerable mediastinal and hilar calcified lymph nodes. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral simple cysts. There is a small amount of bilateral and symmetric perinephric fluid/stranding. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix and colon are normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered vascular calcifications. URINARY BLADDER: Distended. REPRODUCTIVE ORGANS: The uterus is absent. No adnexal mass. BODY WALL: Scattered body wall edema. MUSCULOSKELETAL: Advanced degenerative change of both glenohumeral joints with joint capsular hypertrophy. There is also bilateral high riding humeral heads with pseudoarthrosis in the humeral head and the acromium which can suggest rotator cuff insufficiency. Advanced degenerative change of the SI joints. Prominent chondrocalcinosis in the shoulder joints, sternoclavicular joint and hip joints. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: Grade 1 anterolisthesis of L4 on L5. DISC SPACES AND FACET JOINTS: No acute injury. Advanced degenerative change with lower lumbar spine facet arthropathy. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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MR Lumbar Spine wo+w contrast, MR Thoracic Spine wo+w contrast 1/23/2022 12:24 PM Clinical Information: urinary retention and weakness Spec Inst: metastatic prostate cancer; eval for mets causing spinal cord compression, in setting of urinary retention and weakness Comparison: CT lumbar spine dated 12/30/2021. Technique: MRI of the thoracic and lumbar spine including axial T1/T2 and sagittal T1/T2/STIR and postcontrast axial and sagittal fat-sat T1-weighted images. Patient weight: 235 lbs. IV contrast: ProHance, 10 ml, per protocol. Findings: Diffusely disseminated osteoblastic metastatic disease throughout the entire levels of the thoracic and lumbar spine and pelvic bones is redemonstrated. The vertebral body height and alignment are maintained. There is no evidence of acute pathologic fracture or epidural mass formation. Spondylotic severe spinal canal stenoses at L2-L3 and L3-L4 are again noted. The thoracic spinal canal is capacious. The thoracic spinal cord is of normal course, caliber and signal intensity. The conus medullaris is free from compressive pathology. There is a 3 mm intradural nodular enhancing lesion at L4 level. The cauda equina at other levels is unremarkable. No nerve root edema is appreciated. The left pelvic fossa shows 2.5 cm iliac lymphadenopathy. Large bilateral adrenal masses are also noted. Impression: 1. Disseminated osteoblastic metastatic disease without acute pathologic fracture or epidural mass formation. 2. 3 mm intradural nodular enhancing lesion at L4 level concerning for leptomeningeal metastatic disease involving the cauda equina nerve root. 3. Left iliac lymphadenopathy and large bilateral adrenal masses.
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Findings: Diffusely disseminated osteoblastic metastatic disease throughout the entire levels of the thoracic and lumbar spine and pelvic bones is redemonstrated. The vertebral body height and alignment are maintained. There is no evidence of acute pathologic fracture or epidural mass formation. Spondylotic severe spinal canal stenoses at L2-L3 and L3-L4 are again noted. The thoracic spinal canal is capacious. The thoracic spinal cord is of normal course, caliber and signal intensity. The conus medullaris is free from compressive pathology. There is a 3 mm intradural nodular enhancing lesion at L4 level. The cauda equina at other levels is unremarkable. No nerve root edema is appreciated. The left pelvic fossa shows 2.5 cm iliac lymphadenopathy. Large bilateral adrenal masses are also noted.
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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. Chondrocalcinosis of the atlantooccipital joints. ATLANTODENTAL INTERVAL: Normal (
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MR Cervical Spine wo+w contrast CLINICAL INFORMATION: 67 years Female fluid collection postop Spec Inst: needs to be done by tomorrow at 3 am. will likely be going to OR tomorrow TECHNIQUE: Multiplanar, multisequence MRI of the cervical spine was performed before and after the intravenous administration of contrast. COMPARISON: MR C-spine 1/7/2022 FINDINGS: CRANIOCERVICAL JUNCTION: Preserved alignment. VERTEBRA: Interval multilevel laminectomies from C3 to C6. Posterior spinal fixation extending from C2--T2. Vertebral body height is preserved with slight reversal of the normal cervical lordosis, without spondylolisthesis. Type II Modic endplate changes, most prominent at C6-C7. Marrow signal is otherwise preserved. DISC SPACES AND FACET JOINTS: Multilevel degenerative changes throughout the cervical spine, most prominent in the mid cervical spine with uncovertebral joint hypertrophy and disc bulge, with herniation at C4-C5 without significant interval change. There is also central disc protrusion at C3-C4, C5-C6 and C6-C7. Individual vertebral levels are discussed in detail below. POSTERIOR FOSSA \T\ CORD: Visualized posterior fossa structures have a normal appearance. There is diffuse extradural enhancement about the visualized cervicothoracic spinal cord and nerve roots without discrete epidural collection. Redemonstrated increased intrinsic T2 signal at C4-C5, similar to prior. However mass effect upon the cervical spinal cord at this level has decreased but there is continued flattening. Focal 4 mm T2 hyperintense signal in the right C3 lateral column is similar to prior and again suggestive of intramedullary hemorrhage. PARAVERTEBRAL SOFT TISSUES: Peripherally enhancing fluid collection in the posterior cervical paraspinal soft tissues overlying the laminectomy defects extends posterior to the C2-C5 vertebral bodies and measures approximately 3.8 x 4.0 x 6.1 cm (axial T2 series 601, image 22 and sagittal T2 series 401, image 8). Additional collection extends posterior to the C6-T3 vertebral bodies and measures approximately 3.4 x 2.8 x 6.0 cm (axial T2 series 601, image one and sagittal T2 series 401, image 8). In the posterior cervical subcutaneous soft tissue, a partially imaged peripherally enhancing collection measures at least 2.8 x 4.2 x 9.9 cm (axial T2 series 601, image 9 and sagittal T2 series 401, image 8). These collections appear to communicate There is soft tissue enhancement diffusely throughout the posterior paraspinal musculature. Precervical edema and C4-C5 is slightly improved. VERTEBRAL LEVELS: C2-C3: No significant spinal canal or neuroforaminal narrowing. C3-C4: Circumferential disc bulge with central posterior protrusion resulting in mild spinal canal stenosis without significant neural foraminal narrowing. C4-C5: Disc osteophyte complex with circumferential disc bulge with posterior protrusion/annular fissure resulting in moderate to severe central canal narrowing and moderate to severe bilateral neural foraminal narrowing. C5-C6: Disc osteophyte complex with disc height loss and circumferential disc bulge resulting in moderate spinal canal stenosis. No significant neural foraminal narrowing. C6-C7: Disc osteophyte complex with circumferential disc bulge resulting in mild spinal canal narrowing. No significant neural foraminal narrowing. C7-T1: No significant spinal canal or neural foraminal narrowing. IMPRESSION: 1. Postsurgical changes of decompressive laminectomies from C3 to C6 and C2-T2 posterior fixation. There is decreased mass effect upon the cervical spinal cord at the C4-C5 level but there is continued abnormal signal within the spinal cord at this level. 2. Multiple peripherally enhancing collections in the posterior paraspinal and posterior cervical soft tissues, as above. There is extensive enhancement throughout the paraspinal musculature and while these may represent seromas it would be difficult to exclude an abscess. There is also diffuse epidural enhancement dorsally which may represent postsurgical changes No discrete epidural collection. 3. Multilevel additional degenerative changes with spinal canal narrowing and neural foraminal narrowing as described above. 4. Similar appearance of T2 hypointense small focus in the C3 right lateral column, again suggesting focal intramedullary hemorrhage. 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.
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FINDINGS: CRANIOCERVICAL JUNCTION: Preserved alignment. VERTEBRA: Interval multilevel laminectomies from C3 to C6. Posterior spinal fixation extending from C2--T2. Vertebral body height is preserved with slight reversal of the normal cervical lordosis, without spondylolisthesis. Type II Modic endplate changes, most prominent at C6-C7. Marrow signal is otherwise preserved. DISC SPACES AND FACET JOINTS: Multilevel degenerative changes throughout the cervical spine, most prominent in the mid cervical spine with uncovertebral joint hypertrophy and disc bulge, with herniation at C4-C5 without significant interval change. There is also central disc protrusion at C3-C4, C5-C6 and C6-C7. Individual vertebral levels are discussed in detail below. POSTERIOR FOSSA \T\ CORD: Visualized posterior fossa structures have a normal appearance. There is diffuse extradural enhancement about the visualized cervicothoracic spinal cord and nerve roots without discrete epidural collection. Redemonstrated increased intrinsic T2 signal at C4-C5, similar to prior. However mass effect upon the cervical spinal cord at this level has decreased but there is continued flattening. Focal 4 mm T2 hyperintense signal in the right C3 lateral column is similar to prior and again suggestive of intramedullary hemorrhage. PARAVERTEBRAL SOFT TISSUES: Peripherally enhancing fluid collection in the posterior cervical paraspinal soft tissues overlying the laminectomy defects extends posterior to the C2-C5 vertebral bodies and measures approximately 3.8 x 4.0 x 6.1 cm (axial T2 series 601, image 22 and sagittal T2 series 401, image 8). Additional collection extends posterior to the C6-T3 vertebral bodies and measures approximately 3.4 x 2.8 x 6.0 cm (axial T2 series 601, image one and sagittal T2 series 401, image 8). In the posterior cervical subcutaneous soft tissue, a partially imaged peripherally enhancing collection measures at least 2.8 x 4.2 x 9.9 cm (axial T2 series 601, image 9 and sagittal T2 series 401, image 8). These collections appear to communicate There is soft tissue enhancement diffusely throughout the posterior paraspinal musculature. Precervical edema and C4-C5 is slightly improved. VERTEBRAL LEVELS: C2-C3: No significant spinal canal or neuroforaminal narrowing. C3-C4: Circumferential disc bulge with central posterior protrusion resulting in mild spinal canal stenosis without significant neural foraminal narrowing. C4-C5: Disc osteophyte complex with circumferential disc bulge with posterior protrusion/annular fissure resulting in moderate to severe central canal narrowing and moderate to severe bilateral neural foraminal narrowing. C5-C6: Disc osteophyte complex with disc height loss and circumferential disc bulge resulting in moderate spinal canal stenosis. No significant neural foraminal narrowing. C6-C7: Disc osteophyte complex with circumferential disc bulge resulting in mild spinal canal narrowing. No significant neural foraminal narrowing. C7-T1: No significant spinal canal or neural foraminal narrowing.
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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: Paranasal sinuses are clear. VESSELS: Normal noncontrast appearance of the vessels.
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EXAM:MR Shoulder Right wo contrast CLINICAL INFORMATION:Right shoulder pain COMPARISON:1/13/2022 TECHNIQUE: Multiplanar and multisequence MRI of the right shoulder was obtained without intravenous contrast. FINDINGS: BONES:No fracture, marrow replacement or suspicious focal lesion. ROTATOR CUFF: Supraspinatus:Normal. 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: Small amount of fluid within the subacromial and subdeltoid bursa. ACROMIAL CLAVICULAR JOINT:Mild degenerative changes. No os acromiale. SUBACROMIAL ENCROACHMENT: Mild. MUSCLES:No atrophy. CONCLUSION: 1. No rotator cuff tear. 2. Small amount of fluid within the subacromial and subdeltoid bursa which can be seen with bursitis. 3. Mild degenerative 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.
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FINDINGS: BONES:No fracture, marrow replacement or suspicious focal lesion. ROTATOR CUFF: Supraspinatus:Normal. 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: Small amount of fluid within the subacromial and subdeltoid bursa. ACROMIAL CLAVICULAR JOINT:Mild degenerative changes. No os acromiale. SUBACROMIAL ENCROACHMENT: Mild. MUSCLES:No atrophy.
