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15,200 |
MR Cervical Spine wo+w contrast 1/21/2022 8:04 PM Clinical information: 21 years Male patient with cervical spine fluid collection Comparison: MRI cervical spine without contrast dated 1/19/2022. Technique: Multiplanar multisequence images of the cervical spine were obtained, without intravenous contrast administration. Additionally, sagittal and axial T1 post contrast images were obtained. Patient weight: 233 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 2 ml per sec. Findings: The sagittal images demonstrate mild levocurvature of the cervicothoracic junction, with straightening of the cervical lordosis, without subluxations. The vertebral bodies maintain normal height and marrow signal, without abnormal enhancement. The intervertebral discs appear well hydrated, without significant disc height loss. The spinal cord is normal in size and signal intensity, without expansile lesions or abnormal enhancement. The craniocervical junction appears within normal limits. No significant interval change in known ventral and dorsal epidural fluid collections throughout the visualized cervicothoracic spine, without evidence of abnormal enhancement to suggest epidural abscess. C2-C3: The spinal canal and neuroforamina are patent. C3-C4: No significant spinal canal stenosis or neuroforaminal narrowing. C4-C5: The spinal canal and neuroforamina are patent. C5-C6: No significant spinal canal stenosis or neuroforaminal narrowing. C6-C7: The spinal canal and neuroforamina are patent. C7-T1: No significant spinal canal stenosis or neuroforaminal narrowing. The paraspinal soft tissues appear unremarkable, without organized fluid collections or abnormal enhancement. IMPRESSION: No significant interval change in known ventral and dorsal epidural fluid collections throughout the visualized cervicothoracic spine, without evidence of abnormal enhancement to suggest epidural abscess. Diagnostic possibilities include CSF fistula/intracranial hypotension, and less likely evolving hematomas given the lack of associated post traumatic findings.
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Findings: The sagittal images demonstrate mild levocurvature of the cervicothoracic junction, with straightening of the cervical lordosis, without subluxations. The vertebral bodies maintain normal height and marrow signal, without abnormal enhancement. The intervertebral discs appear well hydrated, without significant disc height loss. The spinal cord is normal in size and signal intensity, without expansile lesions or abnormal enhancement. The craniocervical junction appears within normal limits. No significant interval change in known ventral and dorsal epidural fluid collections throughout the visualized cervicothoracic spine, without evidence of abnormal enhancement to suggest epidural abscess. C2-C3: The spinal canal and neuroforamina are patent. C3-C4: No significant spinal canal stenosis or neuroforaminal narrowing. C4-C5: The spinal canal and neuroforamina are patent. C5-C6: No significant spinal canal stenosis or neuroforaminal narrowing. C6-C7: The spinal canal and neuroforamina are patent. C7-T1: No significant spinal canal stenosis or neuroforaminal narrowing. The paraspinal soft tissues appear unremarkable, without organized fluid collections or abnormal enhancement.
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FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Mildly suboptimal quality with incomplete evaluation of subsegmental pulmonary arteries. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Positive for pulmonary embolus. - Pulmonary Embolus Distribution: Segmental pulmonary arteries supplying the superior segment right lower lobe (series 401 image 66, series 403 image 91). There are additional filling defects seen distally within subsegmental pulmonary arteries supplying the right lower lobe. Questionable involvement in the left upper lobe series 401 image 41. - Pulmonary Artery Diameter: Main pulmonary artery is normal. Both the left and right are mildly prominent measuring up to 1.9 cm on the right and 2.2 cm on the left. - Ascending Aortic Diameter: Measures up to 3.6 cm. - RV:LV Ratio: Normal. - Interventricular Septum: Normal. - Contrast reflux into IVC: Minute LUNGS / AIRWAYS / PLEURA: Peripheral predominant groundglass opacity within the bilateral lungs, right greater than left and lower greater than upper, with associated interlobular and intralobular septal thickening. HEART / OTHER VESSELS: Cardiac chambers and great vessels appear normal in size. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Partially imaged simple cysts of the upper pole left kidney. Otherwise unremarkable for exam technique. MUSCULOSKELETAL: Somewhat mottled appearance of the thoracic spine throughout. Degenerative changes in the spine.
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15,201 |
EXAM:MR Ankle Right wo contrast CLINICAL INFORMATION:Evaluate Achilles tendon. Patient has a known nonocclusive thrombus within the popliteal vein COMPARISON:None. TECHNIQUE: Multiplanar and multisequence MRI of the right ankle was obtained without intravenous contrast. FINDINGS: BONES:No fracture, marrow replacement, or aggressive osseous lesion. ARTICULATIONS: Effusion:None. Tibiotalar joint:Normal. Subtalar joint:Normal. Tarsal joints:Normal. MEDIAL COMPARTMENT: Medial malleolus:Normal. Posterior tibial tendon:Normal. Flexor digitorum longus tendon:Normal. Deltoid ligament complex:Normal. LATERAL COMPARTMENT: Lateral malleolus:Normal. Peroneus longus tendon:Normal. Peroneus quartus is noted. Peroneus brevis tendon:Normal. Anterior tibiofibular ligament:Normal. Posterior tibiofibular ligament:Normal. Anterior talofibular ligament:Normal. Posterior talofibular ligament:Normal. Calcaneofibular ligament:Normal. POSTERIOR COMPARTMENT: Flexor hallucis longus:Normal. Achilles tendon:Normal. Plantar fascia:Normal. ANTERIOR COMPARTMENT: Anterior tibial tendon:Normal. Extensor hallucis longus:Normal. Extensor digitorum longus:Normal. TARSAL TUNNEL:Normal. SINUS TARSI:Normal. CONCLUSION: 1. Unremarkable MRI of the ankle. 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. Tibiotalar joint:Normal. Subtalar joint:Normal. Tarsal joints:Normal. MEDIAL COMPARTMENT: Medial malleolus:Normal. Posterior tibial tendon:Normal. Flexor digitorum longus tendon:Normal. Deltoid ligament complex:Normal. LATERAL COMPARTMENT: Lateral malleolus:Normal. Peroneus longus tendon:Normal. Peroneus quartus is noted. Peroneus brevis tendon:Normal. Anterior tibiofibular ligament:Normal. Posterior tibiofibular ligament:Normal. Anterior talofibular ligament:Normal. Posterior talofibular ligament:Normal. Calcaneofibular ligament:Normal. POSTERIOR COMPARTMENT: Flexor hallucis longus:Normal. Achilles tendon:Normal. Plantar fascia:Normal. ANTERIOR COMPARTMENT: Anterior tibial tendon:Normal. Extensor hallucis longus:Normal. Extensor digitorum longus:Normal. TARSAL TUNNEL:Normal. SINUS TARSI:Normal.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Diffuse cerebral volume loss. Confluent periventricular hypoattenuating areas, compatible with moderate chronic microangiopathic disease. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Ex vacuo dilatation. ORBITS: Bilateral lens replacements. The orbits are otherwise unremarkable. SINUSES: Normal. MASTOIDS: Clear. SOFT TISSUE: Small right frontal scalp laceration. VESSELS: Atherosclerotic calcifications of the intracranial vertebral arteries and carotid siphons. MAXILLOFACIAL: No fracture. Patient is edentulous.
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15,202 |
MR Tibia and Fibula Right wo contrast TECHNIQUE: Multiplanar and multisequence MRI of the right tibia/fibula was obtained. CLINICAL INFORMATION: dvt, I82.439 Acute embolism and thrombosis of unspecified popliteal vein COMPARISON: None FINDINGS: No abnormal bone marrow signal to suggest acute fracture or aggressive osseous lesion. Edema is noted within the medial head of the gastrocnemius in the within the fascial planes between the medial head of gastrocnemius and soleus muscles. Near complete versus complete tear of the plantaris tendon without tendon retraction (images 24-27, series 6). The remaining muscles and tendons are intact and unremarkable. Small amount of superficial soft tissue edema is noted in the posterior aspect of the calf. No focal drainable fluid collection is seen. Conclusion: 1. Near complete versus complete tear of the plantaris tendon without significant tendon retraction. 2. Partial thickness tear of the medial head of the gastrocnemius at the myotendinous junction. 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 abnormal bone marrow signal to suggest acute fracture or aggressive osseous lesion. Edema is noted within the medial head of the gastrocnemius in the within the fascial planes between the medial head of gastrocnemius and soleus muscles. Near complete versus complete tear of the plantaris tendon without tendon retraction (images 24-27, series 6). The remaining muscles and tendons are intact and unremarkable. Small amount of superficial soft tissue edema is noted in the posterior aspect of the calf. No focal drainable fluid collection is seen.
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FINDINGS: Examination quality is mildly limited by beam hardening artifact from patient's arms down positioning. STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Mild apical centrilobular emphysema. There is bibasilar dependent atelectasis. Lungs are otherwise clear without hemo- or pneumothorax. Central airways are patent. HEART / VESSELS: Cardiac chambers and great vessels are normal in size. No central PE. Advanced atherosclerotic calcifications of the aortic arch and descending thoracic aorta. Advanced mitral annular and coronary artery calcifications. A left chest wall pacemaker is seen with leads in the appropriate positioning. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Left chest wall pacemaker as above. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Well-circumscribed, hypoattenuating splenic lesion of the inferior spleen measuring approximately 1.4 x 1.4 cm (series 501 image 248), likely cyst versus hemangioma ADRENALS: Normal. KIDNEYS: Bilateral renal cortical scarring. Bilateral renal hypodensities are too small to adequately characterize, but statistically represent simple cysts. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Postsurgical changes of right hemicolectomy. Large fecal in the rectal vault. PERITONEUM / MESENTERY: No free intraperitoneal air or fluid. RETROPERITONEUM: Normal. VESSELS: Moderate to advanced atherosclerosis of the aorta and iliac arteries. URINARY BLADDER: Limited evaluation secondary to extensive streak artifact from surrounding bilateral hip hardware. REPRODUCTIVE ORGANS: Prostate is not well seen secondary to streak artifact as above. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No evidence of aggressive osseous lesion. Acute/subacute appearing right distal radius fracture with intra-articular extension and mild impaction. Questionable adjacent right scaphoid and trapezoid fractures. Chronic bilateral pars defects at L4 with mild spondylolisthesis. Chronic, healed lateral one third left clavicle fracture. Right total hip arthroplasty, partially imaged. Partially imaged intramedullary nail and screw fixation hardware spanning the proximal left femur. There is extensive heterotopic ossification surrounding the left lesser trochanter. Advanced multilevel degenerative changes of the lumbosacral spine with vacuum phenomena. Advanced bilateral facet arthropathy at L5-S1. ACDF hardware at C6-C7.
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15,203 |
MR Angio Head wo contrast, MR Orbit wo+w contrast, MR Brain wo+w contrast CLINICAL INFORMATION: 23 years Female concern for bilateral optic neuritis Spec Inst: concern for bilateral optic neuritis; prior MRI reportedly with enhancement of bilateral basal ganglia and cerebral peduncles COMPARISON: MR brain 6/28/2019. TECHNIQUE: Multiplanar, multisequence MRI of the brain and orbits was performed before and after the intravenous administration of contrast. FINDINGS: MRA: INTERNAL CAROTID ARTERIES: Patent without filling defect, stenosis or aneurysm. ANTERIOR CEREBRAL ARTERIES: Patent without filling defect, stenosis or aneurysm. MIDDLE CEREBRAL ARTERIES: Patent without filling defect, stenosis or aneurysm. VERTEBRAL ARTERIES: Patent intracranial segments without filling defect, stenosis or aneurysm. BASILAR ARTERY: Patent without filling defect, stenosis or aneurysm. POSTERIOR CEREBRAL ARTERIES: Patent without filling defect, stenosis or aneurysm. MR BRAIN: There is no acute infarction, intracranial hemorrhage, brain edema or mass effect. There are symmetric T1 hyperintensity of the bilateral basal ganglia. No abnormal intracranial enhancement. The ventricular system and basal cisterns have a normal configuration. Extra-axial spaces are preserved. There are multiple small abnormal vessels in the region of the right greater than left posterior fossa which appear to extend to the torcular region Mucosal thickening of the ethmoid air cells with mucous retention cyst in a posterior left ethmoid air cell. Remaining paranasal sinuses, middle ears and mastoid air cells are clear. There are prominent bilateral posterior cervical lymph nodes, however, none are pathologically enlarged. MR ORBITS: The globes and lenses appear normal. The orbital fat and extraocular muscles appear normal. There is patchy T2/STIR signal hyperintensity and patchy linear enhancement of the posterior intraorbital segments of the bilateral optic nerves. IMPRESSION: 1. Minimal patchy T2/STIR signal hyperintensity and enhancement of the posterior intraorbital optic nerves is suspicious for bilateral optic neuritis. 2. Nonspecific symmetric bilateral intrinsic T1 hyperintensity of the bilateral basal ganglia without corresponding signal abnormality on alternative sequences, possibly related to metabolic abnormality. 3. No flow-limiting stenosis of the intracranial vessels.. Suggestion of multiple small abnormal vessels within the inferior vermis. These are not clearly visualized on the prior MRI exam. A CTA may be helpful for further evaluation. 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: MRA: INTERNAL CAROTID ARTERIES: Patent without filling defect, stenosis or aneurysm. ANTERIOR CEREBRAL ARTERIES: Patent without filling defect, stenosis or aneurysm. MIDDLE CEREBRAL ARTERIES: Patent without filling defect, stenosis or aneurysm. VERTEBRAL ARTERIES: Patent intracranial segments without filling defect, stenosis or aneurysm. BASILAR ARTERY: Patent without filling defect, stenosis or aneurysm. POSTERIOR CEREBRAL ARTERIES: Patent without filling defect, stenosis or aneurysm. MR BRAIN: There is no acute infarction, intracranial hemorrhage, brain edema or mass effect. There are symmetric T1 hyperintensity of the bilateral basal ganglia. No abnormal intracranial enhancement. The ventricular system and basal cisterns have a normal configuration. Extra-axial spaces are preserved. There are multiple small abnormal vessels in the region of the right greater than left posterior fossa which appear to extend to the torcular region Mucosal thickening of the ethmoid air cells with mucous retention cyst in a posterior left ethmoid air cell. Remaining paranasal sinuses, middle ears and mastoid air cells are clear. There are prominent bilateral posterior cervical lymph nodes, however, none are pathologically enlarged. MR ORBITS: The globes and lenses appear normal. The orbital fat and extraocular muscles appear normal. There is patchy T2/STIR signal hyperintensity and patchy linear enhancement of the posterior intraorbital segments of the bilateral optic nerves.
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FINDINGS: Examination quality is mildly limited by beam hardening artifact from patient's arms down positioning. STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Mild apical centrilobular emphysema. There is bibasilar dependent atelectasis. Lungs are otherwise clear without hemo- or pneumothorax. Central airways are patent. HEART / VESSELS: Cardiac chambers and great vessels are normal in size. No central PE. Advanced atherosclerotic calcifications of the aortic arch and descending thoracic aorta. Advanced mitral annular and coronary artery calcifications. A left chest wall pacemaker is seen with leads in the appropriate positioning. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Left chest wall pacemaker as above. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Well-circumscribed, hypoattenuating splenic lesion of the inferior spleen measuring approximately 1.4 x 1.4 cm (series 501 image 248), likely cyst versus hemangioma ADRENALS: Normal. KIDNEYS: Bilateral renal cortical scarring. Bilateral renal hypodensities are too small to adequately characterize, but statistically represent simple cysts. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Postsurgical changes of right hemicolectomy. Large fecal in the rectal vault. PERITONEUM / MESENTERY: No free intraperitoneal air or fluid. RETROPERITONEUM: Normal. VESSELS: Moderate to advanced atherosclerosis of the aorta and iliac arteries. URINARY BLADDER: Limited evaluation secondary to extensive streak artifact from surrounding bilateral hip hardware. REPRODUCTIVE ORGANS: Prostate is not well seen secondary to streak artifact as above. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No evidence of aggressive osseous lesion. Acute/subacute appearing right distal radius fracture with intra-articular extension and mild impaction. Questionable adjacent right scaphoid and trapezoid fractures. Chronic bilateral pars defects at L4 with mild spondylolisthesis. Chronic, healed lateral one third left clavicle fracture. Right total hip arthroplasty, partially imaged. Partially imaged intramedullary nail and screw fixation hardware spanning the proximal left femur. There is extensive heterotopic ossification surrounding the left lesser trochanter. Advanced multilevel degenerative changes of the lumbosacral spine with vacuum phenomena. Advanced bilateral facet arthropathy at L5-S1. ACDF hardware at C6-C7.
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15,204 |
MR Angio Head wo contrast, MR Orbit wo+w contrast, MR Brain wo+w contrast CLINICAL INFORMATION: 23 years Female concern for bilateral optic neuritis Spec Inst: concern for bilateral optic neuritis; prior MRI reportedly with enhancement of bilateral basal ganglia and cerebral peduncles COMPARISON: MR brain 6/28/2019. TECHNIQUE: Multiplanar, multisequence MRI of the brain and orbits was performed before and after the intravenous administration of contrast. FINDINGS: MRA: INTERNAL CAROTID ARTERIES: Patent without filling defect, stenosis or aneurysm. ANTERIOR CEREBRAL ARTERIES: Patent without filling defect, stenosis or aneurysm. MIDDLE CEREBRAL ARTERIES: Patent without filling defect, stenosis or aneurysm. VERTEBRAL ARTERIES: Patent intracranial segments without filling defect, stenosis or aneurysm. BASILAR ARTERY: Patent without filling defect, stenosis or aneurysm. POSTERIOR CEREBRAL ARTERIES: Patent without filling defect, stenosis or aneurysm. MR BRAIN: There is no acute infarction, intracranial hemorrhage, brain edema or mass effect. There are symmetric T1 hyperintensity of the bilateral basal ganglia. No abnormal intracranial enhancement. The ventricular system and basal cisterns have a normal configuration. Extra-axial spaces are preserved. There are multiple small abnormal vessels in the region of the right greater than left posterior fossa which appear to extend to the torcular region Mucosal thickening of the ethmoid air cells with mucous retention cyst in a posterior left ethmoid air cell. Remaining paranasal sinuses, middle ears and mastoid air cells are clear. There are prominent bilateral posterior cervical lymph nodes, however, none are pathologically enlarged. MR ORBITS: The globes and lenses appear normal. The orbital fat and extraocular muscles appear normal. There is patchy T2/STIR signal hyperintensity and patchy linear enhancement of the posterior intraorbital segments of the bilateral optic nerves. IMPRESSION: 1. Minimal patchy T2/STIR signal hyperintensity and enhancement of the posterior intraorbital optic nerves is suspicious for bilateral optic neuritis. 2. Nonspecific symmetric bilateral intrinsic T1 hyperintensity of the bilateral basal ganglia without corresponding signal abnormality on alternative sequences, possibly related to metabolic abnormality. 3. No flow-limiting stenosis of the intracranial vessels.. Suggestion of multiple small abnormal vessels within the inferior vermis. These are not clearly visualized on the prior MRI exam. A CTA may be helpful for further evaluation. 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: MRA: INTERNAL CAROTID ARTERIES: Patent without filling defect, stenosis or aneurysm. ANTERIOR CEREBRAL ARTERIES: Patent without filling defect, stenosis or aneurysm. MIDDLE CEREBRAL ARTERIES: Patent without filling defect, stenosis or aneurysm. VERTEBRAL ARTERIES: Patent intracranial segments without filling defect, stenosis or aneurysm. BASILAR ARTERY: Patent without filling defect, stenosis or aneurysm. POSTERIOR CEREBRAL ARTERIES: Patent without filling defect, stenosis or aneurysm. MR BRAIN: There is no acute infarction, intracranial hemorrhage, brain edema or mass effect. There are symmetric T1 hyperintensity of the bilateral basal ganglia. No abnormal intracranial enhancement. The ventricular system and basal cisterns have a normal configuration. Extra-axial spaces are preserved. There are multiple small abnormal vessels in the region of the right greater than left posterior fossa which appear to extend to the torcular region Mucosal thickening of the ethmoid air cells with mucous retention cyst in a posterior left ethmoid air cell. Remaining paranasal sinuses, middle ears and mastoid air cells are clear. There are prominent bilateral posterior cervical lymph nodes, however, none are pathologically enlarged. MR ORBITS: The globes and lenses appear normal. The orbital fat and extraocular muscles appear normal. There is patchy T2/STIR signal hyperintensity and patchy linear enhancement of the posterior intraorbital segments of the bilateral optic nerves.
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Findings: Please note, evaluation is limited due to motion artifact. CT C-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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15,205 |
MR Brain wo contrast 1/21/2022 5:07 PM Clinical information: 72 years Male patient with right arm/leg weakness. Comparison: CT angiogram head and neck with contrast dated 1/21/2022 at 12:47 hours. Technique: Multiplanar, multisequence MRI of the brain was performed without the administration of intravenous contrast. FINDINGS: Cerebral parenchyma: Circumscribed 11 mm focus of restricted diffusion and abnormal hyperintense long TR signal is noted in the left centrum semiovale, centered at the left precentral gyrus, suggestive of acute/early subacute infarct, without evidence of hemorrhagic transformation. Diffuse age-appropriate brain parenchymal volume loss is again seen, resulting in ex vacuo dilatation of the ventricular system. Scattered periventricular and cortical white matter long TR hyperintense signal foci extending into the pons, suggestive of mild chronic microvascular ischemic disease. Remote lacunar infarct is noted in the right putamen. Ventricular system: No hydrocephalus or midline shift. Extra axial spaces: No epidural, subdural, or subarachnoid hemorrhage. No basal cistern effacement. Vascular system: No loss of the major vascular flow voids. Visualized paranasal sinuses: No mucosal thickening. Visualized orbits: No ocular or retrobulbar pathology. Unchanged bilateral lens replacements. Calvarium and skull base: No osseous destruction. Pituitary and Pineal Glands: No mass lesion. Soft tissues: No significant abnormality. IMPRESSION: 1. Circumscribed 11 mm focus of restricted diffusion and abnormal hyperintense long TR signal in the left centrum semiovale, centered at the left precentral gyrus, suggestive of acute/early subacute infarct, without evidence of hemorrhagic transformation. 2. Age-appropriate brain involution and mild chronic microvascular ischemic disease, with remote right putaminal lacunar infarct.
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FINDINGS: Cerebral parenchyma: Circumscribed 11 mm focus of restricted diffusion and abnormal hyperintense long TR signal is noted in the left centrum semiovale, centered at the left precentral gyrus, suggestive of acute/early subacute infarct, without evidence of hemorrhagic transformation. Diffuse age-appropriate brain parenchymal volume loss is again seen, resulting in ex vacuo dilatation of the ventricular system. Scattered periventricular and cortical white matter long TR hyperintense signal foci extending into the pons, suggestive of mild chronic microvascular ischemic disease. Remote lacunar infarct is noted in the right putamen. Ventricular system: No hydrocephalus or midline shift. Extra axial spaces: No epidural, subdural, or subarachnoid hemorrhage. No basal cistern effacement. Vascular system: No loss of the major vascular flow voids. Visualized paranasal sinuses: No mucosal thickening. Visualized orbits: No ocular or retrobulbar pathology. Unchanged bilateral lens replacements. Calvarium and skull base: No osseous destruction. Pituitary and Pineal Glands: No mass lesion. Soft tissues: No significant abnormality.
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FINDINGS: THORACIC SPINE: VERTEBRA: No acute fracture. ACDF changes at C6-C7. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel discogenic degenerative changes with severe endplate degenerative changes in the lower thoracolumbar spine. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Mild anterolisthesis of C7 on T1. Mild retrolisthesis of T12 on L1. LUMBAR SPINE: VERTEBRA: No fracture. Sacralization of L5. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel degenerative changes, most severe from T12-L2 and L3-L4. Multilevel facet arthropathy. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Mild dextroscoliosis. Grade 1 retrolisthesis of L1 on L2. Grade 1 anterolisthesis of L3 over L4.
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15,206 |
MR Cervical Spine wo contrast 1/21/2022 5:32 PM Clinical information: 72 years Male patient with right armleg weakness Comparison: None available. Technique: Multiplanar multisequence images of the cervical spine were obtained, without intravenous contrast administration. Findings: The sagittal images demonstrate preservation of the cervical lordosis, without subluxations. The vertebral bodies maintain normal height, with scattered Modic type II changes and prominent Schmorl nodes. Incidental T1 vertebral body intraosseous hemangioma. The intervertebral discs appear desiccated from decreased T2-weighted signal, with associated moderate C6-C7 and mild C3-C4/C5-C6 disc height loss. The spinal cord is normal in size and signal intensity, without expansile lesions. The craniocervical junction appears within normal limits. C2-C3: Central disc protrusion. The spinal canal and neuroforamina are patent. C3-C4: Disc osteophyte complex, resulting in mild left neuroforaminal narrowing with effacement of the anterior thecal sac, without significant spinal canal stenosis. C4-C5: Mild disc bulge. The spinal canal and neuroforamina are patent. C5-C6: Disc osteophyte complex resulting in mild spinal canal stenosis, without significant neuroforaminal narrowing. C6-C7: Disc osteophyte complex resulting in mild spinal canal stenosis, without significant neuroforaminal narrowing. C7-T1: No significant spinal canal stenosis or neuroforaminal narrowing. The paraspinal soft tissues appear unremarkable, without organized fluid collections. Partially visualized heterogeneous thyroid gland, with multiple internal hyperdense T2-weighted signal nodules, measuring up to 25 x 18 mm, on the right thyroid lobe. IMPRESSION: 1. No evidence of acute findings or abnormal spinal cord signal in the cervical spine. 2. Chronic multilevel degenerative changes as described, most significant at C5-C6 and C6-C7, resulting in mild spinal canal stenosis, with associated mild left C3-C4 neuroforaminal narrowing. 3. Partially visualized heterogeneous thyroid gland, with multiple internal hyperdense T2-weighted signal nodules, measuring up to 25 x 18 mm, on the right thyroid lobe. Dedicated thyroid ultrasound may be helpful for further evaluation, in a nonemergent basis, if not previously performed.
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Findings: The sagittal images demonstrate preservation of the cervical lordosis, without subluxations. The vertebral bodies maintain normal height, with scattered Modic type II changes and prominent Schmorl nodes. Incidental T1 vertebral body intraosseous hemangioma. The intervertebral discs appear desiccated from decreased T2-weighted signal, with associated moderate C6-C7 and mild C3-C4/C5-C6 disc height loss. The spinal cord is normal in size and signal intensity, without expansile lesions. The craniocervical junction appears within normal limits. C2-C3: Central disc protrusion. The spinal canal and neuroforamina are patent. C3-C4: Disc osteophyte complex, resulting in mild left neuroforaminal narrowing with effacement of the anterior thecal sac, without significant spinal canal stenosis. C4-C5: Mild disc bulge. The spinal canal and neuroforamina are patent. C5-C6: Disc osteophyte complex resulting in mild spinal canal stenosis, without significant neuroforaminal narrowing. C6-C7: Disc osteophyte complex resulting in mild spinal canal stenosis, without significant neuroforaminal narrowing. C7-T1: No significant spinal canal stenosis or neuroforaminal narrowing. The paraspinal soft tissues appear unremarkable, without organized fluid collections. Partially visualized heterogeneous thyroid gland, with multiple internal hyperdense T2-weighted signal nodules, measuring up to 25 x 18 mm, on the right thyroid lobe.
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FINDINGS: THORACIC SPINE: VERTEBRA: No acute fracture. ACDF changes at C6-C7. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel discogenic degenerative changes with severe endplate degenerative changes in the lower thoracolumbar spine. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Mild anterolisthesis of C7 on T1. Mild retrolisthesis of T12 on L1. LUMBAR SPINE: VERTEBRA: No fracture. Sacralization of L5. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel degenerative changes, most severe from T12-L2 and L3-L4. Multilevel facet arthropathy. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Mild dextroscoliosis. Grade 1 retrolisthesis of L1 on L2. Grade 1 anterolisthesis of L3 over L4.
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15,207 |
MR Thoracic Spine wo contrast 1/21/2022 5:56 PM CLINICAL INFORMATION: 20 years Female syrinx, G95.0 Syringomyelia and syringobulbia Spec Inst: Chiari malformation, cervical and thoracic syrinx COMPARISON: MR C-spine 10/8/2021 TECHNIQUE: Multisequence, multiplanar images of the lower cervical and thoracic spine were obtained without use of IV contrast. FINDINGS: ALIGNMENT: Mild levocurvature of the cervicothoracic junction, with preservation of the thoracic kyphosis, without subluxations VERTEBRA: Prominent scattered Schmorl nodes, without evidence of acute fractures or abnormal marrow signal. DISC SPACES AND FACET JOINTS: Intervertebral disc spaces are preserved, without discrete disc herniations, significant spinal canal stenosis or neural foraminal narrowing. SPINAL CORD: Redemonstrated cervicothoracic syringohydromyelia, extending from C2 to T12. PARAVERTEBRAL SOFT TISSUES: No significant abnormality. IMPRESSION: 1. No evidence of acute findings or significant interval change identified. 2. Better characterization of known cervicothoracic syringohydromyelia, extending from C2 to T12. 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: ALIGNMENT: Mild levocurvature of the cervicothoracic junction, with preservation of the thoracic kyphosis, without subluxations VERTEBRA: Prominent scattered Schmorl nodes, without evidence of acute fractures or abnormal marrow signal. DISC SPACES AND FACET JOINTS: Intervertebral disc spaces are preserved, without discrete disc herniations, significant spinal canal stenosis or neural foraminal narrowing. SPINAL CORD: Redemonstrated cervicothoracic syringohydromyelia, extending from C2 to T12. PARAVERTEBRAL SOFT TISSUES: No significant abnormality.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Diffuse cerebral volume loss. Confluent periventricular hypoattenuating areas, compatible with moderate chronic microangiopathic disease. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Ex vacuo dilatation. ORBITS: Bilateral lens replacements. The orbits are otherwise unremarkable. SINUSES: Normal. MASTOIDS: Clear. SOFT TISSUE: Small right frontal scalp laceration. VESSELS: Atherosclerotic calcifications of the intracranial vertebral arteries and carotid siphons. MAXILLOFACIAL: No fracture. Patient is edentulous.
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15,208 |
MR Brain wo contrast 1/21/2022 5:56 PM CLINICAL iNFORMATION: 20 years Female Chiari malformation, Z86.69 Personal history of other diseases of the nervous system and sense organs COMPARISON: None available. TECHNIQUE: Multiplanar multisequence MR images of the brain were obtained without administration of intravenous contrast. FINDINGS: The brain parenchymal volume appears normal. The white-gray matter differentiation is preserved. No acute intracranial hemorrhage, acute infarct, brain edema, or intracranial mass. No abnormal parenchymal signal abnormality. Descending cerebellar tonsils of approximately 2.3 cm below the foramen magnum, with associated ballooning of the fourth ventricle with otherwise preserved configuration of the ventricular system and basal cisterns. No hydrocephalus. Partially visualized syringohydromyelia. No abnormal extra-axial collection. The orbits and globes are unremarkable. The paranasal sinuses, middle ears and mastoid air cells are clear. Visualized soft tissues of the scalp, face and skull base are unremarkable. IMPRESSION: 1. No acute intracranial process identified. 2. Descending cerebellar tonsils of approximately 2.3 cm below the foramen magnum, consistent with Chiari type I malformation. Associated mild ballooning of the fourth ventricle, without supratentorial obstructive hydrocephalus. 3. Partially visualized syringohydromyelia. Please refer to concomitant MRI of the thoracic spine for additional findings. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: The brain parenchymal volume appears normal. The white-gray matter differentiation is preserved. No acute intracranial hemorrhage, acute infarct, brain edema, or intracranial mass. No abnormal parenchymal signal abnormality. Descending cerebellar tonsils of approximately 2.3 cm below the foramen magnum, with associated ballooning of the fourth ventricle with otherwise preserved configuration of the ventricular system and basal cisterns. No hydrocephalus. Partially visualized syringohydromyelia. No abnormal extra-axial collection. The orbits and globes are unremarkable. The paranasal sinuses, middle ears and mastoid air cells are clear. Visualized soft tissues of the scalp, face and skull base are unremarkable.