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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 (
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MR Breast Diagnostic Bil wo+w contrast Clinical Information: History of left breast mass status post excisional biopsy with biopsy positive for IDC and left axillary lymph node biopsy positive for carcinoma. Newly diagnosed breast cancer, C50.912 Malignant neoplasm of unspecified site of left female breast 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: 192 lbs. IV contrast: ProHance, 18 ml, per protocol. IV contrast injection rate: 2 ml per sec. Comparison: Diagnostic bilateral mammogram and left breast ultrasound on 1/11/2022. No prior breast MRI examination. Findings: The breasts are composed scattered fibroglandular tissue. Postcontrast administration there is mild background glandular enhancement. LEFT BREAST: There is a peripherally enhancing fluid collection in the 6:00 left breast, middle depth, measuring 61 x 11 x 16 mm (series 400 image 144, series 7 image 61). This is consistent with the excisional biopsy cavity. There is nonmass enhancement extending posterior to the lumpectomy bed concerning for additional disease in this patient with positive margins. This extends 16 mm (series 400 image 147). RIGHT BREAST: No suspicious enhancing mass or nonmass enhancement. LYMPH NODES: There is an enlarged, diffusely enhancing level I left axillary lymph node with loss of the fatty hilum measuring 2.0 x 1.2 cm (series 400, image 175). There is mild edema and a biopsy clip lateral to this lymph node. Two additional level I axillary lymph nodes with irregular cortical thickening are visualized more posteriorly (series 7, image 52 and 58). Conclusion: Right breast: No MR evidence of malignancy. BI-RADS 1: Negative. Left breast: Post excisional biopsy cavity measuring 61 x 11 x 16 mm with peripheral enhancement and nonmass enhancement extending posteriorly 16 mm concerning for residual disease. Lymph nodes: Three Morphologically abnormal level one axillary lymph nodes. One demonstrates a biopsy marker and is biopsy-proven malignancy. BI-RADS 6: Biopsy proven malignancy. Recommend surgical excision when clinically appropriate.. 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.
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Findings: The breasts are composed scattered fibroglandular tissue. Postcontrast administration there is mild background glandular enhancement. LEFT BREAST: There is a peripherally enhancing fluid collection in the 6:00 left breast, middle depth, measuring 61 x 11 x 16 mm (series 400 image 144, series 7 image 61). This is consistent with the excisional biopsy cavity. There is nonmass enhancement extending posterior to the lumpectomy bed concerning for additional disease in this patient with positive margins. This extends 16 mm (series 400 image 147). RIGHT BREAST: No suspicious enhancing mass or nonmass enhancement. LYMPH NODES: There is an enlarged, diffusely enhancing level I left axillary lymph node with loss of the fatty hilum measuring 2.0 x 1.2 cm (series 400, image 175). There is mild edema and a biopsy clip lateral to this lymph node. Two additional level I axillary lymph nodes with irregular cortical thickening are visualized more posteriorly (series 7, image 52 and 58).
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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: The previously seen anterior left frontal convexity hyperdensity was likely artifact. however, increased conspicuity of the thin 3.5 mm left parafalcine subdural hemorrhage (coronal image 73). SKULL AND SKULL BASE: No fracture. Mastoid air cells are clear. Small left frontal/periorbital hematoma, unchanged. Interval removal of the small radiopaque foreign body within the hematoma. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Clear. VESSELS: Normal noncontrast appearance of the vessels.
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MRI brain with and without Indication: Brain mass or lesion, G93.89 Other specified disorders of brain Comparison: 6/18/2021 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: 299 lbs. IV contrast: ProHance, 20 ml, per protocol. Findings: Unchanged size and appearance of a small focus of enhancement along the dura superolateral to the cisternal right trigeminal nerve (series 6 image 87, series 752 image 54). A tiny focus of enhancement along the left cerebral convexity with the cortical vein. No new enhancing lesions identified. Echoplanar diffusion-weighted imaging demonstrates no evidence of restricted diffusion at this time. Whole brain T2 and FLAIR imaging demonstrate no midline shift, mass effect, or other space-occupying lesion. There are no significant white matter FLAIR hyperintensities . The ventricular system is of normal morphology. The basal cisterns are clear. The visualized vascular flow voids appear normal. Post administration of contrast material, there is no other abnormal enhancement. The remaining visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Impression: Unchanged subcentimeter enhancing focus superolateral to the right trigeminal nerve may represent a venous structure/ tiny dural based mass.
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Findings: Unchanged size and appearance of a small focus of enhancement along the dura superolateral to the cisternal right trigeminal nerve (series 6 image 87, series 752 image 54). A tiny focus of enhancement along the left cerebral convexity with the cortical vein. No new enhancing lesions identified. Echoplanar diffusion-weighted imaging demonstrates no evidence of restricted diffusion at this time. Whole brain T2 and FLAIR imaging demonstrate no midline shift, mass effect, or other space-occupying lesion. There are no significant white matter FLAIR hyperintensities . The ventricular system is of normal morphology. The basal cisterns are clear. The visualized vascular flow voids appear normal. Post administration of contrast material, there is no other abnormal enhancement. The remaining visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics.
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Findings: CT head: BRAIN PARENCHYMA: Right basal ganglia hematoma measuring 1.7 x 1.4 cm, previously 1.8 x 1.3 cm, with mild surrounding edema and partial effacement of right lateral ventricle. No significant midline shift, approximately 2 mm. No new hemorrhage. Previously questioned right paramedian frontal lobe hemorrhage likely related to right ACA, better seen today. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No acute fracture. Unchanged small right posterior parietal scalp hematoma. Unchanged left facial swelling. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal.
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MR Breast Diagnostic Bil wo+w contrast CLINICAL INFORMATION: 49-year-old woman with recently diagnosed right breast invasive ductal carcinoma. Tumor cells are positive for estrogen receptor, positive for progesterone receptor, negative for HER-2. Exam is to evaluate extent of disease.. 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: 115 lbs. IV contrast: ProHance, 11 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: Most recent breast MRI: None. Most recent mammogram: 12/16/2021. MRI FINDINGS: This bilateral breast MRI exam demonstrates mild background enhancement. There is heterogeneous fibroglandular tissue. RIGHT BREAST: 1. In the upper outer quadrant, posterior depth there is a irregular mass demonstrating homogeneous enhancement measuring 7 x 7 x 11 mm (series 5 image 244 and series 7 image 129. This demonstrates medium rise and persistent kinetics. Biopsy marker is lateral to the mass. LEFT BREAST:No suspicious enhancing mass or nonmass enhancement. No architectural distortion. LYMPH NODES:No axillary or internal mammary chain adenopathy ADDITIONAL FINDINGS: No marrow signal abnormality IMPRESSION AND RECOMMENDATIONS: RIGHT BREAST: Unifocal 7 x 7 x 11 mm invasive ductal carcinoma with biopsy marker immediately lateral to the mass. No ipsilateral adenopathy. BI-RADS 6: Biopsy proven malignancy. Recommend surgical excision when clinically appropriate. LEFT BREAST: No MRI evidence of occult breast malignancy.. BI-RADS 1: Negative. OVERALL BI-RADS ASSESSMENT:BI-RADS 6: Biopsy proven malignancy. Recommend surgical excision when clinically appropriate.
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FINDINGS: This bilateral breast MRI exam demonstrates mild background enhancement. There is heterogeneous fibroglandular tissue. RIGHT BREAST: 1. In the upper outer quadrant, posterior depth there is a irregular mass demonstrating homogeneous enhancement measuring 7 x 7 x 11 mm (series 5 image 244 and series 7 image 129. This demonstrates medium rise and persistent kinetics. Biopsy marker is lateral to the mass. LEFT BREAST:No suspicious enhancing mass or nonmass enhancement. No architectural distortion. LYMPH NODES:No axillary or internal mammary chain adenopathy ADDITIONAL FINDINGS: No marrow signal abnormality IMPRESSION AND RECOMMENDATIONS: RIGHT BREAST: Unifocal 7 x 7 x 11 mm invasive ductal carcinoma with biopsy marker immediately lateral to the mass. No ipsilateral adenopathy. BI-RADS 6: Biopsy proven malignancy. Recommend surgical excision when clinically appropriate. LEFT BREAST: No MRI evidence of occult breast malignancy.. BI-RADS 1: Negative. OVERALL BI-RADS ASSESSMENT:BI-RADS 6: Biopsy proven malignancy. Recommend surgical excision when clinically appropriate.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Partially imaged moderate to large bilateral pleural effusions with adjacent passive atelectasis. Aerated portions of the lung bases are unremarkable. DISTAL ESOPHAGUS: Clips at the distal esophagus. HEART/VESSELS: Hypodense myocardium relative to blood pool, compatible with anemia. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Punctate nonobstructive left renal calculi versus early excretion of contrast. No hydroureteronephrosis bilaterally. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Postsurgical changes of sleeve gastrectomy. Questionable areas irregularity within the proximal duodenum first evident arterial phase (series 6 images 110 and 125), that appear more prominent on portal venous delay (series 10 image 115, 126). There is also avid enhancement of the distal stomach on the arterial phase series 6 image 97 that was not definitely increased on the portal venous phase. COLON / APPENDIX: Hyperdense material throughout the colon. No colonic wall thickening or pericolonic fat stranding. Appendix is normal. PERITONEUM / MESENTERY: Small volume ascites, prominent in the. Hepatic and perisplenic spaces. RETROPERITONEUM: Normal. VESSELS: Similar appearance of near occlusive DVT within the left common femoral vein and left SFV. URINARY BLADDER: Decompressed around a Foley catheter. Similar appearance of circumferential bladder wall thickening. Excreted contrast is seen within the bladder on nine enhanced phase. REPRODUCTIVE ORGANS: Uterus is surgically absent. There is air in the vagina. Bilateral adnexa are unremarkable. BODY WALL: Severe body wall anasarca. MUSCULOSKELETAL: No aggressive osseous lesions or acute fractures. Degenerative changes in the spine.
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EXAM:MR Shoulder Left wo contrast CLINICAL INFORMATION:Left shoulder pain COMPARISON:None. 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: Increased intrasubstance signal without discrete tear. Infraspinatus:Increased intrasubstance signal with low grade articular sided tear. Subscapularis:Normal. Teres minor:Normal. LONG HEAD BICEPS TENDON:Normal. GLENOHUMERAL JOINT: Position:Normal. Articular cartilage:Normal. Ligaments/Capsule: Small amount pericapsular edema as well as edema within the rotator interval. The ligaments are intact and unremarkable. Labrum:Normal given limitations of non-arthrographic technique. BURSAE:Small amount of fluid within the subacromial and subdeltoid spaces. ACROMIAL CLAVICULAR JOINT: Mild degenerative changes. No os acromiale. SUBACROMIAL ENCROACHMENT:None. MUSCLES:No atrophy. CONCLUSION: 1. Supraspinatus tendinosis with infraspinatus low grade articular sided tear. 2. Small amount pericapsular edema is noted which can be seen with capsulitis. 3. Fluid within the subacromial and subdeltoid bursa which can be seen with bursitis. 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.
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FINDINGS: BONES:No fracture, marrow replacement or suspicious focal lesion. ROTATOR CUFF: Supraspinatus: Increased intrasubstance signal without discrete tear. Infraspinatus:Increased intrasubstance signal with low grade articular sided tear. Subscapularis:Normal. Teres minor:Normal. LONG HEAD BICEPS TENDON:Normal. GLENOHUMERAL JOINT: Position:Normal. Articular cartilage:Normal. Ligaments/Capsule: Small amount pericapsular edema as well as edema within the rotator interval. The ligaments are intact and unremarkable. Labrum:Normal given limitations of non-arthrographic technique. BURSAE:Small amount of fluid within the subacromial and subdeltoid spaces. ACROMIAL CLAVICULAR JOINT: Mild degenerative changes. No os acromiale. SUBACROMIAL ENCROACHMENT:None. MUSCLES:No atrophy.