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Findings: Please note, evaluation is limited due to motion artifact. CT C-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 Brain wo contrast 1/21/2022 5:31 PM CLINICAL iNFORMATION: 19 years Female csf leak, G96.00 Cerebrospinal fluid leak, unspecified Spec Inst: Status post back surgery 2018 intermittent positional headache since COMPARISON: None available TECHNIQUE: Multiplanar multisequence MR images of the brain were obtained without administration of intravenous contrast. FINDINGS: The brain parenchyma volume appears normal. The white-gray matter differentiation is preserved. No intracranial hemorrhage, acute infarct, brain edema, or intracranial mass. No focal parenchymal signal abnormality. There is slight asymmetry of the lateral ventricles, likely developmental in nature, with otherwise preserved configuration of the ventricular system and basal cisterns. No abnormal extra-axial collection. The major intracranial flow voids are present. Orbits and globes are unremarkable. Paranasal sinuses, middle ears and mastoid air cells are clear. Visualized soft tissues of the scalp, face and skull base are unremarkable. IMPRESSION: No acute intracranial abnormality. In particular, no definitive findings to suggest intracranial hypotension. 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 brain parenchyma volume appears normal. The white-gray matter differentiation is preserved. No intracranial hemorrhage, acute infarct, brain edema, or intracranial mass. No focal parenchymal signal abnormality. There is slight asymmetry of the lateral ventricles, likely developmental in nature, with otherwise preserved configuration of the ventricular system and basal cisterns. No abnormal extra-axial collection. The major intracranial flow voids are present. Orbits and globes are unremarkable. Paranasal sinuses, middle ears and mastoid air cells are clear. Visualized soft tissues of the scalp, face and skull base are unremarkable.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Unchanged appearance of advanced UIP changes throughout the right lung with severe fibrosis. Interval development of nodular density in the right lung anteriorly measuring 3.3 cm (series 2 image 38). Scattered calcified granulomas are in seen in the right lung. Postsurgical changes from prior left lung transplant. Within the transplant lung, there is diffuse ground glass densities throughout the left lung, more prominent within the left lower lobe with areas of consolidative densities and nodularity, more in the lower lobe. Bibasilar subsegmental atelectasis with trace left pleural effusion. Endotracheal tube tip terminates approximately 3.9 cm below the carina. HEART / VESSELS: Cardiac chambers and aorta appear normal in size. Severe atherosclerotic calcifications of the native coronary arteries. Pericardial cyst posterior to the left ventricle is unchanged. Central venous catheter is seen within the left brachiocephalic vein with tip terminating at the superior SVC. Dilated main pulmonary artery measuring 3.6 cm in short axis. Mild aortic valvular calcifications. MEDIASTINUM / ESOPHAGUS: Esophagogastric tube is seen with tip terminating at the distal stomach. LYMPH NODES: Unchanged borderline enlarged paraesophageal lymph nodes. Other small noncalcified and calcified mediastinal, bilateral hilar lymph nodes are stable. CHEST WALL: Postsurgical changes of median sternotomy without sternal wire fracture. Bilateral gynecomastia. UPPER ABDOMEN: Imaged portions of the superior abdomen redemonstrated hepatic steatosis, partially visualized right renal cortical cysts, colonic diverticula, and calcified splenic and hepatic granulomas. MUSCULOSKELETAL: No evidence of aggressive osseous lesion or acute fracture.
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MR Brain wo contrast 1/21/2022 6:04 PM Clinical information: 63 years Female patient with ?stroke Comparison: CT angiogram head and neck with contrast dated 1/21/2022 at 16:13 hours. Technique: Multiplanar, multisequence MRI of the brain was performed without the administration of intravenous contrast. FINDINGS: Cerebral parenchyma: Circumscribed 10 mm focus of restricted diffusion and abnormal hyperintense long TR signal involving the right corona radiata, suggestive of acute/early subacute infarct, without evidence of hemorrhagic transformation. Mild diffuse age-appropriate brain parenchymal volume loss is seen. Confluent perihilar ventricular subcortical and deep white matter long TR hyperintense signal foci extending into the pons, suggestive of moderate to severe chronic microvascular ischemic disease. Remote lacunar infarcts are noted in the right central pons and bilateral basal ganglia. Ventricular system: No hydrocephalus or midline shift. Extra axial spaces: No epidural, subdural, or subarachnoid hemorrhage. No basal cistern effacement. Vascular system: No loss of the major vascular flow voids. Visualized paranasal sinuses: Mild scattered anterior ethmoid air cell mucosal thickening. Visualized orbits: No ocular or retrobulbar pathology. Calvarium and skull base: No osseous destruction. Pituitary and Pineal Glands: No mass lesion. Soft tissues: No significant abnormality. IMPRESSION: 1. Circumscribed 10 mm focus of restricted diffusion and abnormal hyperintense long TR signal involving the right corona radiata, suggestive of acute/early subacute infarct, without evidence of hemorrhagic transformation. 2. Persistent age-appropriate brain involution with moderate to severe chronic microvascular ischemic disease and bilateral remote lacunar infarcts as described. Requesting provider was paged on 1/21/2022 at 6:17 PM to communicate findings directly.
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FINDINGS: Cerebral parenchyma: Circumscribed 10 mm focus of restricted diffusion and abnormal hyperintense long TR signal involving the right corona radiata, suggestive of acute/early subacute infarct, without evidence of hemorrhagic transformation. Mild diffuse age-appropriate brain parenchymal volume loss is seen. Confluent perihilar ventricular subcortical and deep white matter long TR hyperintense signal foci extending into the pons, suggestive of moderate to severe chronic microvascular ischemic disease. Remote lacunar infarcts are noted in the right central pons and bilateral basal ganglia. Ventricular system: No hydrocephalus or midline shift. Extra axial spaces: No epidural, subdural, or subarachnoid hemorrhage. No basal cistern effacement. Vascular system: No loss of the major vascular flow voids. Visualized paranasal sinuses: Mild scattered anterior ethmoid air cell mucosal thickening. Visualized orbits: No ocular or retrobulbar pathology. Calvarium and skull base: No osseous destruction. Pituitary and Pineal Glands: No mass lesion. Soft tissues: No significant abnormality.
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Findings: There is no evidence of acute intracranial hemorrhage, infarction, brain edema, mass effect or hydrocephalus. Small hypoattenuation in right frontal and right occipital lobes likely represent chronic lacunar infarcts. The visualized paranasal sinuses are clear. There is fluid in the left middle ear and left greater than right mastoid effusions.
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MR Angio Head wo contrast, MR Orbit wo+w contrast, MR Brain wo+w contrast CLINICAL INFORMATION: 23 years Female concern for bilateral optic neuritis Spec Inst: concern for bilateral optic neuritis; prior MRI reportedly with enhancement of bilateral basal ganglia and cerebral peduncles COMPARISON: MR brain 6/28/2019. TECHNIQUE: Multiplanar, multisequence MRI of the brain and orbits was performed before and after the intravenous administration of contrast. FINDINGS: MRA: INTERNAL CAROTID ARTERIES: Patent without filling defect, stenosis or aneurysm. ANTERIOR CEREBRAL ARTERIES: Patent without filling defect, stenosis or aneurysm. MIDDLE CEREBRAL ARTERIES: Patent without filling defect, stenosis or aneurysm. VERTEBRAL ARTERIES: Patent intracranial segments without filling defect, stenosis or aneurysm. BASILAR ARTERY: Patent without filling defect, stenosis or aneurysm. POSTERIOR CEREBRAL ARTERIES: Patent without filling defect, stenosis or aneurysm. MR BRAIN: There is no acute infarction, intracranial hemorrhage, brain edema or mass effect. There are symmetric T1 hyperintensity of the bilateral basal ganglia. No abnormal intracranial enhancement. The ventricular system and basal cisterns have a normal configuration. Extra-axial spaces are preserved. There are multiple small abnormal vessels in the region of the right greater than left posterior fossa which appear to extend to the torcular region Mucosal thickening of the ethmoid air cells with mucous retention cyst in a posterior left ethmoid air cell. Remaining paranasal sinuses, middle ears and mastoid air cells are clear. There are prominent bilateral posterior cervical lymph nodes, however, none are pathologically enlarged. MR ORBITS: The globes and lenses appear normal. The orbital fat and extraocular muscles appear normal. There is patchy T2/STIR signal hyperintensity and patchy linear enhancement of the posterior intraorbital segments of the bilateral optic nerves. IMPRESSION: 1. Minimal patchy T2/STIR signal hyperintensity and enhancement of the posterior intraorbital optic nerves is suspicious for bilateral optic neuritis. 2. Nonspecific symmetric bilateral intrinsic T1 hyperintensity of the bilateral basal ganglia without corresponding signal abnormality on alternative sequences, possibly related to metabolic abnormality. 3. No flow-limiting stenosis of the intracranial vessels.. Suggestion of multiple small abnormal vessels within the inferior vermis. These are not clearly visualized on the prior MRI exam. A CTA may be helpful for further evaluation. 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: MRA: INTERNAL CAROTID ARTERIES: Patent without filling defect, stenosis or aneurysm. ANTERIOR CEREBRAL ARTERIES: Patent without filling defect, stenosis or aneurysm. MIDDLE CEREBRAL ARTERIES: Patent without filling defect, stenosis or aneurysm. VERTEBRAL ARTERIES: Patent intracranial segments without filling defect, stenosis or aneurysm. BASILAR ARTERY: Patent without filling defect, stenosis or aneurysm. POSTERIOR CEREBRAL ARTERIES: Patent without filling defect, stenosis or aneurysm. MR BRAIN: There is no acute infarction, intracranial hemorrhage, brain edema or mass effect. There are symmetric T1 hyperintensity of the bilateral basal ganglia. No abnormal intracranial enhancement. The ventricular system and basal cisterns have a normal configuration. Extra-axial spaces are preserved. There are multiple small abnormal vessels in the region of the right greater than left posterior fossa which appear to extend to the torcular region Mucosal thickening of the ethmoid air cells with mucous retention cyst in a posterior left ethmoid air cell. Remaining paranasal sinuses, middle ears and mastoid air cells are clear. There are prominent bilateral posterior cervical lymph nodes, however, none are pathologically enlarged. MR ORBITS: The globes and lenses appear normal. The orbital fat and extraocular muscles appear normal. There is patchy T2/STIR signal hyperintensity and patchy linear enhancement of the posterior intraorbital segments of the bilateral optic nerves.
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Findings: Evolving postsurgical changes from evacuation of left convexity subdural empyema with interval removal of the surgical drain. There is decrease in size of left convexity pneumocephalus. Stable foci of hypoattenuation in the left posterior parietal, occipital lobes, right frontal lobe and left cerebellum, corresponding to areas of restricted diffusion on the prior MRI are overall stable except for left cerebellar hypoattenuation which appears increased in extent compared to prior. No new focus of infarction or intracranial hemorrhage. There is a small air-fluid level in the region of the craniectomy. Ventricular system is unchanged. The visualized paranasal sinuses, left mastoid air cells and middle ear cavities are clear. Persistent right mastoid opacification. Both orbits appear normal.
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MR Lumbar Spine wo+w contrast 1/21/2022 5:37 PM CLINICAL INFORMATION: 47 years Female Lumbar radiculopathy, cancer or infection suspected, M54.16 Radiculopathy, lumbar region, M79.18 Myalgia, other site Spec Inst: 47 yo F with abdominal leiomyosarcoma with left psoas weakness left S1 radicular pain onset early Dec primarily COMPARISON: Lumbar spine radiographs dated 11/12/2021 TECHNIQUE: Multisequence, multiplanar images of the lumbar spine were obtained before and after the administration of IV contrast.. Patient weight: 140 lbs. IV contrast: ProHance, 13 ml, per protocol. IV contrast injection rate: 1 ml per sec. FINDINGS: VERTEBRA: Vertebral body height and anterior/posterior alignment are preserved throughout the lumbar spine. Abnormal hypointense T1 and hyperintense T2/STIR signal with associated enhancement is noted in the partially imaged T10, L1, L3, L4, S1-S3 vertebra and left iliac bone, concerning for metastases. DISC SPACES AND FACET JOINTS: Intervertebral disc spaces are preserved without significant degenerative change. No discrete disc herniations, significant spinal canal stenosis or neuroforaminal narrowing. SPINAL CORD: Conus medullaris terminates at the L1 vertebral level. The spinal cord and cauda equina nerve roots demonstrate normal intrinsic signal. T2 hyperintense, T1 hypointense, nonenhancing cystic lesion at the S1 level measures approximately 9 mm and is suggestive of a Tarlov cyst. PARAVERTEBRAL SOFT TISSUES: There are two T2 intermediate signal/T1 isointense to muscle lesions in the paraspinal muscles at the L1-L2 and L4 vertebral levels (axial postcontrast series 901, images 35 and 16 respectively), which demonstrate avid homogeneous enhancement on postcontrast images. These measure approximately 1.0 x 1.1 cm at the L1-L2 level and 9 x 9 mm at the L4 level. Please refer to recent CT of the abdomen for complete description of intra-abdominal findings. IMPRESSION: 1. Multiple abnormal hypointense T1 and hyperintense T2/STIR signal lesions with associated enhancement involving the thoracolumbar spine, sacrum and left iliac bone, concerning for metastases, without evidence of acute pathologic fractures. 2. Enhancing soft tissue nodules in the paraspinal muscles may represent additional metastatic lesions. 3. No evidence of disc herniation, significant spinal canal stenosis or neuroforaminal narrowing. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: VERTEBRA: Vertebral body height and anterior/posterior alignment are preserved throughout the lumbar spine. Abnormal hypointense T1 and hyperintense T2/STIR signal with associated enhancement is noted in the partially imaged T10, L1, L3, L4, S1-S3 vertebra and left iliac bone, concerning for metastases. DISC SPACES AND FACET JOINTS: Intervertebral disc spaces are preserved without significant degenerative change. No discrete disc herniations, significant spinal canal stenosis or neuroforaminal narrowing. SPINAL CORD: Conus medullaris terminates at the L1 vertebral level. The spinal cord and cauda equina nerve roots demonstrate normal intrinsic signal. T2 hyperintense, T1 hypointense, nonenhancing cystic lesion at the S1 level measures approximately 9 mm and is suggestive of a Tarlov cyst. PARAVERTEBRAL SOFT TISSUES: There are two T2 intermediate signal/T1 isointense to muscle lesions in the paraspinal muscles at the L1-L2 and L4 vertebral levels (axial postcontrast series 901, images 35 and 16 respectively), which demonstrate avid homogeneous enhancement on postcontrast images. These measure approximately 1.0 x 1.1 cm at the L1-L2 level and 9 x 9 mm at the L4 level. Please refer to recent CT of the abdomen for complete description of intra-abdominal findings.
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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: Hypoattenuating, possibly subcapsular focus measuring 1.3 cm on series 201 image 57. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Symmetric bilateral enhancement without hydroureteronephrosis or nephrolithiasis. A few subcentimeter bilateral hypoattenuating renal lesions are too small to characterize, but statistically cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Small amount of formed stool throughout the colon and rectum. The appendix is not visualized. PERITONEUM / MESENTERY: There is a small amount of pelvic free fluid which measures simple fluid attenuation without any peripheral rim enhancement. There is ill-defined inflammatory stranding in the anterior aspect of the extraperitoneal pelvis, likely postsurgical in etiology. RETROPERITONEUM: Small groundglass along the left paracolic gutter series 201 image 112 may reflect developing fat necrosis. VESSELS: Dilated right gonadal vein. URINARY BLADDER: Partially decompressed, limiting its evaluation. REPRODUCTIVE ORGANS: Posthysterectomy changes are noted with ill-defined stranding and free fluid in the pelvis. Bilateral adnexa are unremarkable. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: No significant abnormality.