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FINDINGS: BRAIN PARENCHYMA: Large intraparenchymal hemorrhage in the right basal ganglia extending into the right thalamus measuring 3.7 x 3.1 cm (image 34, series #204) with extension into the ventricles as below. Moderate associated edema with partial effacement of the third ventricle. Small microhemorrhage in the left thalamus measuring 14 x 4 mm (image 34 series 201 Associated approximately 6 mm of right-to-left midline shift. Diffuse sulcal effacement and effacement of the basal cisterns. Gray-white matter differentiation is maintained. EXTRA-AXIAL SPACES: Small volume subarachnoid hemorrhage layering in the suprasellar cisterns, cerebellomedullary cisterns, and foramen magnum. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Intraventricular hemorrhage in the right greater than left lateral, third, fourth ventricles, and medial and lateral apertures, extending from the right basal ganglia intraparenchymal hemorrhage. Associated severe diffuse hydrocephalus. ORBITS: Bilateral pseudophakia. SINUSES: Paranasal sinuses are clear. VESSELS: Normal noncontrast appearance of the vessels.
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EXAM: MR Brain wo+w contrast 1/21/2022 3:03 PM CLINICAL INFORMATION: Seizure, nontraumatic, Epilepsy Protocol. Per chart review, history of intermittent left hand/leg jerks and speech difficulty events on antiepileptic therapy. Episode of transient left hemibody numbness in the 1990s. Recently experiencing new events of speech arrest versus expressive aphasia over the past 2 years, concerning for TIA. Normal EEG findings. COMPARISON: CTA head/neck dated same date. 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: 136 lbs. IV contrast: ProHance, 6 ml, per protocol. FINDINGS: There is a 5 mm cavernoma in the left inferior frontal gyrus near the pars opercularis. There is no surrounding parenchymal edema. No other associated vascular malformation is identified. No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, space-occupying lesion, or mass effect. Postcontrast series demonstrates no focal enhancing lesion. Right greater than left PCA stenosis, better appreciated on concomitant CTA head. Mild, age-appropriate frontoparietal cerebral volume loss. Multifocal subcortical, deep cerebral, and periventricular white matter T2/FLAIR hyperintensities, likely mild chronic microangiopathic changes. The ventricular system is normal in caliber. Cavum vellum interpositum, incidental variant. 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 bilateral ethmoid sinus mucosal thickening. Trace left mastoid effusion. The paranasal sinuses and mastoid air cells are otherwise clear. Bilateral ocular lens replacements. _________________________ CONCLUSION: 1. 5 mm cavernoma in the left inferior frontal gyrus. 2. No acute intracranial abnormality. 3. Right greater than left PCA stenosis, better appreciated on concomitant CTA head. 4. Trace left mastoid 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.
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FINDINGS: There is a 5 mm cavernoma in the left inferior frontal gyrus near the pars opercularis. There is no surrounding parenchymal edema. No other associated vascular malformation is identified. No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, space-occupying lesion, or mass effect. Postcontrast series demonstrates no focal enhancing lesion. Right greater than left PCA stenosis, better appreciated on concomitant CTA head. Mild, age-appropriate frontoparietal cerebral volume loss. Multifocal subcortical, deep cerebral, and periventricular white matter T2/FLAIR hyperintensities, likely mild chronic microangiopathic changes. The ventricular system is normal in caliber. Cavum vellum interpositum, incidental variant. 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 bilateral ethmoid sinus mucosal thickening. Trace left mastoid effusion. The paranasal sinuses and mastoid air cells are otherwise clear. Bilateral ocular lens replacements. _________________________
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Bibasilar atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: The heart is mildly enlarged. Vascular calcifications of the coronary arteries. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Redemonstrated significant soft tissue stranding around the left kidney and ureter with residual contrast remaining within the distal left ureter suggesting at least a component of partial obstruction. The amount of perinephric fluid and showing increased slightly and redistributed posteriorly tracking inferiorly within the left retroperitoneum. Bilateral symmetric renal atrophy. Scattered simple renal cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach is normal. The duodenal diverticulum is noted. The small bowel is normal in caliber. COLON / APPENDIX: Sigmoid diverticulosis. The appendix is not identified. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Redemonstrated extensive left perinephric/retroperitoneal fluid. VESSELS: Redemonstrated infrarenal abdominal aortic stent graft. Scattered vascular calcifications. Otherwise unremarkable for technique. URINARY BLADDER: Foley balloon is present. REPRODUCTIVE ORGANS: The prostate is enlarged. There is new stranding extending from the left retroperitoneum into the inguinal canal and left scrotum. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Advanced multilevel discogenic degenerative change lower lumbar spine facet arthropathy.
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EXAM: MR Knee Left wo contrast CLINICAL INFORMATION: Left knee pain COMPARISON: 1/12/2022 TECHNIQUE: Multiplanar and multisequence MRI of the was obtained without intravenous contrast. FINDINGS: BONES:No fracture, marrow replacement, or aggressive osseous lesion. ARTICULATIONS: Effusion:None. Patellofemoral compartment:Mild articular cartilage thinning with partial-thickness fissure of the lateral patellar facet. Medial compartment:Mild articular cartilage thinning without full thickness defect. Small marginal osteophytes are noted. Lateral compartment:Mild articular cartilage thinning without full thickness defect. Small marginal osteophytes are noted. MENISCI: Medial meniscus: Horizontal undersurface tear involving the posterior horn. Lateral meniscus:Intact. LIGAMENTS: Cruciate ligaments:There is thickening and increased signal of the ACL with intact fibers. The PCL is unremarkable. Medial collateral ligament:Intact. Lateral collateral ligament:Intact. Posterolateral corner structures:Intact. EXTENSOR MECHANISM:The distal quadriceps and patellar tendons are intact. Small amount of prepatellar edema. CONCLUSION: 1. Mucoid degeneration of the ACL. 2. Mild tricompartmental degenerative changes. 3. Small horizontal tear of the posterior horn medial meniscus. 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.
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FINDINGS: BONES:No fracture, marrow replacement, or aggressive osseous lesion. ARTICULATIONS: Effusion:None. Patellofemoral compartment:Mild articular cartilage thinning with partial-thickness fissure of the lateral patellar facet. Medial compartment:Mild articular cartilage thinning without full thickness defect. Small marginal osteophytes are noted. Lateral compartment:Mild articular cartilage thinning without full thickness defect. Small marginal osteophytes are noted. MENISCI: Medial meniscus: Horizontal undersurface tear involving the posterior horn. Lateral meniscus:Intact. LIGAMENTS: Cruciate ligaments:There is thickening and increased signal of the ACL with intact fibers. The PCL is unremarkable. Medial collateral ligament:Intact. Lateral collateral ligament:Intact. Posterolateral corner structures:Intact. EXTENSOR MECHANISM:The distal quadriceps and patellar tendons are intact. Small amount of prepatellar edema.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Diffuse cerebral volume loss. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Hyperostosis frontalis interna. VENTRICULAR SYSTEM: Ex vacuo dilatation. ORBITS: Normal. SINUSES: Normal. MASTOIDS: Clear. SOFT TISSUE: Unremarkable.
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MRI brain with and without Indication: Brain metastases suspected, C34.90 Malignant neoplasm of unspecified part of unspecified bronchus or lung 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: 209 lbs. IV contrast: ProHance, 20 ml, per protocol. Findings: Echoplanar diffusion-weighted imaging demonstrates no evidence of restricted diffusion at this time. Encephalomalacia right frontal lobe. Minimal encephalomalacia/gliosis in the left precentral gyrus. A few discrete and mildly confluent nonenhancing T2/FLAIR hyperintensities in the bilateral cerebral white matter, likely related to chronic microvascular ischemic disease. Mild parenchymal atrophy. No enhancing lesion identified. Scattered paranasal sinus mucosal thickening. Small subgaleal right frontal lipoma. Impression: No acute intracranial process. No abnormal enhancement. No intracranial metastasis identified.
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Findings: Echoplanar diffusion-weighted imaging demonstrates no evidence of restricted diffusion at this time. Encephalomalacia right frontal lobe. Minimal encephalomalacia/gliosis in the left precentral gyrus. A few discrete and mildly confluent nonenhancing T2/FLAIR hyperintensities in the bilateral cerebral white matter, likely related to chronic microvascular ischemic disease. Mild parenchymal atrophy. No enhancing lesion identified. Scattered paranasal sinus mucosal thickening. Small subgaleal right frontal lipoma.
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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 (
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MRI brain with and without, MRI orbits with and without contrast Indication: vertigo headaches, H81.4 Vertigo of central origin, R51.9 Headache, unspecified 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: 200 lbs. IV contrast: ProHance, 19 ml, per protocol. Findings: Brain: Echoplanar diffusion-weighted imaging demonstrates no evidence of restrained diffusion at this time. Whole brain T2 and FLAIR imaging demonstrate no midline shift, mass effect, or other space-occupying lesion. There are no significant white matter FLAIR hyperintensities . The ventricular system is of normal morphology. The basal cisterns are clear. The visualized vascular flow voids appear normal. Post administration of contrast material, there is no other abnormal enhancement. Small retention cyst right maxillary sinus. The remaining visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Orbits: Bilateral globes are within normal limits. There is no preseptal or postseptal collections. Bilateral extraocular muscles and optic nerve complexes are within normal limits. No evidence of extraconal or intraconal mass lesions. No abnormal enhancement in the bilateral orbits. Impression: 1. No acute intracranial process. No pathologic enhancement is appreciated. 2. Normal orbits. 3. The bilateral VII/VIII nerve complexes and inner ear structures are unremarkable. No CP angle mass or abnormal enhancement is seen on either side.
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Findings: Brain: Echoplanar diffusion-weighted imaging demonstrates no evidence of restrained diffusion at this time. Whole brain T2 and FLAIR imaging demonstrate no midline shift, mass effect, or other space-occupying lesion. There are no significant white matter FLAIR hyperintensities . The ventricular system is of normal morphology. The basal cisterns are clear. The visualized vascular flow voids appear normal. Post administration of contrast material, there is no other abnormal enhancement. Small retention cyst right maxillary sinus. The remaining visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Orbits: Bilateral globes are within normal limits. There is no preseptal or postseptal collections. Bilateral extraocular muscles and optic nerve complexes are within normal limits. No evidence of extraconal or intraconal mass lesions. No abnormal enhancement in the bilateral orbits.
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FINDINGS: There is no evidence of acute ischemia, intracranial hemorrhage, or intracranial mass. Gray-white differentiation is maintained. Brain parenchymal volume is appropriate for age. The ventricles and basal cisterns are unremarkable. The orbits are unremarkable. Patchy secretions in the ethmoid air cells. The other paranasal sinuses and mastoid air cells are clear. The visualized extra-cranial soft tissues are unremarkable. No acute osseous abnormality.
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MRI brain with and without, MRI orbits with and without contrast Indication: vertigo headaches, H81.4 Vertigo of central origin, R51.9 Headache, unspecified 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: 200 lbs. IV contrast: ProHance, 19 ml, per protocol. Findings: Brain: Echoplanar diffusion-weighted imaging demonstrates no evidence of restrained diffusion at this time. Whole brain T2 and FLAIR imaging demonstrate no midline shift, mass effect, or other space-occupying lesion. There are no significant white matter FLAIR hyperintensities . The ventricular system is of normal morphology. The basal cisterns are clear. The visualized vascular flow voids appear normal. Post administration of contrast material, there is no other abnormal enhancement. Small retention cyst right maxillary sinus. The remaining visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Orbits: Bilateral globes are within normal limits. There is no preseptal or postseptal collections. Bilateral extraocular muscles and optic nerve complexes are within normal limits. No evidence of extraconal or intraconal mass lesions. No abnormal enhancement in the bilateral orbits. Impression: 1. No acute intracranial process. No pathologic enhancement is appreciated. 2. Normal orbits. 3. The bilateral VII/VIII nerve complexes and inner ear structures are unremarkable. No CP angle mass or abnormal enhancement is seen on either side.
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Findings: Brain: Echoplanar diffusion-weighted imaging demonstrates no evidence of restrained diffusion at this time. Whole brain T2 and FLAIR imaging demonstrate no midline shift, mass effect, or other space-occupying lesion. There are no significant white matter FLAIR hyperintensities . The ventricular system is of normal morphology. The basal cisterns are clear. The visualized vascular flow voids appear normal. Post administration of contrast material, there is no other abnormal enhancement. Small retention cyst right maxillary sinus. The remaining visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Orbits: Bilateral globes are within normal limits. There is no preseptal or postseptal collections. Bilateral extraocular muscles and optic nerve complexes are within normal limits. No evidence of extraconal or intraconal mass lesions. No abnormal enhancement in the bilateral orbits.
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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: Small mucus retention cyst in the left posterior ethmoid air cells. VESSELS: Normal noncontrast appearance of the vessels.
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MR Brain wo+w contrast 1/21/2022 3:08 PM Clinical Information: EPILEPSY, G40.009 Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, not intractable, without status epilepticus Comparison: CT head dated 11/5/2021. Technique: Sagittal T1, axial T2, FLAIR, sagittal 3D T1, oblique coronal T1/FLAIR/T2, DWI with ADC map and SWI, postcontrast axial, coronal and sagittal T1. Patient weight: 160 lbs. IV contrast: ProHance, 8 ml, per protocol. Findings: Asymmetric T2 hyperintensity of the left hippocampal tail is noted. The amygdala, parahippocampal gyri, fornix and parolfactory regions are unremarkable. No extratemporal epileptogenic pathology is identified. The gyration/sulcation of the brain appear normal. There is no evidence of postictal encephalopathy. The ventricles, cortical sulci and subarachnoid cisterns are symmetric and age-appropriate. The sella/pituitary gland, and cerebellum are normal in appearance. Bilateral mandibular ORIF hardware and left mandibular subcondylar ununited fracture are noted. Impression: Possible left hippocampal tail sclerosis.
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Findings: Asymmetric T2 hyperintensity of the left hippocampal tail is noted. The amygdala, parahippocampal gyri, fornix and parolfactory regions are unremarkable. No extratemporal epileptogenic pathology is identified. The gyration/sulcation of the brain appear normal. There is no evidence of postictal encephalopathy. The ventricles, cortical sulci and subarachnoid cisterns are symmetric and age-appropriate. The sella/pituitary gland, and cerebellum are normal in appearance. Bilateral mandibular ORIF hardware and left mandibular subcondylar ununited fracture are noted.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, intracranial mass, large territory infarct, or edema. Gray-white matter differentiation maintained. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. No aggressive osseous lesion. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. FACE: Motion artifact limits evaluation. FACIAL BONES: No acute facial or mandibular fracture identified. Chronic fracture of the left medial orbital wall with displacement of bone fragments and orbital fat into the ethmoid sinus. Probable chronic fractures of the nasal bones. ORBITS: No acute orbital fracture. Globes are normal in appearance. SINUSES: Mucous retention cyst within the left maxillary sinus. Mild diffuse paranasal sinus mucosal thickening. Mastoid air cells are clear. SOFT TISSUES: Small laceration overlying the right mandible with underlying trace subcutaneous gas.
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MR Breast Diagnostic Bil wo+w contrast CLINICAL INFORMATION: 53-year-old with surgical excision of atypia the right breast. Patient also had a 5 mm probably benign finding in the right breast for which six-month follow-up was recommended. 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: 155 lbs. IV contrast: ProHance, 15 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: Most recent breast MRI: 7/15/2021. Most recent mammogram: May 24, 2021. MRI FINDINGS: This bilateral breast MRI exam demonstrates mild background enhancement. There is heterogeneous fibroglandular tissue. RIGHT BREAST:There is architectural distortion in the upper outer quadrant consistent with postsurgical change of excision of atypia. The previously identified probably benign enhancing mass is not seen on today's exam. No suspicious enhancing mass or nonmass enhancement identified. LEFT BREAST:No suspicious enhancing mass or nonmass enhancement identified. LYMPH NODES:No axillary or internal mammary chain adenopathy. ADDITIONAL FINDINGS: No marrow signal abnormality. IMPRESSION AND RECOMMENDATIONS: RIGHT BREAST: Interval resolution the previously identified probably benign mass in addition to postsurgical change. No MR evidence of malignancy.. BI-RADS 2: Benign LEFT BREAST: No MRI evidence of occult breast malignancy.. BI-RADS 1: Negative. OVERALL BI-RADS ASSESSMENT:BI-RADS 2: Benign Patient is due for mammography in May 2022.
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FINDINGS: This bilateral breast MRI exam demonstrates mild background enhancement. There is heterogeneous fibroglandular tissue. RIGHT BREAST:There is architectural distortion in the upper outer quadrant consistent with postsurgical change of excision of atypia. The previously identified probably benign enhancing mass is not seen on today's exam. No suspicious enhancing mass or nonmass enhancement identified. LEFT BREAST:No suspicious enhancing mass or nonmass enhancement identified. LYMPH NODES:No axillary or internal mammary chain adenopathy. ADDITIONAL FINDINGS: No marrow signal abnormality. IMPRESSION AND RECOMMENDATIONS: RIGHT BREAST: Interval resolution the previously identified probably benign mass in addition to postsurgical change. No MR evidence of malignancy.. BI-RADS 2: Benign LEFT BREAST: No MRI evidence of occult breast malignancy.. BI-RADS 1: Negative. OVERALL BI-RADS ASSESSMENT:BI-RADS 2: Benign Patient is due for mammography in May 2022.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Subtle groundglass opacities at both bases. No definitive pneumothorax. No pleural effusion. Central are patent. Small tracheal diverticulum. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Fluid within the distal esophagus suggestive of reflux. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Laceration involving the left axilla. Soft tissue emphysema along the right shoulder. Gynecomastia. 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 not identified. The colon is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Two right renal arteries. Otherwise unremarkable. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Penetrating trauma to the right shoulder with multiple foci of gas adjacent to the superior aspect of the scapula and humeral head. A few foci of gas are noted within the bicipital groove as well as intra-articular. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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MR Brain wo+w contrast 1/21/2022 4:59 PM CLINICAL INFORMATION: 66 years Female Concern for Huntington disease Spec Inst: Call floor for IV ativan to be given 1hr prior to scan COMPARISON: CT head without contrast dated 1/11/2022 and MR brain 1/10/2022 TECHNIQUE: Multiplanar multisequence MR images of the brain were obtained before and after the administration of intravenous contrast. Patient weight: 117 lbs. IV contrast: ProHance, 10 ml, per protocol. IV contrast injection rate: 0.50 ml per sec. FINDINGS: Postcontrast images are nondiagnostic secondary to motion artifact. There is no acute infarction, intracranial hemorrhage, brain edema or mass effect. Age advanced cerebral volume loss, most prominent in the bilateral frontal lobes. Periventricular and subcortical white matter T2/FLAIR signal hyperintensities are nonspecific, but suggestive of mild chronic microangiopathic ischemic changes. Lacunar infarcts are noted in the bilateral subinsular cortex and bilateral thalami. Diffuse T2 hypointense signal and SWI susceptibility artifact in the basal ganglia suggestive of iron deposition. Bilateral caudate head atrophy, with decrease of the frontal horn width to intercaudate distance ratio. Mild ex vacuo dilation of the ventricular system. There is no abnormal extra-axial collection. The bilateral orbits and globes have a normal appearance. Mucosal thickening in the left posterior ethmoid air cells with left sphenoid sinus mucous retention cysts. The remaining paranasal sinuses and bilateral mastoid air cells are otherwise clear. No focal soft tissue abnormality. Hyperostosis frontalis interna. IMPRESSION: 1. No acute intracranial abnormality. 2. Age advanced cerebral volume loss, most prominent in the bilateral frontal lobes, with mild chronic microvascular ischemic changes as above. 3. Frontal horn width to intercaudate distance ratio is slightly decreased, suggestive of bilateral caudate head atrophy, associated with iron deposition noted in the bilateral basal ganglia. These findings are nonspecific, however have been described in patients with Huntington's 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.
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FINDINGS: Postcontrast images are nondiagnostic secondary to motion artifact. There is no acute infarction, intracranial hemorrhage, brain edema or mass effect. Age advanced cerebral volume loss, most prominent in the bilateral frontal lobes. Periventricular and subcortical white matter T2/FLAIR signal hyperintensities are nonspecific, but suggestive of mild chronic microangiopathic ischemic changes. Lacunar infarcts are noted in the bilateral subinsular cortex and bilateral thalami. Diffuse T2 hypointense signal and SWI susceptibility artifact in the basal ganglia suggestive of iron deposition. Bilateral caudate head atrophy, with decrease of the frontal horn width to intercaudate distance ratio. Mild ex vacuo dilation of the ventricular system. There is no abnormal extra-axial collection. The bilateral orbits and globes have a normal appearance. Mucosal thickening in the left posterior ethmoid air cells with left sphenoid sinus mucous retention cysts. The remaining paranasal sinuses and bilateral mastoid air cells are otherwise clear. No focal soft tissue abnormality. Hyperostosis frontalis interna.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Subtle groundglass opacities at both bases. No definitive pneumothorax. No pleural effusion. Central are patent. Small tracheal diverticulum. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Fluid within the distal esophagus suggestive of reflux. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Laceration involving the left axilla. Soft tissue emphysema along the right shoulder. Gynecomastia. 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 not identified. The colon is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Two right renal arteries. Otherwise unremarkable. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Penetrating trauma to the right shoulder with multiple foci of gas adjacent to the superior aspect of the scapula and humeral head. A few foci of gas are noted within the bicipital groove as well as intra-articular. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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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.
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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
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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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MR Breast Diagnostic Bil wo+w contrast CLINICAL INFORMATION: History of right breast DCIS status post biopsy undergoing evaluation for extent of disease. 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: 129 lbs. IV contrast: ProHance, 12 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: Most recent breast MRI: None. Most recent mammogram: 12/2/2021. MRI FINDINGS: This bilateral breast MRI exam demonstrates minimal background enhancement. There is extreme fibroglandular tissue. RIGHT BREAST: No suspicious enhancing mass or nonmass enhancement. No architectural distortion. LEFT BREAST: 1. Clumped nonmass enhancement enhancement in the upper outer quadrant, posterior depth of the left breast measures 19 x 9 x 29 mm (series 400, image 382 and series 6, image 36). Adjacent susceptibility artifact related to previous biopsy marker is also seen lateral to the nonmass enhancement. 2. T2 hyperintense, oval enhancing mass with circumscribed margins in the medial 9:00, middle depth left breast measures 5 x 5 x 8 mm (series 400, image 24 and series 6, image 67). LYMPH NODES: Morphologically normal appearing intramammary lymph node in the upper outer quadrant. LYMPH NODES:No axillary adenopathy. ADDITIONAL FINDINGS: None. IMPRESSION AND RECOMMENDATIONS: RIGHT BREAST: No MRI evidence of occult breast malignancy. BI-RADS 1 LEFT BREAST: 1. Clumped nonmass enhancement in the upper-outer quadrant of the left breast is consistent with biopsy-proven DCIS. BI-RADS 6: Biopsy proven malignancy. Recommend surgical excision when clinically appropriate. 2. Small T2 hyperintense enhancing mass in the 9:00 left breast is probably benign. Targeted ultrasound is recommended. If no sonographic correlate, follow-up MR is recommended in six months. BI-RADS 3: Probably benign. OVERALL BI-RADS ASSESSMENT: BI-RADS 6, known malignancy. 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.