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EXAM:MR Shoulder Right wo contrast CLINICAL INFORMATION:Right shoulder pain with limited range of motion and paresthesias. COMPARISON:None. TECHNIQUE: Multiplanar and multisequence MRI of the right shoulder was obtained without intravenous contrast. FINDINGS: Motion artifact. BONES:No fracture, marrow replacement or suspicious focal lesion. ROTATOR CUFF: Supraspinatus:Normal. Infraspinatus:Normal. Subscapularis: Thickening and intermediate signal without definite tear. Teres minor:Normal. LONG HEAD BICEPS TENDON:Normal. GLENOHUMERAL JOINT: Position:Normal. Articular cartilage:Normal. Ligaments/Capsule:Normal. Labrum:The anterior labrum appears blunted and irregular with changes in the adjacent articular cartilage. BURSAE:No fluid. ACROMIAL CLAVICULAR JOINT: Moderate degenerative changes with capsular hypertrophy and marginal osteophyte formation. No os acromiale. SUBACROMIAL ENCROACHMENT:None. MUSCLES:Atrophy of the teres minor. CONCLUSION: 1. Subscapularis tendinosis. 2. Diffuse irregularity of the anterior labrum with possible focal tear more superiorly 3. 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: Motion artifact. BONES:No fracture, marrow replacement or suspicious focal lesion. ROTATOR CUFF: Supraspinatus:Normal. Infraspinatus:Normal. Subscapularis: Thickening and intermediate signal without definite tear. Teres minor:Normal. LONG HEAD BICEPS TENDON:Normal. GLENOHUMERAL JOINT: Position:Normal. Articular cartilage:Normal. Ligaments/Capsule:Normal. Labrum:The anterior labrum appears blunted and irregular with changes in the adjacent articular cartilage. BURSAE:No fluid. ACROMIAL CLAVICULAR JOINT: Moderate degenerative changes with capsular hypertrophy and marginal osteophyte formation. No os acromiale. SUBACROMIAL ENCROACHMENT:None. MUSCLES:Atrophy of the teres minor.
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FINDINGS: There is no acute territorial loss of gray-white differentiation. Mild scattered bilateral white matter hypodensities. There is no intracranial hemorrhage or extra-axial collection. There is no intracranial mass effect or midline shift. The ventricular caliber and configuration are within normal limits. Basal cisterns are patent. Right lens replacement. The mastoid air cells are clear. Mild scattered paranasal mucosal thickening. clear. No calvarial fracture is appreciated.
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MR Cervical Spine wo contrast 1/21/2022 6:16 PM CLINICAL INFORMATION: 53 years Male CHRONIC PAIN AFTER TRAUMA, G89.21 Chronic pain due to trauma COMPARISON: MRI cervical spine 4/9/2021 TECHNIQUE: T1 sagittal and axial spin echo, sagittal STIR, T2 sagittal and axial fast spin echo, sagittal GRE and coronal PD. FINDINGS: VERTEBRA: Cervical vertebral body height and anterior/posterior alignment are preserved. No suspicious marrow signal abnormality. CRANIOCERVICAL JUNCTION: Craniocervical alignment is preserved. DISC SPACES AND FACET JOINTS: There are multilevel degenerative changes with disc desiccation and disc bulge throughout the cervical spine, similar to multiple prior exams. Individual vertebral levels are discussed in detail below. POSTERIOR FOSSA \T\ CORD: Visualized posterior fossa structures have a normal appearance. The spinal cord demonstrates normal signal. PARAVERTEBRAL SOFT TISSUES: Normal. VERTEBRAL LEVELS: C2-C3: Mild disc desiccation without significant height loss, bulge, or herniation. No neural foraminal narrowing. C3-C4: Mild circumferential disc bulge resulting in mild spinal canal narrowing. No significant neural foraminal narrowing. C4-C5: Disc height loss with circumferential disc bulge with central posterior protrusion and bilateral right greater than left uncovertebral joint hypertrophy resulting in moderate spinal canal narrowing and moderate left and severe right neural foraminal narrowing. C5-C6: Disc height loss with circumferential disc bulge and uncovertebral joint hypertrophy resulting in mild to moderate spinal canal narrowing and mild bilateral neural foraminal narrowing, increased from prior. C6-C7: Mild disc height loss and circumferential disc bulge and left greater than right uncovertebral joint hypertrophy resulting in mild spinal canal narrowing and mild to moderate bilateral neural foraminal narrowing. C7-T1: Disc height loss and mild bilateral uncovertebral joint hypertrophy resulting in mild spinal canal narrowing without significant neural foraminal narrowing. IMPRESSION: Redemonstrated multilevel degenerative changes throughout the cervical spine as above, again most prominent at C4-C5 with moderate spinal canal narrowing and severe right and moderate to severe left neural foraminal narrowing. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: VERTEBRA: Cervical vertebral body height and anterior/posterior alignment are preserved. No suspicious marrow signal abnormality. CRANIOCERVICAL JUNCTION: Craniocervical alignment is preserved. DISC SPACES AND FACET JOINTS: There are multilevel degenerative changes with disc desiccation and disc bulge throughout the cervical spine, similar to multiple prior exams. Individual vertebral levels are discussed in detail below. POSTERIOR FOSSA \T\ CORD: Visualized posterior fossa structures have a normal appearance. The spinal cord demonstrates normal signal. PARAVERTEBRAL SOFT TISSUES: Normal. VERTEBRAL LEVELS: C2-C3: Mild disc desiccation without significant height loss, bulge, or herniation. No neural foraminal narrowing. C3-C4: Mild circumferential disc bulge resulting in mild spinal canal narrowing. No significant neural foraminal narrowing. C4-C5: Disc height loss with circumferential disc bulge with central posterior protrusion and bilateral right greater than left uncovertebral joint hypertrophy resulting in moderate spinal canal narrowing and moderate left and severe right neural foraminal narrowing. C5-C6: Disc height loss with circumferential disc bulge and uncovertebral joint hypertrophy resulting in mild to moderate spinal canal narrowing and mild bilateral neural foraminal narrowing, increased from prior. C6-C7: Mild disc height loss and circumferential disc bulge and left greater than right uncovertebral joint hypertrophy resulting in mild spinal canal narrowing and mild to moderate bilateral neural foraminal narrowing. C7-T1: Disc height loss and mild bilateral uncovertebral joint hypertrophy resulting in mild spinal canal narrowing without significant neural foraminal narrowing.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Calcified granuloma of the posterior right lower lobe. Lungs are otherwise clear bilaterally. No hemothorax or pneumothorax. HEART / VESSELS: Mild left-sided cardiomegaly with left atrial dilatation. Great vessels are normal in size. No central PE. No pericardial effusion. Advanced native coronary artery calcific lesions of postsurgical changes of CABG. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: Mildly prominent mid mediastinal lymph nodes. Some of these are enlarged including a paraesophageal/retrotracheal lymph node on series 501 image 40 measuring 1.8 x 1.2 cm. CHEST WALL: Postsurgical changes of median sternotomy with intact sternal wires. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Mild fatty atrophy, particularly at the pancreatic head and neck. Otherwise unremarkable. SPLEEN: Somewhat ill-defined splenic lesion of the inferior, posterior spleen measuring approximately 2.9 x 2.5 cm (series 501 image 232). Otherwise unremarkable. ADRENALS: Small right adrenal myelolipoma. KIDNEYS: Marked bilateral renal atrophy. No hydroureteronephrosis or radiopaque urinary tract calculi bilaterally. Numerous bilateral simple renal cysts, largest is located at the inferior left lower pole. There are indeterminate density renal lesions, for example series 501 image 293 on the left. Other hyperdense lesion is present in the left upper pole best seen series 503 image 78. There may be a small enhancing focus at the right lower pole series 503 image 69 versus cortical lobulation. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach is unremarkable for degree of underdistention. Small bowel is normal in enhancement and caliber throughout COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No free intraperitoneal air or fluid. RETROPERITONEUM: Normal. VESSELS: Advanced atherosclerotic calcifications of the abdominal aorta and iliac vasculature. Punctate areas of saccular dilatation along the infrarenal abdominal aorta without discrete abdominal aortic aneurysm. Partially thrombosed aneurysm of the proximal left common iliac artery measuring approximately 3.4 x 2.3 cm. The distal left iliac arteries are patent. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small bilateral fat-containing inguinal hernias. MUSCULOSKELETAL: Innumerable sclerotic lesions throughout the length of the thoracic and lumbar spine. There are additional sclerotic lesions within the bony pelvis, most prominent at the superior right iliac bone measuring approximately 2.2 x 1.8 cm (series 501 image 425). Additional sclerotic lesion is seen at the superior left scapula. Additional sclerotic lesion of the inferior right iliac bone, felt to be bone islands given degree of density. Advanced degenerative changes of the right AC joint. L2 superior endplate compression deformity. See separate lumbar spine report for further details.
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EXAM:MR Shoulder Left wo contrast CLINICAL INFORMATION:Left shoulder pain COMPARISON:1/5/2022 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:Mild thickening and intermediate signal of the distal tendon Infraspinatus:Mild thickening and intermediate signal of the distal tendon 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:Trace amount of fluid is seen within the subacromial and subdeltoid spaces. ACROMIAL CLAVICULAR JOINT:Unremarkable. No os acromiale. SUBACROMIAL ENCROACHMENT:None. MUSCLES:No atrophy. CONCLUSION: 1. Supraspinatus and infraspinatus tendinosis. 2. Trace fluid is seen 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:Mild thickening and intermediate signal of the distal tendon Infraspinatus:Mild thickening and intermediate signal of the distal tendon 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:Trace amount of fluid is seen within the subacromial and subdeltoid spaces. ACROMIAL CLAVICULAR JOINT:Unremarkable. No os acromiale. SUBACROMIAL ENCROACHMENT:None. MUSCLES:No atrophy.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Calcified granuloma of the posterior right lower lobe. Lungs are otherwise clear bilaterally. No hemothorax or pneumothorax. HEART / VESSELS: Mild left-sided cardiomegaly with left atrial dilatation. Great vessels are normal in size. No central PE. No pericardial effusion. Advanced native coronary artery calcific lesions of postsurgical changes of CABG. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: Mildly prominent mid mediastinal lymph nodes. Some of these are enlarged including a paraesophageal/retrotracheal lymph node on series 501 image 40 measuring 1.8 x 1.2 cm. CHEST WALL: Postsurgical changes of median sternotomy with intact sternal wires. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Mild fatty atrophy, particularly at the pancreatic head and neck. Otherwise unremarkable. SPLEEN: Somewhat ill-defined splenic lesion of the inferior, posterior spleen measuring approximately 2.9 x 2.5 cm (series 501 image 232). Otherwise unremarkable. ADRENALS: Small right adrenal myelolipoma. KIDNEYS: Marked bilateral renal atrophy. No hydroureteronephrosis or radiopaque urinary tract calculi bilaterally. Numerous bilateral simple renal cysts, largest is located at the inferior left lower pole. There are indeterminate density renal lesions, for example series 501 image 293 on the left. Other hyperdense lesion is present in the left upper pole best seen series 503 image 78. There may be a small enhancing focus at the right lower pole series 503 image 69 versus cortical lobulation. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach is unremarkable for degree of underdistention. Small bowel is normal in enhancement and caliber throughout COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No free intraperitoneal air or fluid. RETROPERITONEUM: Normal. VESSELS: Advanced atherosclerotic calcifications of the abdominal aorta and iliac vasculature. Punctate areas of saccular dilatation along the infrarenal abdominal aorta without discrete abdominal aortic aneurysm. Partially thrombosed aneurysm of the proximal left common iliac artery measuring approximately 3.4 x 2.3 cm. The distal left iliac arteries are patent. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small bilateral fat-containing inguinal hernias. MUSCULOSKELETAL: Innumerable sclerotic lesions throughout the length of the thoracic and lumbar spine. There are additional sclerotic lesions within the bony pelvis, most prominent at the superior right iliac bone measuring approximately 2.2 x 1.8 cm (series 501 image 425). Additional sclerotic lesion is seen at the superior left scapula. Additional sclerotic lesion of the inferior right iliac bone, felt to be bone islands given degree of density. Advanced degenerative changes of the right AC joint. L2 superior endplate compression deformity. See separate lumbar spine report for further details.
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MR Hand Left wo+w contrast TECHNIQUE: Multiplanar and multisequence MRI of the left hand was obtained without and with intravenous contrast. Patient weight: 170 lbs. IV contrast: ProHance, 16 ml, per protocol. CLINICAL INFORMATION: Index finger pain and swelling, L08.9 Local infection of the skin and subcutaneous tissue, unspecified COMPARISON: 1/3/2022 FINDINGS: Osseous structures: Alignment is anatomic. Marrow edema is noted within the middle and distal phalanges of the index finger. There is no evidence of acute fracture or dislocation. Articular surfaces: Joint space loss of the distal interphalangeal joint of the index finger with associated joint effusion. There are mild degenerative changes of the remaining visualized interphalangeal joints. No other joint effusion is present. Tendons: The flexor tendons are normal in course, contour and signal. The flexor pulleys are intact. Extensor tendons/extensor hoods are intact. Trace fluid and postcontrast enhancement is noted around the flexor and extensor tendons of the index finger. Musculature: Visualized musculature is well-developed. There is no atrophy, edema or mass. Soft tissues: Soft tissue edema is noted about the distal and middle phalanges of the index finger. No focal drainable fluid collection. CONCLUSION: 1. Joint space loss of the index finger DIP joint with small effusion and surrounding soft tissue and bone marrow edema concerning for septic arthritis and osteomyelitis. 2. Tenosynovitis of the index finger flexor and extensor tendons. 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: Osseous structures: Alignment is anatomic. Marrow edema is noted within the middle and distal phalanges of the index finger. There is no evidence of acute fracture or dislocation. Articular surfaces: Joint space loss of the distal interphalangeal joint of the index finger with associated joint effusion. There are mild degenerative changes of the remaining visualized interphalangeal joints. No other joint effusion is present. Tendons: The flexor tendons are normal in course, contour and signal. The flexor pulleys are intact. Extensor tendons/extensor hoods are intact. Trace fluid and postcontrast enhancement is noted around the flexor and extensor tendons of the index finger. Musculature: Visualized musculature is well-developed. There is no atrophy, edema or mass. Soft tissues: Soft tissue edema is noted about the distal and middle phalanges of the index finger. No focal drainable fluid collection.
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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 Brain wo+w contrast 1/21/2022 8:53 PM Clinical information: 31 years Female patient with Brain metastases, monitor, C50.919 Malignant neoplasm of unspecified site of unspecified female breast, C79.31 Secondary malignant neoplasm of brain Comparison: MRI brain with and without contrast dated 10/7/2021. Technique: Multiplanar, multisequence MRI of the brain was performed before and after the administration of intravenous contrast. Patient weight: 125 lbs. IV contrast: ProHance, 12 ml, per protocol. FINDINGS: Cerebral parenchyma: Interval enlargement of previously seen left cerebellar enhancing nodule, now measuring 6.8 mm (previously measured 4.8 mm), with progressive surrounding abnormal hyperintense long TR signal, suggestive of edema. Unchanged scattered bilateral rounded hyperintense long TR signal foci within the subcortical white matter. Ventricular system: No hydrocephalus or midline shift. Extra axial spaces: No epidural, subdural, or subarachnoid hemorrhage. No basal cistern effacement. Vascular system: No loss of the major vascular flow voids. Visualized paranasal sinuses: Trace bilateral maxillary sinus mucosal thickening, unchanged. Visualized orbits: No ocular or retrobulbar pathology. Calvarium and skull base: No osseous destruction. Pituitary and Pineal Glands: No mass lesion. Soft tissues: No significant abnormality. IMPRESSION: Interval enlargement of previously seen left cerebellar enhancing nodule, now measuring 6.8 mm (previously measured 4.8 mm), concerning for metastases, with progressive surrounding abnormal hyperintense long TR signal, suggestive of edema.