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FINDINGS: This bilateral breast MRI exam demonstrates minimal background enhancement. There is extreme fibroglandular tissue. RIGHT BREAST: No suspicious enhancing mass or nonmass enhancement. No architectural distortion. LEFT BREAST: 1. Clumped nonmass enhancement enhancement in the upper outer quadrant, posterior depth of the left breast measures 19 x 9 x 29 mm (series 400, image 382 and series 6, image 36). Adjacent susceptibility artifact related to previous biopsy marker is also seen lateral to the nonmass enhancement. 2. T2 hyperintense, oval enhancing mass with circumscribed margins in the medial 9:00, middle depth left breast measures 5 x 5 x 8 mm (series 400, image 24 and series 6, image 67). LYMPH NODES: Morphologically normal appearing intramammary lymph node in the upper outer quadrant. LYMPH NODES:No axillary adenopathy. ADDITIONAL FINDINGS: None. IMPRESSION AND RECOMMENDATIONS: RIGHT BREAST: No MRI evidence of occult breast malignancy. BI-RADS 1 LEFT BREAST: 1. Clumped nonmass enhancement in the upper-outer quadrant of the left breast is consistent with biopsy-proven DCIS. BI-RADS 6: Biopsy proven malignancy. Recommend surgical excision when clinically appropriate. 2. Small T2 hyperintense enhancing mass in the 9:00 left breast is probably benign. Targeted ultrasound is recommended. If no sonographic correlate, follow-up MR is recommended in six months. BI-RADS 3: Probably benign. OVERALL BI-RADS ASSESSMENT: BI-RADS 6, known malignancy. 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.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Subtle groundglass opacities at both bases. No definitive pneumothorax. No pleural effusion. Central are patent. Small tracheal diverticulum. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Fluid within the distal esophagus suggestive of reflux. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Laceration involving the left axilla. Soft tissue emphysema along the right shoulder. Gynecomastia. 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 not identified. The colon is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Two right renal arteries. Otherwise unremarkable. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Penetrating trauma to the right shoulder with multiple foci of gas adjacent to the superior aspect of the scapula and humeral head. A few foci of gas are noted within the bicipital groove as well as intra-articular. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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EXAM: MULTIPARAMETRIC MRI OF THE PROSTATE W AND WO IV CONTRAST CLINICAL INDICATION: Elevated PSA, atypical glands on one core (right mid gland; 9/2021) PSA trend: 8/10/2021 = 19.3 5/28/2021 = 21 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, 9 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: None. FINDINGS: STRUCTURED REPORT: MRI Prostate Examination is mildly degraded by motion artifact. PROSTATE: Measurement: 6.2 x 5.2 x 5.7 cm; estimated volume: 95.6 cc, PSA density = .22 Focal lesion(s): None Diffuse prostate abnormalities: Diffusely striated appearance of the peripheral zone on T2WI may reflect prostatitis. Scattered T1 hyperintensity cold reflect blood products. Other prostate findings: Enlarged with multiple BPH nodules. VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. BLADDER: Trabeculated appearance. OTHER PELVIC FINDINGS: None. BODY WALL: Small fat containing bilateral inguinal hernias. MUSCULOSKELETAL: Left flank lipoma. 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: No focal lesion suspicious for clinically significant prostate cancer 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.
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FINDINGS: STRUCTURED REPORT: MRI Prostate Examination is mildly degraded by motion artifact. PROSTATE: Measurement: 6.2 x 5.2 x 5.7 cm; estimated volume: 95.6 cc, PSA density = .22 Focal lesion(s): None Diffuse prostate abnormalities: Diffusely striated appearance of the peripheral zone on T2WI may reflect prostatitis. Scattered T1 hyperintensity cold reflect blood products. Other prostate findings: Enlarged with multiple BPH nodules. VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. BLADDER: Trabeculated appearance. OTHER PELVIC FINDINGS: None. BODY WALL: Small fat containing bilateral inguinal hernias. MUSCULOSKELETAL: Left flank lipoma. 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
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Subtle groundglass opacities at both bases. No definitive pneumothorax. No pleural effusion. Central are patent. Small tracheal diverticulum. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Fluid within the distal esophagus suggestive of reflux. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Laceration involving the left axilla. Soft tissue emphysema along the right shoulder. Gynecomastia. 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 not identified. The colon is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Two right renal arteries. Otherwise unremarkable. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Penetrating trauma to the right shoulder with multiple foci of gas adjacent to the superior aspect of the scapula and humeral head. A few foci of gas are noted within the bicipital groove as well as intra-articular. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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15,189 |
EXAM: MR Foot Left wo contrast CLINICAL INFORMATION: Left forefoot pain with concern for neuroma. COMPARISON: 11/3/2021. TECHNIQUE: Multiplanar multisequence MRI of left foot was obtained without intravenous contrast. FINDINGS: BONES: No fracture, marrow replacement or aggressive osseous lesion. JOINTS: Alignment: Normal, including Lisfranc alignment. Effusion: None. Cartilage: Normal. Degenerative changes: Minimal degenerative changes of the great toe MTP joint.. Fluid is seen between the heads of the second and third metatarsals. Additionally, small amount of fluid is seen within the heads of the first and second and third and fourth metatarsals. MUSCLES/TENDON: Normal. OTHER: Soft tissue edema is noted along the dorsal lateral aspect of the foot. CONCLUSION: 1. Findings most consistent with intermetatarsal bursitis of the first through fourth toes, most prominent between the heads of the second and third metatarsals. 2. No neuroma. 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.
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FINDINGS: BONES: No fracture, marrow replacement or aggressive osseous lesion. JOINTS: Alignment: Normal, including Lisfranc alignment. Effusion: None. Cartilage: Normal. Degenerative changes: Minimal degenerative changes of the great toe MTP joint.. Fluid is seen between the heads of the second and third metatarsals. Additionally, small amount of fluid is seen within the heads of the first and second and third and fourth metatarsals. MUSCLES/TENDON: Normal. OTHER: Soft tissue edema is noted along the dorsal lateral aspect of the foot.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, intracranial mass, large territory infarct, or edema. Gray-white matter differentiation maintained. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. No aggressive osseous lesion. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. FACE: Motion artifact limits evaluation. FACIAL BONES: No acute facial or mandibular fracture identified. Chronic fracture of the left medial orbital wall with displacement of bone fragments and orbital fat into the ethmoid sinus. Probable chronic fractures of the nasal bones. ORBITS: No acute orbital fracture. Globes are normal in appearance. SINUSES: Mucous retention cyst within the left maxillary sinus. Mild diffuse paranasal sinus mucosal thickening. Mastoid air cells are clear. SOFT TISSUES: Small laceration overlying the right mandible with underlying trace subcutaneous gas.
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MRI brain with and without, MRA head without contrast, MRA neck with and without contrast Indication: headache, Z86.73 Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits Spec Inst: 46 yo with polysubastance use hx of cocaine and methadone OD in 2007 sustained R hemiparesis and aphasia , sister with GBM and recent new onset headache and worsenign -last used drugs in 2013 has aphasia and L face V2 V3 sensory loss Comparison: CT head without contrast 8/23/2012 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: 236 lbs. IV contrast injection rate: 2 ml per sec. (Accession MR220002746), Patient weight: 236 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 2 ml per sec. (Accession MR220002747), Patient weight: 236 lbs. IV contrast injection rate: 2 ml per sec. (Accession MR220002745) Findings: Brain: Echoplanar diffusion-weighted imaging demonstrates no evidence of restricted diffusion at this time. Deep white matter gliosis centrum semiovale and corona radiata and left cerebral hemisphere with ex vacuo dilatation of the left lateral ventricle. Adjacent cortical gyral atrophy and encephalomalacia in the left MCA territory. Whole brain T2 and FLAIR imaging demonstrate no midline shift, mass effect, or other space-occupying lesion. There are no significant white matter FLAIR hyperintensities . The ventricular system is of normal morphology. The basal cisterns are clear. The visualized vascular flow voids appear normal. Post administration of contrast material, there is no other abnormal enhancement. The remaining visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. MRA head without contrast: There is no evidence of flow related enhancement in the left ICA and left MCA. Diminutive flow in the A1 segment of the left ACA. Remainder of the left ACA preserving flow through eight, The right vertebral artery is hypoplastic. Prominent right posterior communicating artery is seen. The basal artery and both posterior cerebral arteries are unremarkable. The right anterior circulation shows no evidence of flow-limiting stenosis or occlusion. MRA neck with and without contrast: Narrow caliber of the left common carotid. Severely narrow caliber of the left cervical ICA about 1 cm beyond its origin The right vertebral artery is hyperplastic and ends in the hips lateral PICA. The right CCA, ICA appear unremarkable. Impression: 1. No acute intracranial process. 2. Remote left MCA infarct with predominant white matter volume loss and small amount of transformation. 3. Small caliber left CCA, previously narrow caliber of the left cervical ICA with complete loss of flow related enhancement on 3-D TOF MRA in the intracranial ICA, MCA. Minimal reconstitution seen on CEMRA. 4. Hypoplastic right vertebral artery.
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Findings: Brain: Echoplanar diffusion-weighted imaging demonstrates no evidence of restricted diffusion at this time. Deep white matter gliosis centrum semiovale and corona radiata and left cerebral hemisphere with ex vacuo dilatation of the left lateral ventricle. Adjacent cortical gyral atrophy and encephalomalacia in the left MCA territory. Whole brain T2 and FLAIR imaging demonstrate no midline shift, mass effect, or other space-occupying lesion. There are no significant white matter FLAIR hyperintensities . The ventricular system is of normal morphology. The basal cisterns are clear. The visualized vascular flow voids appear normal. Post administration of contrast material, there is no other abnormal enhancement. The remaining visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. MRA head without contrast: There is no evidence of flow related enhancement in the left ICA and left MCA. Diminutive flow in the A1 segment of the left ACA. Remainder of the left ACA preserving flow through eight, The right vertebral artery is hypoplastic. Prominent right posterior communicating artery is seen. The basal artery and both posterior cerebral arteries are unremarkable. The right anterior circulation shows no evidence of flow-limiting stenosis or occlusion. MRA neck with and without contrast: Narrow caliber of the left common carotid. Severely narrow caliber of the left cervical ICA about 1 cm beyond its origin The right vertebral artery is hyperplastic and ends in the hips lateral PICA. The right CCA, ICA appear unremarkable.
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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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15,191 |
MRI brain with and without, MRA head without contrast, MRA neck with and without contrast Indication: headache, Z86.73 Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits Spec Inst: 46 yo with polysubastance use hx of cocaine and methadone OD in 2007 sustained R hemiparesis and aphasia , sister with GBM and recent new onset headache and worsenign -last used drugs in 2013 has aphasia and L face V2 V3 sensory loss Comparison: CT head without contrast 8/23/2012 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: 236 lbs. IV contrast injection rate: 2 ml per sec. (Accession MR220002746), Patient weight: 236 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 2 ml per sec. (Accession MR220002747), Patient weight: 236 lbs. IV contrast injection rate: 2 ml per sec. (Accession MR220002745) Findings: Brain: Echoplanar diffusion-weighted imaging demonstrates no evidence of restricted diffusion at this time. Deep white matter gliosis centrum semiovale and corona radiata and left cerebral hemisphere with ex vacuo dilatation of the left lateral ventricle. Adjacent cortical gyral atrophy and encephalomalacia in the left MCA territory. Whole brain T2 and FLAIR imaging demonstrate no midline shift, mass effect, or other space-occupying lesion. There are no significant white matter FLAIR hyperintensities . The ventricular system is of normal morphology. The basal cisterns are clear. The visualized vascular flow voids appear normal. Post administration of contrast material, there is no other abnormal enhancement. The remaining visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. MRA head without contrast: There is no evidence of flow related enhancement in the left ICA and left MCA. Diminutive flow in the A1 segment of the left ACA. Remainder of the left ACA preserving flow through eight, The right vertebral artery is hypoplastic. Prominent right posterior communicating artery is seen. The basal artery and both posterior cerebral arteries are unremarkable. The right anterior circulation shows no evidence of flow-limiting stenosis or occlusion. MRA neck with and without contrast: Narrow caliber of the left common carotid. Severely narrow caliber of the left cervical ICA about 1 cm beyond its origin The right vertebral artery is hyperplastic and ends in the hips lateral PICA. The right CCA, ICA appear unremarkable. Impression: 1. No acute intracranial process. 2. Remote left MCA infarct with predominant white matter volume loss and small amount of transformation. 3. Small caliber left CCA, previously narrow caliber of the left cervical ICA with complete loss of flow related enhancement on 3-D TOF MRA in the intracranial ICA, MCA. Minimal reconstitution seen on CEMRA. 4. Hypoplastic right vertebral artery.
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Findings: Brain: Echoplanar diffusion-weighted imaging demonstrates no evidence of restricted diffusion at this time. Deep white matter gliosis centrum semiovale and corona radiata and left cerebral hemisphere with ex vacuo dilatation of the left lateral ventricle. Adjacent cortical gyral atrophy and encephalomalacia in the left MCA territory. Whole brain T2 and FLAIR imaging demonstrate no midline shift, mass effect, or other space-occupying lesion. There are no significant white matter FLAIR hyperintensities . The ventricular system is of normal morphology. The basal cisterns are clear. The visualized vascular flow voids appear normal. Post administration of contrast material, there is no other abnormal enhancement. The remaining visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. MRA head without contrast: There is no evidence of flow related enhancement in the left ICA and left MCA. Diminutive flow in the A1 segment of the left ACA. Remainder of the left ACA preserving flow through eight, The right vertebral artery is hypoplastic. Prominent right posterior communicating artery is seen. The basal artery and both posterior cerebral arteries are unremarkable. The right anterior circulation shows no evidence of flow-limiting stenosis or occlusion. MRA neck with and without contrast: Narrow caliber of the left common carotid. Severely narrow caliber of the left cervical ICA about 1 cm beyond its origin The right vertebral artery is hyperplastic and ends in the hips lateral PICA. The right CCA, ICA appear unremarkable.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Evaluation of the lung parenchyma is limited secondary to extensive patient respiratory motion artifact, particularly at the lung bases. No large consolidative changes bilaterally. Small bilateral pleural effusions with adjacent passive atelectasis. HEART / VESSELS: Moderate pericardial effusion. A right internal jugular central venous catheter is seen with tip terminating at the superior cavoatrial junction. Cardiac chambers and great vessels are normal in size. MEDIASTINUM / ESOPHAGUS: Esophagogastric tube is seen with tip terminating at the distal stomach. Otherwise unremarkable. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Similar appearance of scattered hepatic cysts and other hypoattenuating foci that are poorly characterized on a noncontrast exam. The liver is otherwise unremarkable for unenhanced technique. BILIARY TRACT: Pneumobilia, unchanged. Mild intrahepatic biliary ductal dilatation. There is hyperdensity in the distal common bile duct, similar to prior. GALLBLADDER: Surgically absent. PANCREAS: Mildly atrophic. SPLEEN: Unremarkable parenchyma within limits of motion. Tracking fluid involving the posterior aspect of the spleen. ADRENALS: Normal. KIDNEYS: Unchanged moderate atrophy of the native kidneys with innumerable hyper and hypoattenuating cysts bilaterally. No hydroureteronephrosis or radiopaque urinary tract calculi bilaterally. Similar appearance of bilateral pelvic renal transplants without hydroureteronephrosis or peritransplant fluid collection. No transplant radiopaque urinary calculi. Trace focus of air within the right transplant which may reflect reflux of gas in the presence of Foley catheterization. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Interval placement of a metallic clip at the proximal duodenum. Stomach and small bowel are otherwise unremarkable without small bowel obstruction. COLON / APPENDIX: Prominent fecal ball at the rectum without evidence of stercoral colitis. The remainder of the colon appears unremarkable without colonic wall thickening or pericolonic fat stranding. PERITONEUM / MESENTERY: Mild left retroperitoneal fat stranding. No free intraperitoneal fluid or air. RETROPERITONEUM: Moderate sized left retroperitoneal hematoma with layering hematocrit level, suggestive of recent hemorrhage. Hematoma measures approximately 13.5 x 10.8 x 21.0 cm (series 204 image 163) though is ill-defined. There is extensive surrounding left retroperitoneal fat stranding. Hemorrhage extends into the left psoas/iliopsoas muscle along with mass effect on the left kidney. VESSELS: Moderate atherosclerotic calcifications of the aortoiliac vessels. The infrarenal abdominal aorta is aneurysmal at 3.2 cm (series and one image 334). IVC filter is seen in appropriate positioning below the level of the renal veins. URINARY BLADDER: Decompressed around a Foley catheter. Small foci of air within the bladder lumen suggestive of recent catheter manipulation. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Moderate body wall anasarca, left greater than right. MUSCULOSKELETAL: No destructive lesions. Degenerative changes in the spine. Decreased bone mineral density throughout. There are multiple old left rib fractures. Posterior right rib fractures are also again noted. Prior sternal body fracture severe motion limiting this area simulating an additional sternal body fracture unless there has been interval trauma. Chronic L1 vertebral body compression fracture. Similar appearance of intervertebral disc space narrowing along the length of the lumbosacral spine.
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15,192 |
MRI brain with and without, MRA head without contrast, MRA neck with and without contrast Indication: headache, Z86.73 Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits Spec Inst: 46 yo with polysubastance use hx of cocaine and methadone OD in 2007 sustained R hemiparesis and aphasia , sister with GBM and recent new onset headache and worsenign -last used drugs in 2013 has aphasia and L face V2 V3 sensory loss Comparison: CT head without contrast 8/23/2012 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: 236 lbs. IV contrast injection rate: 2 ml per sec. (Accession MR220002746), Patient weight: 236 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 2 ml per sec. (Accession MR220002747), Patient weight: 236 lbs. IV contrast injection rate: 2 ml per sec. (Accession MR220002745) Findings: Brain: Echoplanar diffusion-weighted imaging demonstrates no evidence of restricted diffusion at this time. Deep white matter gliosis centrum semiovale and corona radiata and left cerebral hemisphere with ex vacuo dilatation of the left lateral ventricle. Adjacent cortical gyral atrophy and encephalomalacia in the left MCA territory. Whole brain T2 and FLAIR imaging demonstrate no midline shift, mass effect, or other space-occupying lesion. There are no significant white matter FLAIR hyperintensities . The ventricular system is of normal morphology. The basal cisterns are clear. The visualized vascular flow voids appear normal. Post administration of contrast material, there is no other abnormal enhancement. The remaining visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. MRA head without contrast: There is no evidence of flow related enhancement in the left ICA and left MCA. Diminutive flow in the A1 segment of the left ACA. Remainder of the left ACA preserving flow through eight, The right vertebral artery is hypoplastic. Prominent right posterior communicating artery is seen. The basal artery and both posterior cerebral arteries are unremarkable. The right anterior circulation shows no evidence of flow-limiting stenosis or occlusion. MRA neck with and without contrast: Narrow caliber of the left common carotid. Severely narrow caliber of the left cervical ICA about 1 cm beyond its origin The right vertebral artery is hyperplastic and ends in the hips lateral PICA. The right CCA, ICA appear unremarkable. Impression: 1. No acute intracranial process. 2. Remote left MCA infarct with predominant white matter volume loss and small amount of transformation. 3. Small caliber left CCA, previously narrow caliber of the left cervical ICA with complete loss of flow related enhancement on 3-D TOF MRA in the intracranial ICA, MCA. Minimal reconstitution seen on CEMRA. 4. Hypoplastic right vertebral artery.
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Findings: Brain: Echoplanar diffusion-weighted imaging demonstrates no evidence of restricted diffusion at this time. Deep white matter gliosis centrum semiovale and corona radiata and left cerebral hemisphere with ex vacuo dilatation of the left lateral ventricle. Adjacent cortical gyral atrophy and encephalomalacia in the left MCA territory. Whole brain T2 and FLAIR imaging demonstrate no midline shift, mass effect, or other space-occupying lesion. There are no significant white matter FLAIR hyperintensities . The ventricular system is of normal morphology. The basal cisterns are clear. The visualized vascular flow voids appear normal. Post administration of contrast material, there is no other abnormal enhancement. The remaining visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. MRA head without contrast: There is no evidence of flow related enhancement in the left ICA and left MCA. Diminutive flow in the A1 segment of the left ACA. Remainder of the left ACA preserving flow through eight, The right vertebral artery is hypoplastic. Prominent right posterior communicating artery is seen. The basal artery and both posterior cerebral arteries are unremarkable. The right anterior circulation shows no evidence of flow-limiting stenosis or occlusion. MRA neck with and without contrast: Narrow caliber of the left common carotid. Severely narrow caliber of the left cervical ICA about 1 cm beyond its origin The right vertebral artery is hyperplastic and ends in the hips lateral PICA. The right CCA, ICA appear unremarkable.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Evaluation of the lung parenchyma is limited secondary to extensive patient respiratory motion artifact, particularly at the lung bases. No large consolidative changes bilaterally. Small bilateral pleural effusions with adjacent passive atelectasis. HEART / VESSELS: Moderate pericardial effusion. A right internal jugular central venous catheter is seen with tip terminating at the superior cavoatrial junction. Cardiac chambers and great vessels are normal in size. MEDIASTINUM / ESOPHAGUS: Esophagogastric tube is seen with tip terminating at the distal stomach. Otherwise unremarkable. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Similar appearance of scattered hepatic cysts and other hypoattenuating foci that are poorly characterized on a noncontrast exam. The liver is otherwise unremarkable for unenhanced technique. BILIARY TRACT: Pneumobilia, unchanged. Mild intrahepatic biliary ductal dilatation. There is hyperdensity in the distal common bile duct, similar to prior. GALLBLADDER: Surgically absent. PANCREAS: Mildly atrophic. SPLEEN: Unremarkable parenchyma within limits of motion. Tracking fluid involving the posterior aspect of the spleen. ADRENALS: Normal. KIDNEYS: Unchanged moderate atrophy of the native kidneys with innumerable hyper and hypoattenuating cysts bilaterally. No hydroureteronephrosis or radiopaque urinary tract calculi bilaterally. Similar appearance of bilateral pelvic renal transplants without hydroureteronephrosis or peritransplant fluid collection. No transplant radiopaque urinary calculi. Trace focus of air within the right transplant which may reflect reflux of gas in the presence of Foley catheterization. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Interval placement of a metallic clip at the proximal duodenum. Stomach and small bowel are otherwise unremarkable without small bowel obstruction. COLON / APPENDIX: Prominent fecal ball at the rectum without evidence of stercoral colitis. The remainder of the colon appears unremarkable without colonic wall thickening or pericolonic fat stranding. PERITONEUM / MESENTERY: Mild left retroperitoneal fat stranding. No free intraperitoneal fluid or air. RETROPERITONEUM: Moderate sized left retroperitoneal hematoma with layering hematocrit level, suggestive of recent hemorrhage. Hematoma measures approximately 13.5 x 10.8 x 21.0 cm (series 204 image 163) though is ill-defined. There is extensive surrounding left retroperitoneal fat stranding. Hemorrhage extends into the left psoas/iliopsoas muscle along with mass effect on the left kidney. VESSELS: Moderate atherosclerotic calcifications of the aortoiliac vessels. The infrarenal abdominal aorta is aneurysmal at 3.2 cm (series and one image 334). IVC filter is seen in appropriate positioning below the level of the renal veins. URINARY BLADDER: Decompressed around a Foley catheter. Small foci of air within the bladder lumen suggestive of recent catheter manipulation. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Moderate body wall anasarca, left greater than right. MUSCULOSKELETAL: No destructive lesions. Degenerative changes in the spine. Decreased bone mineral density throughout. There are multiple old left rib fractures. Posterior right rib fractures are also again noted. Prior sternal body fracture severe motion limiting this area simulating an additional sternal body fracture unless there has been interval trauma. Chronic L1 vertebral body compression fracture. Similar appearance of intervertebral disc space narrowing along the length of the lumbosacral spine.