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FINDINGS: Cerebral parenchyma: Interval enlargement of previously seen left cerebellar enhancing nodule, now measuring 6.8 mm (previously measured 4.8 mm), with progressive surrounding abnormal hyperintense long TR signal, suggestive of edema. Unchanged scattered bilateral rounded hyperintense long TR signal foci within the subcortical white matter. Ventricular system: No hydrocephalus or midline shift. Extra axial spaces: No epidural, subdural, or subarachnoid hemorrhage. No basal cistern effacement. Vascular system: No loss of the major vascular flow voids. Visualized paranasal sinuses: Trace bilateral maxillary sinus mucosal thickening, unchanged. Visualized orbits: No ocular or retrobulbar pathology. Calvarium and skull base: No osseous destruction. Pituitary and Pineal Glands: No mass lesion. Soft tissues: No significant abnormality.
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FINDINGS: THORACIC SPINE: VERTEBRA: No vertebral body fracture. Numerous sclerotic lesions throughout the length of the thoracic spine.. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No traumatic malalignment LUMBAR SPINE: VERTEBRA: Mild compression deformity of the L2 vertebral body with approximately 20% vertebral body height loss. No appreciable disruption of the superior endplate. Prominent Schmorl's node is seen adjacent to this region. Innumerable sclerotic lesions throughout the lumbosacral spine and bony pelvis. DISC SPACES AND FACET JOINTS: No acute injury. Prominent Schmorl's nodes at the superior endplate of L2, L4, and L5. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No traumatic malalignment. Please refer to chest, abdomen and pelvis CT for pertinent findings.
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MR Brain wo contrast 1/22/2022 5:25 PM Clinical information: 70 years Male patient with stroke Comparison: CT angiogram head and neck with contrast dated 1/21/2022. Technique: Multiplanar, multisequence MRI of the brain was performed without the administration of intravenous contrast. FINDINGS: Cerebral parenchyma: Confluent cortical-based, wedge-shaped, restricted diffusion with abnormal hyperintense long TR signal is noted in the right posterior parietal lobe and additional tiny rounded foci along the right centrum semiovale, suggestive of acute/early subacute infarcts, with associated right parietal serpiginous SWI susceptibility artifact, most likely petechial hemorrhagic transformation. Persistent diffuse age-appropriate brain parenchymal volume loss, resulting in mild ex vacuo dilatation of the lateral ventricles. Additional scattered periventricular and cortical white matter long TR hyperintense signal foci are seen, suggestive of mild chronic microvascular ischemic disease. Extra axial spaces: No epidural, subdural, or subarachnoid hemorrhage. No basal cistern effacement. Vascular system: No loss of the major vascular flow voids. Visualized paranasal sinuses: Persistent moderate opacification of the left sphenoid sinus with internal hypointense T2-weighted signal, suggesting inspissated secretions. Mild progressive bilateral scattered ethmoid air cell mucosal thickening. Visualized orbits: No ocular or retrobulbar pathology. Calvarium and skull base: No osseous destruction. Pituitary and Pineal Glands: No mass lesion. Soft tissues: No significant abnormality. IMPRESSION: 1. Confluent cortical-based, wedge-shaped, restricted diffusion with abnormal hyperintense long TR signal in the right posterior parietal lobe and additional tiny rounded foci along the right centrum semiovale, suggestive of acute/early subacute infarcts, with associated right parietal serpiginous SWI susceptibility artifact, most likely petechial hemorrhagic transformation. 2. Persistent age-appropriate brain involution and mild chronic microvascular ischemic disease.
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FINDINGS: Cerebral parenchyma: Confluent cortical-based, wedge-shaped, restricted diffusion with abnormal hyperintense long TR signal is noted in the right posterior parietal lobe and additional tiny rounded foci along the right centrum semiovale, suggestive of acute/early subacute infarcts, with associated right parietal serpiginous SWI susceptibility artifact, most likely petechial hemorrhagic transformation. Persistent diffuse age-appropriate brain parenchymal volume loss, resulting in mild ex vacuo dilatation of the lateral ventricles. Additional scattered periventricular and cortical white matter long TR hyperintense signal foci are seen, suggestive of mild chronic microvascular ischemic disease. Extra axial spaces: No epidural, subdural, or subarachnoid hemorrhage. No basal cistern effacement. Vascular system: No loss of the major vascular flow voids. Visualized paranasal sinuses: Persistent moderate opacification of the left sphenoid sinus with internal hypointense T2-weighted signal, suggesting inspissated secretions. Mild progressive bilateral scattered ethmoid air cell mucosal thickening. Visualized orbits: No ocular or retrobulbar pathology. Calvarium and skull base: No osseous destruction. Pituitary and Pineal Glands: No mass lesion. Soft tissues: No significant abnormality.
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FINDINGS: THORACIC SPINE: VERTEBRA: No vertebral body fracture. Numerous sclerotic lesions throughout the length of the thoracic spine.. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No traumatic malalignment LUMBAR SPINE: VERTEBRA: Mild compression deformity of the L2 vertebral body with approximately 20% vertebral body height loss. No appreciable disruption of the superior endplate. Prominent Schmorl's node is seen adjacent to this region. Innumerable sclerotic lesions throughout the lumbosacral spine and bony pelvis. DISC SPACES AND FACET JOINTS: No acute injury. Prominent Schmorl's nodes at the superior endplate of L2, L4, and L5. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No traumatic malalignment. Please refer to chest, abdomen and pelvis CT for pertinent findings.
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MR Brain wo contrast 1/23/2022 12:24 PM CLINICAL iNFORMATION: 57 years Female stroke COMPARISON: CT head 1/21/2022 TECHNIQUE: Multiplanar multisequence MR images of the brain were obtained without administration of intravenous contrast. FINDINGS: Multifocal diffusion restriction in the right frontal and parietal lobes suggesting acute infarcts. Additional focus of diffusion restriction in the left basal ganglia demonstrates increased signal on ADC map consistent with T2 shine through and suggesting a chronic lacunar infarct. SWI images are degraded by motion, limiting evaluation for intracranial hemorrhage. No discrete intracranial hemorrhage is seen. CONCLUSION: 1. Multifocal diffusion restriction involving the right frontal and parietal lobes suggesting acute infarcts, possibly embolic in etiology. No discrete intracranial hemorrhage, however, evaluation of this tibial images is limited by motion. 2. Chronic lacunar infarct in the left basal ganglia. 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: Multifocal diffusion restriction in the right frontal and parietal lobes suggesting acute infarcts. Additional focus of diffusion restriction in the left basal ganglia demonstrates increased signal on ADC map consistent with T2 shine through and suggesting a chronic lacunar infarct. SWI images are degraded by motion, limiting evaluation for intracranial hemorrhage. No discrete intracranial hemorrhage is seen.
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FINDINGS: No acute maxillofacial or mandibular fracture. No suspicious osseous lesion is identified. Mucosal thickening of bilateral frontal sinuses and ethmoid air cells. Mucous retention cysts in the right sphenoid sinus. Right lens replacement. The left orbit is normal. Atherosclerotic calcifications of bilateral cervical ICAs as well as the intracranial vertebral arteries and carotid siphons. Surgical clips seen in the left proximal neck soft tissues. Soft tissues are otherwise unremarkable.
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MR Brain wo contrast 1/23/2022 11:09 AM Clinical Information: stroke Comparison: CT head dated 7/6/2010. Technique: Sagittal T1, axial T2, FLAIR, DWI with ADC map and SWI. Findings: A focal hemorrhagic lesion involves the left hippocampal head measuring 2.2 x 1.5 cm. Multiple scattered microhemorrhages are seen in the left putamen, temporooccipital lobe, left dorsal midbrain, and bilateral parietal areas. There is left PCA territory acute infarction involving the medial temporal and occipital lobes including optic radiation and hippocampal formation, and partly splenium of the corpus callosum. The left hippocampal tail shows pronounced thickening with cytotoxic edema. No intracranial mass effect or obstructive hydrocephalus is noted. The right frontotemporal area shows large area of ferromagnetic susceptibility signal dephasing artifact arising from an aneurysm clip. Impression: 1. Left PCA territory acute infarction likely complication of the left hippocampal head hemorrhage. 2. Multiple cerebral microhemorrhages.
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Findings: A focal hemorrhagic lesion involves the left hippocampal head measuring 2.2 x 1.5 cm. Multiple scattered microhemorrhages are seen in the left putamen, temporooccipital lobe, left dorsal midbrain, and bilateral parietal areas. There is left PCA territory acute infarction involving the medial temporal and occipital lobes including optic radiation and hippocampal formation, and partly splenium of the corpus callosum. The left hippocampal tail shows pronounced thickening with cytotoxic edema. No intracranial mass effect or obstructive hydrocephalus is noted. The right frontotemporal area shows large area of ferromagnetic susceptibility signal dephasing artifact arising from an aneurysm clip.
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FINDINGS: CT ANGIOGRAM HEAD: Circumferential calcified plaque in the bilateral cavernous and supraclinoid ICAs resulting up to mild narrowing on the right and mild to moderate narrowing on the left. Mild multifocal intracranial atherosclerosis throughout the intracranial arteries. There is no occlusion, or flow-limiting stenosis in either anterior cerebral, or middle cerebral arteries. Severe stenosis in the inferior P3 segment of the right posterior cerebral artery due to calcified plaque (series 403 image 135). Left posterior cerebral artery is patent. Mild to moderate right and mild left V4 vertebral artery narrowings. Small inferior directed 2 mm right supraclinoid aneurysm (series 412 image 103) CT ANGIOGRAM NECK: Aortic arch has conventional 3-vessel branching. Scattered calcified plaque in the major arteries, without significant stenosis. Brachiocephalic and right subclavian arteries are patent. Left subclavian artery is patent. Calcified and noncalcified plaque at the right carotid bifurcation results in moderate stenosis of the proximal right internal carotid artery. Calcified plaque at the left carotid bifurcation without significant stenosis of the left internal carotid artery.1 Moderate stenosis of the right vertebral artery origin due to calcified plaque. Left vertebral artery is patent. Please represent a CT chest report for the assessment of thoracic findings.
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MR Brain wo contrast 1/22/2022 2:41 AM CLINICAL iNFORMATION: 34 years Female ro stroke COMPARISON: MRA brain 1/21/2022 and CTA of/CTV brain 1/21/2022 TECHNIQUE: Multiplanar multisequence MR images of the brain were obtained without administration of intravenous contrast. FINDINGS: No acute intracranial bleed, infarct, brain edema or mass effect. There is stable mildly enlarged soft tissue within the sella demonstrating mild T1 shortening and measures approximately 13 mm in craniocaudal dimension. There is no significant hyperattenuation on recent CT and T1 shortening may represent proteinaceous material although small amount of hemorrhage is also a possibility. No parenchymal signal abnormality on FLAIR. Extra-axial spaces are preserved. Ventricular system and basal cisterns have a normal configuration. Major intracranial vessels appear within normal limits. Orbits and globes are unremarkable. Paranasal sinuses, middle ears and mastoid air cells are clear. Soft tissues of the scalp, face and skull base are unremarkable. CONCLUSION: 01. No acute intracranial abnormality. 02. Stable mildly enlarged pituitary gland may simply be related to pregnancy status. Cannot exclude small amount of hemorrhage within the pituitary gland 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 intracranial bleed, infarct, brain edema or mass effect. There is stable mildly enlarged soft tissue within the sella demonstrating mild T1 shortening and measures approximately 13 mm in craniocaudal dimension. There is no significant hyperattenuation on recent CT and T1 shortening may represent proteinaceous material although small amount of hemorrhage is also a possibility. No parenchymal signal abnormality on FLAIR. Extra-axial spaces are preserved. Ventricular system and basal cisterns have a normal configuration. Major intracranial vessels appear within normal limits. Orbits and globes are unremarkable. Paranasal sinuses, middle ears and mastoid air cells are clear. Soft tissues of the scalp, face and skull base are unremarkable.
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FINDINGS: CT ANGIOGRAM HEAD: Circumferential calcified plaque in the bilateral cavernous and supraclinoid ICAs resulting up to mild narrowing on the right and mild to moderate narrowing on the left. Mild multifocal intracranial atherosclerosis throughout the intracranial arteries. There is no occlusion, or flow-limiting stenosis in either anterior cerebral, or middle cerebral arteries. Severe stenosis in the inferior P3 segment of the right posterior cerebral artery due to calcified plaque (series 403 image 135). Left posterior cerebral artery is patent. Mild to moderate right and mild left V4 vertebral artery narrowings. Small inferior directed 2 mm right supraclinoid aneurysm (series 412 image 103) CT ANGIOGRAM NECK: Aortic arch has conventional 3-vessel branching. Scattered calcified plaque in the major arteries, without significant stenosis. Brachiocephalic and right subclavian arteries are patent. Left subclavian artery is patent. Calcified and noncalcified plaque at the right carotid bifurcation results in moderate stenosis of the proximal right internal carotid artery. Calcified plaque at the left carotid bifurcation without significant stenosis of the left internal carotid artery.1 Moderate stenosis of the right vertebral artery origin due to calcified plaque. Left vertebral artery is patent. Please represent a CT chest report for the assessment of thoracic findings.
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EXAM: MR Cholangiopancreatography MRCP CLINICAL INFORMATION: 78-year-old man with history of biliary dilation. Evaluate etiology. COMPARISON: Abdominal CT 1/21/2022, abdominal ultrasound 1/21/2022 TECHNIQUE: MR Cholangiopancreatography MRCP FINDINGS: STRUCTURED REPORT: MRI Abdomen, MRCP LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Normal. BILIARY TRACT: Diffuse dilation of the intra and extrahepatic bile ducts is present with abrupt termination in the pancreatic head region. There is no intraductal filling defect or abnormal enhancement along the bile duct wall. GALLBLADDER: The gallbladder is distended but not hydropic. There is no surrounding inflammation or focal wall thickening. PANCREAS: Diffuse dilation of the main pancreatic duct and sidebranches is present, extending to the papilla. There is a 2.2 x 1.7 cm area of hypoenhancing tissue located in the posterior-inferior pancreatic head (image 20 series 1301-T1 fat-suppressed arterial phase) which corresponds to focal restricted diffusion (image 172 series 705) but is very poorly marginated on the other postcontrast sequences. There is no definite corresponding area of abnormality on the portal venous phase CT. No peripancreatic vascular abnormalities are identified. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Anterior rotation of the right kidney, normal otherwise. The left kidney is normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality in visualized portions. COLON: No abnormality in visualized portions. PERITONEUM / MESENTERY: There is no free fluid. RETROPERITONEUM: Normal. VESSELS: No variant hepatic arterial anatomy is noted. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Findings are suspicious for small uncinate mass at the site of biliary and main pancreatic duct cut off near the papilla, given the restricted diffusion. Recommendation is for US with FNA. 2. No distant metastatic disease or MR evidence of peripancreatic vascular abnormalities. 3. No choledocholithiasis or MR evidence of cholecystitis, though the gallbladder is dilated.
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FINDINGS: STRUCTURED REPORT: MRI Abdomen, MRCP LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Normal. BILIARY TRACT: Diffuse dilation of the intra and extrahepatic bile ducts is present with abrupt termination in the pancreatic head region. There is no intraductal filling defect or abnormal enhancement along the bile duct wall. GALLBLADDER: The gallbladder is distended but not hydropic. There is no surrounding inflammation or focal wall thickening. PANCREAS: Diffuse dilation of the main pancreatic duct and sidebranches is present, extending to the papilla. There is a 2.2 x 1.7 cm area of hypoenhancing tissue located in the posterior-inferior pancreatic head (image 20 series 1301-T1 fat-suppressed arterial phase) which corresponds to focal restricted diffusion (image 172 series 705) but is very poorly marginated on the other postcontrast sequences. There is no definite corresponding area of abnormality on the portal venous phase CT. No peripancreatic vascular abnormalities are identified. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Anterior rotation of the right kidney, normal otherwise. The left kidney is normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality in visualized portions. COLON: No abnormality in visualized portions. PERITONEUM / MESENTERY: There is no free fluid. RETROPERITONEUM: Normal. VESSELS: No variant hepatic arterial anatomy is noted. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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Findings: Motion degradation. RAPID images demonstrate CBF less than 30% volume: 0 cc and T. Max greater than 6seconds volume: 0 cc. Mismatch volume is 0 cc. Color parametric maps demonstrate symmetric rCBF, rCBV, MTT, and Tmax values.. Prognostic maps demonstrate no areas with high probability for completed infarction (rCBF reduced by >70%) or areas of ischemia (Tmax >6 seconds).. There is no abnormal MTT, T max, CBV and CBF to suggest significant ischemia or infarction at the territory of the major intracranial arteries.
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MR Lumbar Spine wo contrast 1/22/2022 2:03 AM Clinical Information: L3 fracture with concerns for cord compression. Comparison: CT lumbar spine 1/21/2022. Technique: Multiplanar, multisequence imagine was performed through the lumbar spine without IV contrast. Findings: Redemonstration of central compression deformity of L3 without retropulsion. There is approximately 25% height loss. No significant vertebral body edema. No evidence of cord compression. Extensive patchy regions of bone marrow replacement throughout the lumbosacral spine and imaged pelvis. The remaining lumbar vertebral body heights, and alignment are maintained. The conus is normal in appearance, terminating at the superior endplate of L1. The cauda equina is normal. Contrast was not used to evaluate for enhancement. L4-L5 central disc protrusion which contacts the descending right L5 nerve root without displacement. Minimal broad-based disc bulge at L5-S1. Disc spaces otherwise preserved. Impression: 1. Approximately 25% compression fracture of L3 with diffuse marrow replacement of the lumbosacral spine suggestive of disseminated multiple myeloma, which makes evaluation for acuity of fracture more difficult, but fracture is suspected acute. No associated cord compression. No mass effect on conus medullaris or cauda equina nerve roots. 2. L4-L5 intervertebral central disc protrusion without nerve compression. 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: Redemonstration of central compression deformity of L3 without retropulsion. There is approximately 25% height loss. No significant vertebral body edema. No evidence of cord compression. Extensive patchy regions of bone marrow replacement throughout the lumbosacral spine and imaged pelvis. The remaining lumbar vertebral body heights, and alignment are maintained. The conus is normal in appearance, terminating at the superior endplate of L1. The cauda equina is normal. Contrast was not used to evaluate for enhancement. L4-L5 central disc protrusion which contacts the descending right L5 nerve root without displacement. Minimal broad-based disc bulge at L5-S1. Disc spaces otherwise preserved.
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FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Moderate to severely suboptimal quality with incomplete evaluation of segmental and subsegmental pulmonary arteries. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: No large central pulmonary embolus. Many of the pulmonary arterial branches are suboptimally evaluated secondary to streak artifact, slightly suboptimal bolus timing, respiratory motion and diffuse pulmonary opacities. LUNGS / AIRWAYS / PLEURA: Diffuse, bilateral, peripheral predominant, groundglass opacities with intralobular septal thickening. Bibasilar predominant subsegmental atelectasis. No pleural effusions. HEART / OTHER VESSELS: Cardiac chambers and great vessels are normal in size. No pericardial effusion. A right chest wall port catheter is seen with tip terminating at superior cavoatrial junction. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Right chest wall port catheter. Otherwise unremarkable. UPPER ABDOMEN: Imaged portions of the superior abdomen are unremarkable for arterial phase technique. MUSCULOSKELETAL: No aggressive osseous lesion or acute fracture.
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MRI brain with and without Indication: Left eye trauma. 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: 172 lbs. IV contrast: ProHance, 10 ml, per protocol. IV contrast injection rate: 0.50 ml per sec. 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. Mild periventricular and scattered subcortical white matter 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 enhancing intracranial pathology. The globes are intact. Increased T2 signal within the retrobulbar fat of the left orbit and within the preseptal soft tissues. Additionally there is a small foci of gas within the left extraconal space superiorly. Conclusion: Increased T2 signal within the left retrobulbar fat concerning for retrobulbar hemorrhage. Additionally, increased T2 signal of the preseptal soft tissues is consistent with periorbital contusion and gas. Maxillofacial CT is recommended given the history of trauma to exclude fractures of the orbit. 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: 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. Mild periventricular and scattered subcortical white matter 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 enhancing intracranial pathology. The globes are intact. Increased T2 signal within the retrobulbar fat of the left orbit and within the preseptal soft tissues. Additionally there is a small foci of gas within the left extraconal space superiorly.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Patchy of groundglass opacities in the right lower lung. Small right and trace left pleural effusions with associated overlying atelectasis. DISTAL ESOPHAGUS: Small hiatal hernia. HEART / VESSELS: Coronary artery calcifications. Aortic valve replacement. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Small cystic lesion in the pancreatic head measures 1.0 x 1.0 cm on axial series 3 image 108. Additional cystic lesion of the pancreatic body measuring 15 mm on axial image 88. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Unchanged cysts within the kidneys. The bilateral native kidneys are atrophic. Right lower quadrant transplant kidney is noted without hydronephrosis or renal calculi. There is heterogeneous enhancement of the transplant kidney LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is not identified. Diverticulosis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Extensive vascular calcifications. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The prostate is enlarged. BODY WALL: Mild stranding and skin thickening overlying the right lower anterior abdominal wall as well as the mid left anterior abdominal wall. Fat-containing umbilical hernia. More superiorly there is a fat-containing hernia partially through the right oblique musculature. MUSCULOSKELETAL: Multilevel discogenic degenerative change.
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MRI brain with and without Indication: Left eye trauma. 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: 172 lbs. IV contrast: ProHance, 10 ml, per protocol. IV contrast injection rate: 0.50 ml per sec. 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. Mild periventricular and scattered subcortical white matter 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 enhancing intracranial pathology. The globes are intact. Increased T2 signal within the retrobulbar fat of the left orbit and within the preseptal soft tissues. Additionally there is a small foci of gas within the left extraconal space superiorly. Conclusion: Increased T2 signal within the left retrobulbar fat concerning for retrobulbar hemorrhage. Additionally, increased T2 signal of the preseptal soft tissues is consistent with periorbital contusion and gas. Maxillofacial CT is recommended given the history of trauma to exclude fractures of the orbit. 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: 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. Mild periventricular and scattered subcortical white matter 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 enhancing intracranial pathology. The globes are intact. Increased T2 signal within the retrobulbar fat of the left orbit and within the preseptal soft tissues. Additionally there is a small foci of gas within the left extraconal space superiorly.
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FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Moderately suboptimal quality with incomplete evaluation of subsegmental pulmonary arteries secondary to respiratory motion. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Questionable tiny left upper lobe peripheral segmental filling defect on series 401 image 53 in the left upper lobe. Main pulmonary artery is enlarged measuring up to 3.5 cm. LUNGS / AIRWAYS / PLEURA: Diffuse, bilateral, peripheral predominant, groundglass opacities with interlobular septal thickening with some areas of "crazy paving". No pleural effusions. There are extensive emphysematous changes in the upper lungs, right greater than left. HEART / OTHER VESSELS: Cardiac chambers and great vessels are borderline in size. No pericardial effusion. Coronary calcifications. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Postsurgical changes of median sternotomy without evidence of sternal wire fracture. UPPER ABDOMEN: Imaged portions of the superior abdomen are unremarkable for arterial phase technique. MUSCULOSKELETAL: No aggressive osseous lesion or acute fracture. Thoracic spine DISH.
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MR Brain wo+w contrast 1/22/2022 10:02 AM CLINICAL INFORMATION: 66 years Male TBI, AMS Spec Inst: Eval progression of TBI hemorrhages COMPARISON: CT head 1/20/2021 TECHNIQUE: Multiplanar multisequence MR images of the brain were obtained before and after the administration of intravenous contrast. Patient weight: 185 lbs. IV contrast: ProHance, 9 ml, per protocol. FINDINGS: There is multifocal susceptibility artifact involving the left posterior parietal and bilateral occipital lobes with associated foci of T2/T1 hyperintense signal in the posterior left parietal lobe, suggesting cortical contusions with subacute intraparenchymal hemorrhage. There is surrounding confluent T2/FLAIR signal hyperintensity and gyriform diffusion restriction involving the left posterior parietal and occipital cerebral cortices representing associated vasogenic edema and cortical ischemia with laminar necrosis. No extra-axial hemorrhage. No suspicious intracranial enhancement Diffuse cerebral volume loss, advanced for patient's age, with chronic lacunar prior noted in the left pons. Expected dilation of the ventricular system, with mild effacement of the occipital horn of the left lateral ventricle. No intraventricular hemorrhage. Orbits and globes are unremarkable. Paranasal sinuses, middle ears and mastoid air cells are clear. Left parieto-occipital scalp contusions are noted with underlying comminuted calvarial fracture. CONCLUSION: Expected evolution of left parieto-occipital and right occipital cortical contusions/subacute intraparenchymal hemorrhages with associated vasogenic edema and cortical ischemia with laminar necrosis. No abnormal contrast enhancement, new intraparenchymal or extra-axial hemorrhage, or intraventricular extension. 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 multifocal susceptibility artifact involving the left posterior parietal and bilateral occipital lobes with associated foci of T2/T1 hyperintense signal in the posterior left parietal lobe, suggesting cortical contusions with subacute intraparenchymal hemorrhage. There is surrounding confluent T2/FLAIR signal hyperintensity and gyriform diffusion restriction involving the left posterior parietal and occipital cerebral cortices representing associated vasogenic edema and cortical ischemia with laminar necrosis. No extra-axial hemorrhage. No suspicious intracranial enhancement Diffuse cerebral volume loss, advanced for patient's age, with chronic lacunar prior noted in the left pons. Expected dilation of the ventricular system, with mild effacement of the occipital horn of the left lateral ventricle. No intraventricular hemorrhage. Orbits and globes are unremarkable. Paranasal sinuses, middle ears and mastoid air cells are clear. Left parieto-occipital scalp contusions are noted with underlying comminuted calvarial fracture.
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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: Normal. SINUSES: Small mucous retention cysts in the left maxillary sinus. The other paranasal sinuses are clear. MASTOIDS: Clear. SOFT TISSUE: Multiple small left chin lacerations and retained punctate foreign bodies. MAXILLOFACIAL: No fracture. Periapical lucency along the right central incisor related to a small periapical abscess. Impacted third mandibular molars.
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MR Breast Diagnostic Bil wo+w contrast CLINICAL INFORMATION: History of premenopausal left breast triple negative invasive ductal carcinoma status post lumpectomy, radiation, and chemotherapy. 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: 210 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: Most recent breast MRI: 10/21/2020. Most recent mammogram: 5/17/2021. MRI FINDINGS: This bilateral breast MRI exam demonstrates minimal background enhancement. There is scattered fibroglandular tissue. RIGHT BREAST:No suspicious enhancing mass or nonmass enhancement. No architectural distortion. Unchanged susceptibility artifact in the upper inner quadrant, posterior depth. LEFT BREAST:Heterogeneous T2 and T1 hyperintense collection in the upper outer quadrant is unchanged. Adjacent foci of susceptibility are consistent with surgical clips. Enhancing foci in the subareolar region region remain unchanged. No new suspicious enhancement. Unchanged skin and trabecular thickening. LYMPH NODES:No axillary adenopathy. ADDITIONAL FINDINGS: None. IMPRESSION AND RECOMMENDATIONS: RIGHT BREAST: No MRI evidence of occult breast malignancy. BI-RADS 2, Benign. LEFT BREAST: Stable post treatment changes from lumpectomy and radiation. BI-RADS 2, benign. OVERALL BI-RADS ASSESSMENT: BI-RADS 2, benign. 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 scattered fibroglandular tissue. RIGHT BREAST:No suspicious enhancing mass or nonmass enhancement. No architectural distortion. Unchanged susceptibility artifact in the upper inner quadrant, posterior depth. LEFT BREAST:Heterogeneous T2 and T1 hyperintense collection in the upper outer quadrant is unchanged. Adjacent foci of susceptibility are consistent with surgical clips. Enhancing foci in the subareolar region region remain unchanged. No new suspicious enhancement. Unchanged skin and trabecular thickening. LYMPH NODES:No axillary adenopathy. ADDITIONAL FINDINGS: None. IMPRESSION AND RECOMMENDATIONS: RIGHT BREAST: No MRI evidence of occult breast malignancy. BI-RADS 2, Benign. LEFT BREAST: Stable post treatment changes from lumpectomy and radiation. BI-RADS 2, benign. OVERALL BI-RADS ASSESSMENT: BI-RADS 2, benign. 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: Study quality is mildly limited secondary to beam hardening artifact from patient's left arm down positioning. STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Trace biapical pleural-parenchymal scarring. Lungs are otherwise clear. There is a possible trace pneumothorax at the anterior aspect of the right lung series 501 image 109, and image 79 of the sagittal sequence. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant chest wall hematoma. There is calcification posterior near the xiphoid on series 504 image 75, unclear if this is partial calcification versus displacement given patient young age. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No evidence of acute fracture or aggressive osseous lesion.
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EXAM: MR Knee Left wo contrast Indication: Knee pain and weakness Technique: Multiplanar multisequence images were obtained through the knee. Comparison: Radiographs dated 12/15/2021 Findings: There is extensive full-thickness cartilage loss along the lateral patellar facet. There is mild degenerative fissuring in the medial patellar cartilage. There is edema in the superior lateral aspect of Hoffa's fat. The middle third of the ACL has amorphous intermediate signal intensity, and there is surrounding fat stranding. The majority of the ACL appears intact. The PCL is unremarkable. Menisci are normal. The quadriceps and patellar tendons are intact. The medial collateral ligament, patellar retinaculum complex, iliotibial band, and posterior lateral corner structures are unremarkable. Impression: 1. Extensive lateral patellar cartilage loss. Edema in the adjacent Hoffa's fat suggests impingement due to the lateral patellar tracking. 2. Abnormal signal in the middle third of the ACL suggests partial ACL tear. Acuteness is uncertain although there is some edema in the adjacent soft tissues which could be acute. Correlate clinically for evidence of ACL insufficiency.
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Findings: There is extensive full-thickness cartilage loss along the lateral patellar facet. There is mild degenerative fissuring in the medial patellar cartilage. There is edema in the superior lateral aspect of Hoffa's fat. The middle third of the ACL has amorphous intermediate signal intensity, and there is surrounding fat stranding. The majority of the ACL appears intact. The PCL is unremarkable. Menisci are normal. The quadriceps and patellar tendons are intact. The medial collateral ligament, patellar retinaculum complex, iliotibial band, and posterior lateral corner structures are unremarkable.
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FINDINGS: Study quality is mildly limited secondary to beam hardening artifact from patient's left arm down positioning. STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Trace biapical pleural-parenchymal scarring. Lungs are otherwise clear. There is a possible trace pneumothorax at the anterior aspect of the right lung series 501 image 109, and image 79 of the sagittal sequence. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant chest wall hematoma. There is calcification posterior near the xiphoid on series 504 image 75, unclear if this is partial calcification versus displacement given patient young age. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No evidence of acute fracture or aggressive osseous lesion.