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15,193 |
MR Lumbar Spine wo contrast 1/21/2022 5:01 PM Clinical information: 63 years Female patient with Low back pain, M54.50 Low back pain, unspecified Spec Inst: Ongoing low back pain with radicular symptoms not responding to conservative measures of nonsteroidal anti-inflammatory medications and rest Comparison: Plain films of the lumbar spine dated 2/25/2020. Technique: Sagittal and axial T1, T2 and STIR images were obtained of the lumbar spine, without intravenous contrast administration. Findings: The sagittal images demonstrate persistent preservation of the lumbar lordosis, without subluxations. The vertebral bodies maintain normal height and marrow signal. Prominent Schmorl nodes are noted along the inferior endplates of T11 and T12. Incidental L2 and L3 vertebral body intraosseous hemangiomas. Mild disc desiccation is noted at L4-L5 from decreased T2-weighted signal, without significant disc height loss. The intervertebral discs appear otherwise well-hydrated, without significant disc height loss. The distal spinal cord is normal in size and signal intensity, without expansile lesions. The tip of the conus medullaris terminates normally at T12/L1. L1-L2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-L3: The spinal canal and neural foramina are patent. L3-4: No significant spinal canal stenosis or neuroforaminal narrowing. L4-5: Minimal circumferential disc bulge with left foraminal annular fissure, without significant spinal canal stenosis or neuroforaminal narrowing. L5-S1: Epidural lipomatosis extending into the sacral canal, without significant spinal canal stenosis or neuroforaminal narrowing. The paraspinal soft tissues appear unremarkable, without organized fluid collections. IMPRESSION: 1. No evidence of acute findings in the lumbar spine. 2. Early chronic degenerative changes as described, most significant at L4-L5, with minimal circumferential disc bulge and left foraminal annular fissure, without significant spinal canal stenosis or neuroforaminal narrowing.
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Findings: The sagittal images demonstrate persistent preservation of the lumbar lordosis, without subluxations. The vertebral bodies maintain normal height and marrow signal. Prominent Schmorl nodes are noted along the inferior endplates of T11 and T12. Incidental L2 and L3 vertebral body intraosseous hemangiomas. Mild disc desiccation is noted at L4-L5 from decreased T2-weighted signal, without significant disc height loss. The intervertebral discs appear otherwise well-hydrated, without significant disc height loss. The distal spinal cord is normal in size and signal intensity, without expansile lesions. The tip of the conus medullaris terminates normally at T12/L1. L1-L2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-L3: The spinal canal and neural foramina are patent. L3-4: No significant spinal canal stenosis or neuroforaminal narrowing. L4-5: Minimal circumferential disc bulge with left foraminal annular fissure, without significant spinal canal stenosis or neuroforaminal narrowing. L5-S1: Epidural lipomatosis extending into the sacral canal, without significant spinal canal stenosis or neuroforaminal narrowing. The paraspinal soft tissues appear unremarkable, without organized fluid collections.
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FINDINGS: BONES/JOINTS: There is a fracture through the Left femoral head with proximal and posterior subluxation of the distal fracture segments. The more proximal femoral head fragment remains within the acetabulum. Fracture of the posterior superior left acetabular wall is displaced. There is also a fracture through the inferior posterior right acetabular wall. SOFT TISSUES: Findings are discussed on separate CT abdomen and pelvis report.
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15,194 |
RADIOLOGIC EXAM: MR Brain wo+w contrast, MR Angio Head wo contrast, MR Angio Neck wo+w contrast CLINICAL INFORMATION: Transient ischemic attack (TIA). Sp: With CISS study, history of acoustic neuroma. Per chart review, history of acoustic status post resection in 2002, complicated by stroke, now with recurrent neuroma as of September 2018. Complaining of recurrent headaches, vision impairment, left arm paresthesias. Concern for TIA versus migrainous phenomenon. COMPARISON: MRI brain dated 10/21/2020, 4/9/2019, 9/21/2018. 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. MRA of the head and neck was performed before and after the administration of intravenous contrast. Multiple MIP images were generated. IV contrast: Meglumine Dotarem, 15 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: MRI Brain: Stable postsurgical changes from prior left suboccipital craniotomy with chronic left cerebellar hemisphere encephalomalacia/gliosis. No significant change in size or appearance of nodular enhancement at the left internal acoustic meatus, likely residual schwannoma. No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, space-occupying lesion, or mass effect. Stable chronic cystic encephalomalacia in the left greater than right pons. Small developmental venous anomaly in the right cerebellum is again seen. Multifocal punctate bilateral cerebral white matter T2/FLAIR hyperintensities, overall unchanged, likely chronic microhemorrhage hepatic changes. 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. Left ocular lens replacement. MRA Brain: 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. FINDINGS: 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. MRI Neck: AORTIC ARCH: Normal left-sided configuration and the origins of the great vessels are normal. RIGHT CAROTID CIRCULATION: Normal in course, caliber, and contour. LEFT CAROTID CIRCULATION: Normal in course, caliber, and contour. VERTEBRAL ARTERIES: Normal in course, caliber, and contour. INTRACRANIAL ARTERIAL CIRCULATION: There is no evidence of aneurysm or large vessel occlusion at the circle of Willis. CONCLUSION: 1. No acute intracranial process. 2. Stable postsurgical changes from prior left suboccipital craniotomy and tumor resection. No significant interval change in nodular enhancement at the left internal acoustic meatus, likely residual schwannoma. 3. Stable chronic encephalomalacia in the pons. 4. Normal MRA of the head and neck. 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.
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FINDINGS: MRI Brain: Stable postsurgical changes from prior left suboccipital craniotomy with chronic left cerebellar hemisphere encephalomalacia/gliosis. No significant change in size or appearance of nodular enhancement at the left internal acoustic meatus, likely residual schwannoma. No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, space-occupying lesion, or mass effect. Stable chronic cystic encephalomalacia in the left greater than right pons. Small developmental venous anomaly in the right cerebellum is again seen. Multifocal punctate bilateral cerebral white matter T2/FLAIR hyperintensities, overall unchanged, likely chronic microhemorrhage hepatic changes. 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. Left ocular lens replacement. MRA Brain: 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. FINDINGS: 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. MRI Neck: AORTIC ARCH: Normal left-sided configuration and the origins of the great vessels are normal. RIGHT CAROTID CIRCULATION: Normal in course, caliber, and contour. LEFT CAROTID CIRCULATION: Normal in course, caliber, and contour. VERTEBRAL ARTERIES: Normal in course, caliber, and contour. INTRACRANIAL ARTERIAL CIRCULATION: There is no evidence of aneurysm or large vessel occlusion at the circle of Willis.
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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 (
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15,195 |
RADIOLOGIC EXAM: MR Brain wo+w contrast, MR Angio Head wo contrast, MR Angio Neck wo+w contrast CLINICAL INFORMATION: Transient ischemic attack (TIA). Sp: With CISS study, history of acoustic neuroma. Per chart review, history of acoustic status post resection in 2002, complicated by stroke, now with recurrent neuroma as of September 2018. Complaining of recurrent headaches, vision impairment, left arm paresthesias. Concern for TIA versus migrainous phenomenon. COMPARISON: MRI brain dated 10/21/2020, 4/9/2019, 9/21/2018. 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. MRA of the head and neck was performed before and after the administration of intravenous contrast. Multiple MIP images were generated. IV contrast: Meglumine Dotarem, 15 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: MRI Brain: Stable postsurgical changes from prior left suboccipital craniotomy with chronic left cerebellar hemisphere encephalomalacia/gliosis. No significant change in size or appearance of nodular enhancement at the left internal acoustic meatus, likely residual schwannoma. No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, space-occupying lesion, or mass effect. Stable chronic cystic encephalomalacia in the left greater than right pons. Small developmental venous anomaly in the right cerebellum is again seen. Multifocal punctate bilateral cerebral white matter T2/FLAIR hyperintensities, overall unchanged, likely chronic microhemorrhage hepatic changes. 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. Left ocular lens replacement. MRA Brain: 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. FINDINGS: 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. MRI Neck: AORTIC ARCH: Normal left-sided configuration and the origins of the great vessels are normal. RIGHT CAROTID CIRCULATION: Normal in course, caliber, and contour. LEFT CAROTID CIRCULATION: Normal in course, caliber, and contour. VERTEBRAL ARTERIES: Normal in course, caliber, and contour. INTRACRANIAL ARTERIAL CIRCULATION: There is no evidence of aneurysm or large vessel occlusion at the circle of Willis. CONCLUSION: 1. No acute intracranial process. 2. Stable postsurgical changes from prior left suboccipital craniotomy and tumor resection. No significant interval change in nodular enhancement at the left internal acoustic meatus, likely residual schwannoma. 3. Stable chronic encephalomalacia in the pons. 4. Normal MRA of the head and neck. 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.
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FINDINGS: MRI Brain: Stable postsurgical changes from prior left suboccipital craniotomy with chronic left cerebellar hemisphere encephalomalacia/gliosis. No significant change in size or appearance of nodular enhancement at the left internal acoustic meatus, likely residual schwannoma. No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, space-occupying lesion, or mass effect. Stable chronic cystic encephalomalacia in the left greater than right pons. Small developmental venous anomaly in the right cerebellum is again seen. Multifocal punctate bilateral cerebral white matter T2/FLAIR hyperintensities, overall unchanged, likely chronic microhemorrhage hepatic changes. 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. Left ocular lens replacement. MRA Brain: 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. FINDINGS: 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. MRI Neck: AORTIC ARCH: Normal left-sided configuration and the origins of the great vessels are normal. RIGHT CAROTID CIRCULATION: Normal in course, caliber, and contour. LEFT CAROTID CIRCULATION: Normal in course, caliber, and contour. VERTEBRAL ARTERIES: Normal in course, caliber, and contour. INTRACRANIAL ARTERIAL CIRCULATION: There is no evidence of aneurysm or large vessel occlusion at the circle of Willis.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: There is a lesion replacing the entire left hepatic lobe and portions of the right hepatic lobe with multiple additional similar appearing liver lesions scattered throughout the remainder of the right hepatic lobe. This lesion demonstrates peripheral nodular discontinuous enhancement that progressively fills in on delayed phases. There is no portal venous or hepatic venous thrombus. No definite evidence of cirrhosis or hepatic steatosis. BILIARY TRACT: Normal. GALLBLADDER: Collapsed. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Right renal cysts. Otherwise 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: Focal enhancement in the left peripheral zone of the prostate. Otherwise normal. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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15,196 |
RADIOLOGIC EXAM: MR Brain wo+w contrast, MR Angio Head wo contrast, MR Angio Neck wo+w contrast CLINICAL INFORMATION: Transient ischemic attack (TIA). Sp: With CISS study, history of acoustic neuroma. Per chart review, history of acoustic status post resection in 2002, complicated by stroke, now with recurrent neuroma as of September 2018. Complaining of recurrent headaches, vision impairment, left arm paresthesias. Concern for TIA versus migrainous phenomenon. COMPARISON: MRI brain dated 10/21/2020, 4/9/2019, 9/21/2018. 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. MRA of the head and neck was performed before and after the administration of intravenous contrast. Multiple MIP images were generated. IV contrast: Meglumine Dotarem, 15 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: MRI Brain: Stable postsurgical changes from prior left suboccipital craniotomy with chronic left cerebellar hemisphere encephalomalacia/gliosis. No significant change in size or appearance of nodular enhancement at the left internal acoustic meatus, likely residual schwannoma. No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, space-occupying lesion, or mass effect. Stable chronic cystic encephalomalacia in the left greater than right pons. Small developmental venous anomaly in the right cerebellum is again seen. Multifocal punctate bilateral cerebral white matter T2/FLAIR hyperintensities, overall unchanged, likely chronic microhemorrhage hepatic changes. 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. Left ocular lens replacement. MRA Brain: 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. FINDINGS: 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. MRI Neck: AORTIC ARCH: Normal left-sided configuration and the origins of the great vessels are normal. RIGHT CAROTID CIRCULATION: Normal in course, caliber, and contour. LEFT CAROTID CIRCULATION: Normal in course, caliber, and contour. VERTEBRAL ARTERIES: Normal in course, caliber, and contour. INTRACRANIAL ARTERIAL CIRCULATION: There is no evidence of aneurysm or large vessel occlusion at the circle of Willis. CONCLUSION: 1. No acute intracranial process. 2. Stable postsurgical changes from prior left suboccipital craniotomy and tumor resection. No significant interval change in nodular enhancement at the left internal acoustic meatus, likely residual schwannoma. 3. Stable chronic encephalomalacia in the pons. 4. Normal MRA of the head and neck. 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.