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EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: 56-year-old male with posterior neck and right forearm melanoma, and basal cell carcinoma of the left upper back, evaluate suspected hepatic metastasis. COMPARISON: Whole body PET/CT dated 1/11/2022. TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 280 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: The liver is steatotic. There is a 6.2 x 4.7 cm T1 and T2 isointense mass centered at the caudate lobe which demonstrates arterial enhancement and heterogeneous appearance on the delayed phases, hypoattenuating. There is questionable infiltration into the left hepatic lobe segment IV and right hepatic lobe segment VIII. It restricts diffusion BILIARY TRACT: Mass effect causes obstruction at the level of the hilum and moderate to severe left hepatic lobe biliary ductal dilation with stricturing at the level of the mass. 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: Infiltrative mass centered at the caudate lobe with possible extension into the right hepatic lobe segment VIII and left hepatic lobe segment IVa and IVb is highly suspicious for malignancy, favoring intrahepatic cholangiocarcinoma given the overall imaging appearance though an infiltrative melanoma metastasis is also in the differential. Mass effect results in moderate to severe left hepatic lobe biliary ductal dilation. 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: The liver is steatotic. There is a 6.2 x 4.7 cm T1 and T2 isointense mass centered at the caudate lobe which demonstrates arterial enhancement and heterogeneous appearance on the delayed phases, hypoattenuating. There is questionable infiltration into the left hepatic lobe segment IV and right hepatic lobe segment VIII. It restricts diffusion BILIARY TRACT: Mass effect causes obstruction at the level of the hilum and moderate to severe left hepatic lobe biliary ductal dilation with stricturing at the level of the mass. 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: CT C-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 Screening wo+w contrast CLINICAL INFORMATION: 45-year-old woman with a elevated lifetime risk for development of breast cancer greater than 20%. This is a high risk 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: 135 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: 11/11/2021. MRI FINDINGS: This bilateral breast MRI exam demonstrates minimal background enhancement. There is extremely dense fibroglandular tissue. RIGHT BREAST: No suspicious enhancing mass or nonmass enhancement. No architectural distortion. LEFT BREAST: T2 hyperintense, homogenously enhancing oval mass with circumscribed margins measuring 10 x 5 x 6 mm (series 400 image 143, series 6 image 43) in the upper outer quadrant of the left breast, posterior depth. LYMPH NODES:No axillary or internal mammary chain adenopathy ADDITIONAL FINDINGS: None. IMPRESSION AND RECOMMENDATIONS: RIGHT BREAST: No MRI evidence of occult breast malignancy.. BI-RADS 1: Negative. LEFT BREAST: Probably benign oval circumscribed mass in the upper outer quadrant, posterior depth. Targeted ultrasound is recommended. If no sonographic correlate, follow-up MRI is recommended in six months. BI-RADS 3: Probably benign. OVERALL BI-RADS ASSESSMENT:BI-RADS 3: Probably benign. 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 extremely dense fibroglandular tissue. RIGHT BREAST: No suspicious enhancing mass or nonmass enhancement. No architectural distortion. LEFT BREAST: T2 hyperintense, homogenously enhancing oval mass with circumscribed margins measuring 10 x 5 x 6 mm (series 400 image 143, series 6 image 43) in the upper outer quadrant of the left breast, posterior depth. LYMPH NODES:No axillary or internal mammary chain adenopathy ADDITIONAL FINDINGS: None. IMPRESSION AND RECOMMENDATIONS: RIGHT BREAST: No MRI evidence of occult breast malignancy.. BI-RADS 1: Negative. LEFT BREAST: Probably benign oval circumscribed mass in the upper outer quadrant, posterior depth. Targeted ultrasound is recommended. If no sonographic correlate, follow-up MRI is recommended in six months. BI-RADS 3: Probably benign. OVERALL BI-RADS ASSESSMENT:BI-RADS 3: Probably benign. 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: THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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MR Breast Screening wo+w contrast CLINICAL INFORMATION: 36-year-old woman with elevated lifetime risk for development of breast cancer. This is a high risk 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: 132 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: 1/6/2022. MRI FINDINGS: This bilateral breast MRI exam demonstrates marked background enhancement. There is extreme fibroglandular tissue. RIGHT BREAST:No suspicious enhancing mass or nonmass enhancement. No architectural distortion. Small enhancing skin lesions in the upper inner quadrant of the right breast. LEFT BREAST:No suspicious enhancing mass or nonmass enhancement. No architectural distortion. Small enhancing skin lesion in the upper inner quadrant of the left breast. LYMPH NODES:No axillary adenopathy. ADDITIONAL FINDINGS: None. IMPRESSION AND RECOMMENDATIONS: RIGHT BREAST: No MRI evidence of occult breast malignancy. BI-RADS 2: Benign LEFT BREAST: No MRI evidence of occult breast malignancy. BI-RADS 2: Benign Clinical correlation is recommended for enhancing skin lesions. OVERALL BI-RADS ASSESSMENT:BI-RADS 2: Benign 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 marked background enhancement. There is extreme fibroglandular tissue. RIGHT BREAST:No suspicious enhancing mass or nonmass enhancement. No architectural distortion. Small enhancing skin lesions in the upper inner quadrant of the right breast. LEFT BREAST:No suspicious enhancing mass or nonmass enhancement. No architectural distortion. Small enhancing skin lesion in the upper inner quadrant of the left breast. LYMPH NODES:No axillary adenopathy. ADDITIONAL FINDINGS: None. IMPRESSION AND RECOMMENDATIONS: RIGHT BREAST: No MRI evidence of occult breast malignancy. BI-RADS 2: Benign LEFT BREAST: No MRI evidence of occult breast malignancy. BI-RADS 2: Benign Clinical correlation is recommended for enhancing skin lesions. OVERALL BI-RADS ASSESSMENT:BI-RADS 2: Benign 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: THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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15,232 |
EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: 59-year-old male with indeterminate liver lesion. COMPARISON: MR abdomen from outside facility dated 12/8/2021. CT abdomen and pelvis from outside facility dated 11/9/2021. 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: The liver is cirrhotic and mildly steatotic. There a large area of arterial enhancement measuring 9.4 x 5.1 cm on series 7 one image 37. Subtle washout on the delayed phase and is subtly hypoenhancing on the hepatobiliary phase. Additional areas of arterial enhancement in the posterior right lobe on series 701 image 64 as well as numerous nodules in the left hepatic lobe on image 40 are present. The left portal vein is expanded and filled with thrombus which may reflect tumor thrombus as it is slightly T2 hyperintense on series 4 image 27. Suspected vascular involvement of the right portal vein branches in the large anterior area as well. There is a 1.6 x 1.3 cm well-circumscribed T1 and T2 isointense nodule in segment VII which is hypoenhancing relative to normal liver parenchyma. This lesion appears increased in size since prior MRI, when it measured 1.3 x 1.1 cm. The additional hypoenhancing lesion seen in the left hepatic lobe on prior CT is not visualized on MRI. Numerous foci of diffusion restriction throughout both lobes. BILIARY TRACT: Normal. GALLBLADDER: Collapsed and poorly evaluated. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. Scattered tiny renal cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Moderate volume ascites. RETROPERITONEUM: Normal. VESSELS: Vascular involvement as above. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Overall findings suspicious for multifocal hepatocellular carcinoma with tumor thrombus in the left hepatic lobe and suspected vascular involvement in the right hepatic lobe. The rounded focus in the posterior right hepatic lobe becomes more prominent on the delayed phases with surrounding arterial enhancement and could also represent a focus of hepatocellular carcinoma. 2. Moderate volume ascites. 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: The liver is cirrhotic and mildly steatotic. There a large area of arterial enhancement measuring 9.4 x 5.1 cm on series 7 one image 37. Subtle washout on the delayed phase and is subtly hypoenhancing on the hepatobiliary phase. Additional areas of arterial enhancement in the posterior right lobe on series 701 image 64 as well as numerous nodules in the left hepatic lobe on image 40 are present. The left portal vein is expanded and filled with thrombus which may reflect tumor thrombus as it is slightly T2 hyperintense on series 4 image 27. Suspected vascular involvement of the right portal vein branches in the large anterior area as well. There is a 1.6 x 1.3 cm well-circumscribed T1 and T2 isointense nodule in segment VII which is hypoenhancing relative to normal liver parenchyma. This lesion appears increased in size since prior MRI, when it measured 1.3 x 1.1 cm. The additional hypoenhancing lesion seen in the left hepatic lobe on prior CT is not visualized on MRI. Numerous foci of diffusion restriction throughout both lobes. BILIARY TRACT: Normal. GALLBLADDER: Collapsed and poorly evaluated. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. Scattered tiny renal cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Moderate volume ascites. RETROPERITONEUM: Normal. VESSELS: Vascular involvement as above. 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: Normal. SINUSES: Small mucous retention cysts in the left maxillary sinus. The other paranasal sinuses are clear. MASTOIDS: Clear. SOFT TISSUE: Multiple small left chin lacerations and retained punctate foreign bodies. MAXILLOFACIAL: No fracture. Periapical lucency along the right central incisor related to a small periapical abscess. Impacted third mandibular molars.
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15,233 |
MRI face: History: Covid confirmed facial mass Comparison: Prior CT from 1/21/2022 Technique: Axial DWI, axial FLAIR, coronal STIR, coronal T1, axial STIR, axial T1, sagittal T1, axial SWI, postcontrast axial and coronal and sagittal T1 weighted images of the face were obtained. Patient weight: 165 lbs. IV contrast: ProHance, 16 ml, per protocol. Findings: There is a large heterogeneously enhancing mass lesion involving the superficial and deep lobes of the parotid gland, measures approximately 6.5 x 7.8 x 5.7 cm in AP, transverse and craniocaudad dimensions. The lesion extends anteromedially and exerting moderate mass effect on the oropharynx and left side. There is complete effacement of the parapharyngeal fat planes. The lesion also extending anterolaterally into the masticator space. Lesion extending superiorly and abutting the skull base and also involving the foramen ovale which appears to be enlarged. The lesion also involving the mandibular foramen on left side. There is diffuse atrophy of the masticator muscles on left side. There is mild asymmetric enlargement of the left cavernous sinus. There is widening of the stylomastoid foramen. No definite bony erosion is identified in the left mandible. The lesion abutting the carotid space posteriorly. Left internal jugular vein is not visualized, probably compressed by the mass. There is subtle enhancing focus involving the left side of the body of the corpus callosum, concern for metastasis. Remaining brain parenchyma is within normal limits. Impression: 1. Heterogeneously enhancing large mass involving the superficial and deep lobe of the parotid gland and extending superiorly to the skull base and possibly involving the foramen ovale as well as left mandibular foramen and also extending into the masticator space as described above. The features are consistent with malignant mass lesion. There is possible enhancement along the V3 segment, consistent with perineural tumor spread. No definite abnormal enhancement is identified along the left facial nerve. 2. Focal enhancing nodular lesion in the body of the corpus callosum, concern for intracranial metastasis. ADDENDUM: There are multiple foci of restricted diffusion involving the left corona radiata, adjacent basal ganglia, left temporal lobes. Associated T2/FLAIR hyperintensity. Mild hazy enhancement in the left basal ganglia (series 1201 image 86) These are consistent with late acute to subacute infarcts. There is a focus of slightly less intense restricted diffusion in the left side of the body of the corpus callosum with associated T2/FLAIR hyperintensity and mild enhancement. Favor this to be a subacute infarct due to presence of additional infarcts on this side of the brain. Metastatic lesion is considered less likely. Small focus of microhemorrhage in the left temporal lobe on SWI image 85 Findings are possibly related to close abutment of the left internal carotid artery by the parotid tumor (best seen on series 1401 image 51, series 101 image 16). Findings were conveyed to Dr. Ye on the oncology service by Dr. Tanwar at 4:33 Pm on 1/24/2022.
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Findings: There is a large heterogeneously enhancing mass lesion involving the superficial and deep lobes of the parotid gland, measures approximately 6.5 x 7.8 x 5.7 cm in AP, transverse and craniocaudad dimensions. The lesion extends anteromedially and exerting moderate mass effect on the oropharynx and left side. There is complete effacement of the parapharyngeal fat planes. The lesion also extending anterolaterally into the masticator space. Lesion extending superiorly and abutting the skull base and also involving the foramen ovale which appears to be enlarged. The lesion also involving the mandibular foramen on left side. There is diffuse atrophy of the masticator muscles on left side. There is mild asymmetric enlargement of the left cavernous sinus. There is widening of the stylomastoid foramen. No definite bony erosion is identified in the left mandible. The lesion abutting the carotid space posteriorly. Left internal jugular vein is not visualized, probably compressed by the mass. There is subtle enhancing focus involving the left side of the body of the corpus callosum, concern for metastasis. Remaining brain parenchyma is within normal limits.
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Findings: CT C-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 face: History: Covid confirmed facial mass Comparison: Prior CT from 1/21/2022 Technique: Axial DWI, axial FLAIR, coronal STIR, coronal T1, axial STIR, axial T1, sagittal T1, axial SWI, postcontrast axial and coronal and sagittal T1 weighted images of the face were obtained. Patient weight: 165 lbs. IV contrast: ProHance, 16 ml, per protocol. Findings: There is a large heterogeneously enhancing mass lesion involving the superficial and deep lobes of the parotid gland, measures approximately 6.5 x 7.8 x 5.7 cm in AP, transverse and craniocaudad dimensions. The lesion extends anteromedially and exerting moderate mass effect on the oropharynx and left side. There is complete effacement of the parapharyngeal fat planes. The lesion also extending anterolaterally into the masticator space. Lesion extending superiorly and abutting the skull base and also involving the foramen ovale which appears to be enlarged. The lesion also involving the mandibular foramen on left side. There is diffuse atrophy of the masticator muscles on left side. There is mild asymmetric enlargement of the left cavernous sinus. There is widening of the stylomastoid foramen. No definite bony erosion is identified in the left mandible. The lesion abutting the carotid space posteriorly. Left internal jugular vein is not visualized, probably compressed by the mass. There is subtle enhancing focus involving the left side of the body of the corpus callosum, concern for metastasis. Remaining brain parenchyma is within normal limits. Impression: 1. Heterogeneously enhancing large mass involving the superficial and deep lobe of the parotid gland and extending superiorly to the skull base and possibly involving the foramen ovale as well as left mandibular foramen and also extending into the masticator space as described above. The features are consistent with malignant mass lesion. There is possible enhancement along the V3 segment, consistent with perineural tumor spread. No definite abnormal enhancement is identified along the left facial nerve. 2. Focal enhancing nodular lesion in the body of the corpus callosum, concern for intracranial metastasis. ADDENDUM: There are multiple foci of restricted diffusion involving the left corona radiata, adjacent basal ganglia, left temporal lobes. Associated T2/FLAIR hyperintensity. Mild hazy enhancement in the left basal ganglia (series 1201 image 86) These are consistent with late acute to subacute infarcts. There is a focus of slightly less intense restricted diffusion in the left side of the body of the corpus callosum with associated T2/FLAIR hyperintensity and mild enhancement. Favor this to be a subacute infarct due to presence of additional infarcts on this side of the brain. Metastatic lesion is considered less likely. Small focus of microhemorrhage in the left temporal lobe on SWI image 85 Findings are possibly related to close abutment of the left internal carotid artery by the parotid tumor (best seen on series 1401 image 51, series 101 image 16). Findings were conveyed to Dr. Ye on the oncology service by Dr. Tanwar at 4:33 Pm on 1/24/2022.
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Findings: There is a large heterogeneously enhancing mass lesion involving the superficial and deep lobes of the parotid gland, measures approximately 6.5 x 7.8 x 5.7 cm in AP, transverse and craniocaudad dimensions. The lesion extends anteromedially and exerting moderate mass effect on the oropharynx and left side. There is complete effacement of the parapharyngeal fat planes. The lesion also extending anterolaterally into the masticator space. Lesion extending superiorly and abutting the skull base and also involving the foramen ovale which appears to be enlarged. The lesion also involving the mandibular foramen on left side. There is diffuse atrophy of the masticator muscles on left side. There is mild asymmetric enlargement of the left cavernous sinus. There is widening of the stylomastoid foramen. No definite bony erosion is identified in the left mandible. The lesion abutting the carotid space posteriorly. Left internal jugular vein is not visualized, probably compressed by the mass. There is subtle enhancing focus involving the left side of the body of the corpus callosum, concern for metastasis. Remaining brain parenchyma is within normal limits.
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Bulky right mediastinal/hilar mass, difficult to measure but appears to be at least 6.3 x 5.8 cm in greatest axial dimensions (series 201 image 43). This mass encases the adjacent right mainstem bronchus with erosion of the tracheal bifurcation. Large tracheoesophageal fistula is seen contacting the adjacent esophageal stent (series 201 image 37). Left lower lobe consolidation. Solid, noncalcified nodules of the right lung are noted, largest of which measures 1.4 x 1.3 cm (series 201 image 39). Small bilateral pleural effusions. HEART / VESSELS: Borderline heart size. Great vessels are normal in size. No central PE. MEDIASTINUM / ESOPHAGUS: Esophageal stent is seen in appropriate positioning at the mid thoracic esophagus. There is nonocclusive debris along the proximal and distal aspects of the stent. LYMPH NODES: Enlarged pretracheal lymph node measures 2.1 x 1.6 cm (series 201 image 33) CHEST WALL: No significant abnormality. UPPER ABDOMEN: Focal fat infiltration along the falciform ligament. A few prominent upper abdominal lymph nodes are partially imaged. MUSCULOSKELETAL: No significant abnormality.