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FINDINGS: MRI Brain: Stable postsurgical changes from prior left suboccipital craniotomy with chronic left cerebellar hemisphere encephalomalacia/gliosis. No significant change in size or appearance of nodular enhancement at the left internal acoustic meatus, likely residual schwannoma. No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, space-occupying lesion, or mass effect. Stable chronic cystic encephalomalacia in the left greater than right pons. Small developmental venous anomaly in the right cerebellum is again seen. Multifocal punctate bilateral cerebral white matter T2/FLAIR hyperintensities, overall unchanged, likely chronic microhemorrhage hepatic changes. 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. Left ocular lens replacement. MRA Brain: 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. FINDINGS: 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. MRI Neck: AORTIC ARCH: Normal left-sided configuration and the origins of the great vessels are normal. RIGHT CAROTID CIRCULATION: Normal in course, caliber, and contour. LEFT CAROTID CIRCULATION: Normal in course, caliber, and contour. VERTEBRAL ARTERIES: Normal in course, caliber, and contour. INTRACRANIAL ARTERIAL CIRCULATION: There is no evidence of aneurysm or large vessel occlusion at the circle of Willis.
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FINDINGS: There is no evidence of acute ischemia, intracranial hemorrhage, or intracranial mass. The ventricles and basal cisterns are unremarkable. The orbits are unremarkable. Mucosal thickening of bilateral ethmoid air cells, maxillary and frontal sinuses. No layering fluid level. The mastoid air cells are clear. The visualized extra-cranial soft tissues are unremarkable. No acute osseous abnormality.
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15,197 |
EXAM: MR Knee Left wo contrast CLINICAL INFORMATION: 22-year-old male with left lateral knee pain, evaluate for meniscal tear. COMPARISON: Left knee radiograph 1/13/2022. TECHNIQUE: MR Knee Left wo contrast STRUCTURED REPORT: MRI Knee 1/2/2020 FINDINGS: BONES:No fracture, marrow replacement, or aggressive osseous lesion. ARTICULATIONS: Effusion:None. Patellofemoral compartment: No cartilage defect. Medial compartment:No cartilage defect. Lateral compartment:No cartilage defect. MENISCI: Medial meniscus:Patchy intermediate signal within the posterior horn of the medial meniscus without definite extension to an articular surface (series 5 image 16 and 17). 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. Subcutaneous edema overlying the patellar tendon and extending laterally over the iliotibial band. CONCLUSION: 1. Subcutaneous edema overlying the patellar tendon and extending laterally, suggestive of pre-patellar bursitis. 2. Patchy intermediate signal of the posterior horn of the medial meniscus without a definite tear, likely degenerative. 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.
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FINDINGS: BONES:No fracture, marrow replacement, or aggressive osseous lesion. ARTICULATIONS: Effusion:None. Patellofemoral compartment: No cartilage defect. Medial compartment:No cartilage defect. Lateral compartment:No cartilage defect. MENISCI: Medial meniscus:Patchy intermediate signal within the posterior horn of the medial meniscus without definite extension to an articular surface (series 5 image 16 and 17). 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. Subcutaneous edema overlying the patellar tendon and extending laterally over the iliotibial band.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Extensive ground glass opacities of the bilateral lower lobes with small volume right pleural effusion. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Partially imaged ECMO cannula within the SVC with tip terminating just below the intrahepatic IVC. Coronary calcifications. ABDOMEN and PELVIS: LIVER: Unremarkable for unenhanced technique. BILIARY TRACT: Normal. GALLBLADDER: Filled with vicarious contrast excretion, otherwise unremarkable. PANCREAS: Unremarkable for unenhanced technique. SPLEEN: Enlarged. ADRENALS: Unremarkable for unenhanced technique. KIDNEYS: No hydroureteronephrosis or radiopaque urinary tract calculi bilaterally. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Percutaneous gastrostomy catheter is seen with balloon appropriately positioned within the gastric lumen. COLON / APPENDIX: Enteric contrast is seen throughout the colon are no colonic wall thickening or pericolonic fat stranding. Fecal management device is seen within the rectum. PERITONEUM / MESENTERY: Moderate free intraperitoneal air located level the anterior abdomen and in the perigastric region. Small amount of fluid in the pelvis. RETROPERITONEUM: Normal. VESSELS: Venous ECMO cannula as above. Otherwise unremarkable URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing periumbilical hernia. MUSCULOSKELETAL: No aggressive osseous lesion or acute fracture.
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15,198 |
MRI brain with and without contrast Clinical Information: Male aged 37 years. Seizure, abnormal neuro exam, G40.219 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, per chart review Comparison: CT 4/3/2004. Technique: Multiplanar, multisequence MRI of the brain were obtained in multiple planes pre-and post administration of intravenous contrast per departmental protocol. Patient weight: 175 lbs. IV contrast: ProHance, 8 ml, per protocol. Findings: No acute infarct or intracranial hemorrhage. No midline shift, hydrocephalus, mass effect, or other space-occupying lesion. The right choroidal fissure is asymmetrically widened containing prominent choroid plexus. No hippocampal atrophy, gray-white matter abnormalities/heterotopia, focal architectural distortions, cephaloceles. Normal flow voids within the visualized vessels. No vascular abnormalities identified. No abnormal parenchymal or leptomeningeal enhancement. No significant abnormality of the extracranial osseous and soft tissue structures. Conclusion: No intracranial process to explain patient's focal seizures. 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.
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Findings: No acute infarct or intracranial hemorrhage. No midline shift, hydrocephalus, mass effect, or other space-occupying lesion. The right choroidal fissure is asymmetrically widened containing prominent choroid plexus. No hippocampal atrophy, gray-white matter abnormalities/heterotopia, focal architectural distortions, cephaloceles. Normal flow voids within the visualized vessels. No vascular abnormalities identified. No abnormal parenchymal or leptomeningeal enhancement. No significant abnormality of the extracranial osseous and soft tissue structures.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Multiple small air cyst/pneumatocele seen in the lower lobes. Scattered atelectasis. DISTAL ESOPHAGUS: Small hiatal hernia. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: 1.8 cm hypoattenuating focus at the posterior dome, increased from prior though measures simple fluid density. BILIARY TRACT: Slight extrahepatic biliary prominence, similar to prior. GALLBLADDER: Possible tiny stones. PANCREAS: Normal. SPLEEN: Normal size with adjacent splenules. ADRENALS: Mild nodular thickening of both adrenal glands. KIDNEYS: Small hypoattenuating bilateral renal lesions are too small to characterize but unchanged seen. No hydronephrosis. LYMPH NODES: Nonenlarged. Few prominent retroperitoneal nodes. STOMACH / SMALL BOWEL: Hiatal hernia as above. Otherwise stomach and small bowel are unremarkable. COLON / APPENDIX: Scattered colonic diverticula. Normal appendix. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No destructive lesions. Degenerative changes in the spine. Sclerotic area in the L4 endplate appears to be associated with degenerative change.
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15,199 |
MR Angio Head wo contrast 1/21/2022 5:27 PM Clinical information: 34 years Female patient with Headache Spec Inst: MRAMRV head for intractable headache in pregnancy TECHNIQUE: Time-of-flight MRA/MRV of the head was performed without intravenous contrast. COMPARISON: None. FINDINGS: Internal carotid arteries: No filling defect or hemodynamically significant stenosis. Anterior cerebral arteries: No filling defect or hemodynamically significant stenosis. Middle Cerebral arteries: No filling defect or hemodynamically significant stenosis. Vertebral arteries: The left vertebral artery is dominant. No filling defect or hemodynamically significant stenosis. Basilar artery: No filling defect or hemodynamically significant stenosis. Posterior cerebral arteries: Mild diffuse decreased caliber of the right P1 segment, likely mild hypoplasia. No filling defect or hemodynamically significant stenosis. Aneurysm/Vascular malformation: No aneurysm or vascular malformation. Superior sagittal sinus: No stenosis, occlusion, or filling defect. Inferior sagittal sinus: No stenosis, occlusion, or filling defect. Internal cerebral veins: No stenosis, occlusion, or filling defect. Straight sinus: No stenosis, occlusion, or filling defect. Transverse sinuses: 5.7 mm ovoid shaped lack of flow-related signal focus along the left transverse sinus is noted. Otherwise, no stenosis, occlusion, or filling defect. Sigmoid sinuses: No stenosis, occlusion, or filling defect. Upper jugular veins: No stenosis, occlusion, or filling defect. IMPRESSION: 1. 5.7 mm ovoid shaped lack of flow-related signal focus along the left transverse sinus may represent a prominent arachnoid granulation, however nonocclusive thrombi cannot be entirely excluded. 2. Unremarkable MRA of the head, without flow-limiting stenoses or intracranial aneurysms.
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FINDINGS: Internal carotid arteries: No filling defect or hemodynamically significant stenosis. Anterior cerebral arteries: No filling defect or hemodynamically significant stenosis. Middle Cerebral arteries: No filling defect or hemodynamically significant stenosis. Vertebral arteries: The left vertebral artery is dominant. No filling defect or hemodynamically significant stenosis. Basilar artery: No filling defect or hemodynamically significant stenosis. Posterior cerebral arteries: Mild diffuse decreased caliber of the right P1 segment, likely mild hypoplasia. No filling defect or hemodynamically significant stenosis. Aneurysm/Vascular malformation: No aneurysm or vascular malformation. Superior sagittal sinus: No stenosis, occlusion, or filling defect. Inferior sagittal sinus: No stenosis, occlusion, or filling defect. Internal cerebral veins: No stenosis, occlusion, or filling defect. Straight sinus: No stenosis, occlusion, or filling defect. Transverse sinuses: 5.7 mm ovoid shaped lack of flow-related signal focus along the left transverse sinus is noted. Otherwise, no stenosis, occlusion, or filling defect. Sigmoid sinuses: No stenosis, occlusion, or filling defect. Upper jugular veins: No stenosis, occlusion, or filling defect.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Bibasilar groundglass opacities with interlobular septal thickening. Small bilateral pleural effusions, right greater than left. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Partially imaged periaortic thickening secondary to aortic interposition graft, unchanged. Coronary calcifications. Probably enlarged main pulmonary artery. Cardiomegaly. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Heterogeneously enhancing. ADRENALS: Normal. KIDNEYS: Cortical thinning and lobular appearance bilaterally. Hypoattenuating foci are too small to characterize. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Avid gastric mucosal enhancement. Stomach appears otherwise normal for underdistention. Small bowel is normal in caliber throughout. There are no areas of contrast extravasation within the intraluminal small bowel to suggest bleeding. COLON / APPENDIX: Postsurgical changes of transverse colectomy and double barrel colostomy at the left hemiabdomen. Contrast pools in the area of the cecum on the arterial phase as seen on series 7 image 155, slightly increased on the venous phase consistent with active bleeding in this area. There is a small area of linear arterial contrast extending to the antimesenteric surface of the colostomy (series 7 image 139). The areas of antimesenteric contrast are more prominent on portal venous delay, particularly on the left lateral aspect (series 11 image 132). PERITONEUM / MESENTERY: No free intraperitoneal air or fluid. RETROPERITONEUM: Normal. VESSELS: Advanced atherosclerotic calcifications of aortoiliac vessels. URINARY BLADDER: Foley catheter in place. Dependent air suggesting recent catheter manipulation. REPRODUCTIVE ORGANS: Uterus is surgically absent. Bilateral adnexa appear unremarkable. BODY WALL: Left abdominal colostomy as above. MUSCULOSKELETAL: No aggressive osseous lesion or acute fracture. Unchanged chronic compression deformity of T11 with vertebroplasty changes. Chronic T12 compression deformity is also unchanged. Severe intervertebral disc space narrowing with reactive sclerosis at the T12-L1 level are unchanged with vacuum phenomenon. Similar appearance of mild levoscoliosis of the lumbosacral spine with apex at L4.
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