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MR Brain wo+w contrast, MR Angio Head wo contrast Clinical Information: 66-year-old male follow-up right occipital hemorrhagic infarct. Comparison: CT head dated 1/22/2022. MR brain dated 11/20/2021. Technique: Multiplanar, multisequence MR images of the brain with and without contrast and 3-D time-of-flight MR angiogram images of the cranial vasculature, with 3-D MIP reformats. Patient weight: 225 lbs. IV contrast: ProHance, 10 ml, per protocol. Findings: Right parietal lobe hemorrhage is not significant changed in the interval, occupying an area of approximately 3.5 x 1.8 cm and demonstrating a rim of diffusion restriction and vasogenic edema which causes mass effect on the occipital horn of the right lateral ventricle, without significant midline shift. There are several punctate areas of microhemorrhage surrounding the primary lesion. No new acute infarct or hemorrhage. Age-appropriate brain atrophy. Ventricles are normal in size without hydrocephalus. Orbits appear normal. Mild mucosal thickening in the bilateral maxillary and ethmoid sinuses. Remaining paranasal sinuses and mastoid air cells are clear. No abnormal contrast enhancement. The visualized portions of the bilateral internal carotid and vertebral arteries, as well as the bilateral MCAs, ACAs, and PCAs are patent without evidence of aneurysm or vascular malformation. Conclusion: 1. Stable appearance of right parietal lobe hemorrhage with adjacent vasogenic edema and mild mass effect on the occipital horn of the right lateral ventricle without evidence of hydrocephalus or midline shift. No evidence of underlying mass or other acute intracranial abnormality. 2. Patent right PCA without evidence of aneurysm or vascular malformation. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: Right parietal lobe hemorrhage is not significant changed in the interval, occupying an area of approximately 3.5 x 1.8 cm and demonstrating a rim of diffusion restriction and vasogenic edema which causes mass effect on the occipital horn of the right lateral ventricle, without significant midline shift. There are several punctate areas of microhemorrhage surrounding the primary lesion. No new acute infarct or hemorrhage. Age-appropriate brain atrophy. Ventricles are normal in size without hydrocephalus. Orbits appear normal. Mild mucosal thickening in the bilateral maxillary and ethmoid sinuses. Remaining paranasal sinuses and mastoid air cells are clear. No abnormal contrast enhancement. The visualized portions of the bilateral internal carotid and vertebral arteries, as well as the bilateral MCAs, ACAs, and PCAs are patent without evidence of aneurysm or vascular malformation.
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FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Moderately suboptimal quality with incomplete evaluation of segmental and subsegmental pulmonary arteries secondary to delayed bolus timing and mild respiratory artifact. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for large pulmonary embolus given limits above. LUNGS / AIRWAYS / PLEURA: Diffuse, bilateral, peripheral predominant, groundglass opacities with anterior septal thickening and some areas of "crazy paving". No pleural effusions. HEART / OTHER VESSELS: Cardiac chambers and great vessels are normal in size. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Imaged portions of the superior abdomen are unremarkable for arterial phase technique. MUSCULOSKELETAL: No evidence of aggressive osseous lesion or acute fracture. Degenerative changes in the spine.
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MR Brain wo+w contrast, MR Angio Head wo contrast Clinical Information: 66-year-old male follow-up right occipital hemorrhagic infarct. Comparison: CT head dated 1/22/2022. MR brain dated 11/20/2021. Technique: Multiplanar, multisequence MR images of the brain with and without contrast and 3-D time-of-flight MR angiogram images of the cranial vasculature, with 3-D MIP reformats. Patient weight: 225 lbs. IV contrast: ProHance, 10 ml, per protocol. Findings: Right parietal lobe hemorrhage is not significant changed in the interval, occupying an area of approximately 3.5 x 1.8 cm and demonstrating a rim of diffusion restriction and vasogenic edema which causes mass effect on the occipital horn of the right lateral ventricle, without significant midline shift. There are several punctate areas of microhemorrhage surrounding the primary lesion. No new acute infarct or hemorrhage. Age-appropriate brain atrophy. Ventricles are normal in size without hydrocephalus. Orbits appear normal. Mild mucosal thickening in the bilateral maxillary and ethmoid sinuses. Remaining paranasal sinuses and mastoid air cells are clear. No abnormal contrast enhancement. The visualized portions of the bilateral internal carotid and vertebral arteries, as well as the bilateral MCAs, ACAs, and PCAs are patent without evidence of aneurysm or vascular malformation. Conclusion: 1. Stable appearance of right parietal lobe hemorrhage with adjacent vasogenic edema and mild mass effect on the occipital horn of the right lateral ventricle without evidence of hydrocephalus or midline shift. No evidence of underlying mass or other acute intracranial abnormality. 2. Patent right PCA without evidence of aneurysm or vascular malformation. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: Right parietal lobe hemorrhage is not significant changed in the interval, occupying an area of approximately 3.5 x 1.8 cm and demonstrating a rim of diffusion restriction and vasogenic edema which causes mass effect on the occipital horn of the right lateral ventricle, without significant midline shift. There are several punctate areas of microhemorrhage surrounding the primary lesion. No new acute infarct or hemorrhage. Age-appropriate brain atrophy. Ventricles are normal in size without hydrocephalus. Orbits appear normal. Mild mucosal thickening in the bilateral maxillary and ethmoid sinuses. Remaining paranasal sinuses and mastoid air cells are clear. No abnormal contrast enhancement. The visualized portions of the bilateral internal carotid and vertebral arteries, as well as the bilateral MCAs, ACAs, and PCAs are patent without evidence of aneurysm or vascular malformation.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Atelectasis. DISTAL ESOPHAGUS: Small hiatal hernia. HEART / VESSELS: Partially imaged coronary calcification. Small pericardial effusion. Low density blood pool may reflect anemia. ABDOMEN and PELVIS: LIVER: Unchanged appearance of posterior right hepatic lobe hemangioma. Liver is otherwise unremarkable BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Tiny well-circumscribed hypodensity of the superior, medial spleen measuring approximately 7 mm. Spleen is otherwise unremarkable. ADRENALS: Normal. KIDNEYS: Simple cysts of the posterior right upper pole. Kidneys otherwise unremarkable without suspicious renal lesion, hydroureteronephrosis, or radiopaque urinary tract calculi bilaterally. On delayed phase imaging, no filling defect is seen within the bilateral collecting systems or ureters. Contrast is seen excreted into the bladder without evidence of hyperenhancing bladder mass. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach is otherwise unremarkable for underdistention. Small gas containing proximal duodenal diverticulum. Small bowel is normal in caliber and enhancement throughout. COLON / APPENDIX: Hyperdense material is seen at the level of the ileocecal valve. Distal transverse, descending, and sigmoid colon diverticulosis without surrounding inflammation. A few small lymph nodes are present in this area. Colon is otherwise unremarkable. PERITONEUM / MESENTERY: No free intraperitoneal air or fluid. RETROPERITONEUM: Normal. VESSELS: Calcifications of the infrarenal abdominal aorta and iliac vessels without aneurysmal dilatation. URINARY BLADDER: Mucosal hyperenhancement of the bladder with perivesicular fat stranding. REPRODUCTIVE ORGANS: Uterus is present. Bilateral adnexa appear unremarkable. BODY WALL: Unremarkable. MUSCULOSKELETAL: Osteoporosis. No evidence of aggressive osseous lesion or acute fracture. Multilevel degenerative changes of the lumbosacral spine with vacuum phenomenon. Right L3 and L4 pars defects
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MR Brain wo+w contrast Clinical Information: 71-year-old female with newly diagnosed small cell lung cancer presenting for initial diagnosis/staging and treatment planning. Comparison: CT head dated 9/8/2019 and whole body PET/CT dated 12/17/2021. Technique: Multiplanar, multisequence MR images of the brain with and without contrast. Patient weight: 83 lbs. IV contrast: ProHance, 7 ml, per protocol. Findings: No acute infarct or hemorrhage. Unchanged chronic infarct versus dilated perivascular space in the left basal ganglia. Normal brain volume and gray-white matter differentiation. No mass, hydrocephalus, or midline shift. Orbits appear normal. Mild mucosal thickening in the anterior ethmoid sinuses. Remaining paranasal sinuses and mastoid air cells are clear. No aggressive osseous lesion. Major proximal intracranial flow voids are intact. No abnormal postcontrast enhancement. Conclusion: No acute intracranial abnormality or evidence of intracranial metastasis. 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. Unchanged chronic infarct versus dilated perivascular space in the left basal ganglia. Normal brain volume and gray-white matter differentiation. No mass, hydrocephalus, or midline shift. Orbits appear normal. Mild mucosal thickening in the anterior ethmoid sinuses. Remaining paranasal sinuses and mastoid air cells are clear. No aggressive osseous lesion. Major proximal intracranial flow voids are intact. No abnormal postcontrast enhancement.
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Findings: Changes from left mandibular molar extraction are noted. There is a small fluid collection overlying the left mandibular body measuring approximately 0.7 x 0.5 cm with subtle peripheral enhancement (axial image 172, coronal image 31). Enlarged left submental and submandibular lymph nodes, likely reactive. Left mandibular soft tissue edema within the inflammatory changes and overlying skin thickening. A separate ill-defined left mandibular hypoattenuating collection measures approximately 1.5 x 1.9 cm (axial image 162), likely mixed blood products, versus an enlarged lymph node. The nasopharynx and oropharynx are normal in appearance. The base of the tongue and lymphoid tissue within Waldeyer's ring are unremarkable. The hypopharynx and larynx appear normal. The parotid, submandibular, and thyroid glands appear normal. Included portions of the brain and skull base appear normal. Patchy secretions in the right maxillary sinus. The other paranasal sinuses and mastoid air cells are clear. The orbits are normal. Advanced centrilobular and paraseptal emphysematous changes in bilateral lung apices.
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EXAM: MR Knee Right wo contrast CLINICAL INFORMATION: 41-year-old male who was hit by car in 2019 and has tenderness over the medial joint space, evaluate meniscus and ligamentous pathology. COMPARISON: Bilateral knee radiographs 11/18/2021. TECHNIQUE: MR Knee Right wo contrast STRUCTURED REPORT: MRI Knee 1/2/2020 FINDINGS: BONES:No fracture, marrow replacement, or aggressive osseous lesion. Findings of prior Osgood-Schlatter disease. Small area of bone marrow signal abnormality in the distal femur and proximal tibia appears non-aggressive, likely focal red marrow. ARTICULATIONS: Effusion:Trace suprapatellar effusion with small amount of debris. Patellofemoral compartment:Mild chondromalacia of the lateral patellar facet. Medial compartment:No cartilage defect. Lateral compartment:No cartilage defect. MENISCI: Medial meniscus:There is artifact partially obscuring the posterior horn of the medial meniscus without a large tear. 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 intermediate signal and thickening of the patellar tendon. CONCLUSION: 1. Mild degenerative changes of the lateral patellofemoral compartment. 2. Patellar tendinosis. 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. Findings of prior Osgood-Schlatter disease. Small area of bone marrow signal abnormality in the distal femur and proximal tibia appears non-aggressive, likely focal red marrow. ARTICULATIONS: Effusion:Trace suprapatellar effusion with small amount of debris. Patellofemoral compartment:Mild chondromalacia of the lateral patellar facet. Medial compartment:No cartilage defect. Lateral compartment:No cartilage defect. MENISCI: Medial meniscus:There is artifact partially obscuring the posterior horn of the medial meniscus without a large tear. 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 intermediate signal and thickening of the patellar tendon.
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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: Normal. SINUSES: Mucosal thickening of the ethmoid air cells and left-sided nasal passage. MASTOIDS: Clear. SOFT TISSUE: Small right frontal scalp hematoma. MAXILLOFACIAL: No fracture. Patient is edentulous
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MR Stroke Protocol wo contrast with MRAs 1/23/2022 1:29 AM CLINICAL iNFORMATION: 58 years Female invasive fungal infection with evolving strokes COMPARISON: MRI brain 1/20/2022 TECHNIQUE: Multiplanar multisequence MR images of the brain were obtained without administration of intravenous contrast. Additional MRA of the head was performed without intravenous contrast utilizing 3-D time-of-flight technique. Multiple MIP images were generated. Axial diffusion weighted sequence was also obtained. FINDINGS: MR BRAIN: FLAIR images are limited due to incomplete fluid suppression. Similar appearance of the multifocal diffusion restriction involving the posterior left frontal and parietal lobes and left thalamus with associated T2/FLAIR signal hyperintensity. Additional restricted diffusion involving the left optic nerve with extension to the left optic chiasm is also similar to prior. No new focus of diffusion restriction. No intraparenchymal hemorrhage. Normal configuration of the ventricular system and basal cisterns. Extra-axial spaces are preserved. There are redemonstrated postsurgical changes of paranasal sinus debridement with similar diffuse mucosal thickening and T2 heterogeneous material within the paranasal sinuses, with intrinsic T1 hyperintense signal suggesting blood products. Bilateral mastoid effusions are similar. Asymmetric increased T2 signal within the left intraorbital/retrobulbar fat is similar to prior. Right orbit and globe are within normal limits. Visualized soft tissues of the scalp, face and skull base are unremarkable. MRA NECK: There is no significant stenosis of the left common carotid artery. There is also no significant narrowing involving the left carotid bifurcation. Left cervical ICA demonstrates mild narrowing proximally but without flow-limiting stenosis There is no significant stenosis of the right common carotid artery or the right carotid bifurcation. There is mild narrowing of the proximal right cervical ICA but no flow-limiting stenosis Left vertebral artery appears within normal limits. There is mild focal narrowing of the proximal right vertebral artery MRA BRAIN: RIGHT INTERNAL CAROTID ARTERY: No filling defect or aneurysmal dilation. Mild focal stenosis involving the distal right supraclinoid ICA LEFT INTERNAL CAROTID ARTERY: Suggestion of significant focal stenosis involving the junction of the petrous and cavernous segments (see series 308, image 12). Vessel returns to normal caliber without additional areas of narrowing. RIGHT ANTERIOR CEREBRAL ARTERY: No filling defect, significant stenosis or aneurysmal dilation. LEFT ANTERIOR CEREBRAL ARTERY: No filling defect, stenosis or aneurysmal dilation. RIGHT MIDDLE CEREBRAL ARTERY: No filling defect, stenosis or aneurysmal dilatation LEFT MIDDLE CEREBRAL ARTERY: No filling defect, stenosis or aneurysmal dilatation RIGHT VERTEBRAL ARTERY:No filling defect, stenosis or aneurysmal dilation. LEFT VERTEBRAL ARTERY: No filling defect, stenosis or aneurysmal dilation. BASILAR ARTERY: Note is made of incidental focal fenestration of the mid basilar artery No filling defect, stenosis or aneurysmal dilation. RIGHT POSTERIOR CEREBRAL ARTERY: No filling defect, stenosis or aneurysmal dilation. LEFT POSTERIOR CEREBRAL ARTERY: No filling defect, stenosis or aneurysmal dilation. CONCLUSION: 1. Similar appearance of evolving left MCA watershed infarcts. No new focus of infarction. 2. Unchanged appearance of diffusion restriction involving the left optic nerve with similar inflammatory changes of the left intraorbital/retrobulbar fat. 3. Essentially Unremarkable MRA of the neck. There is only mild irregular narrowing of both cervical ICAs without flow-limiting stenosis. 4.. Asymmetric focal narrowing of the left ICA at the junction of the petrous and cavernous segments.. Vessel returns to normal caliber distally. No other significant intracranial stenosis 5. Stable appearing extensive paranasal sinus postsurgical changes As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: MR BRAIN: FLAIR images are limited due to incomplete fluid suppression. Similar appearance of the multifocal diffusion restriction involving the posterior left frontal and parietal lobes and left thalamus with associated T2/FLAIR signal hyperintensity. Additional restricted diffusion involving the left optic nerve with extension to the left optic chiasm is also similar to prior. No new focus of diffusion restriction. No intraparenchymal hemorrhage. Normal configuration of the ventricular system and basal cisterns. Extra-axial spaces are preserved. There are redemonstrated postsurgical changes of paranasal sinus debridement with similar diffuse mucosal thickening and T2 heterogeneous material within the paranasal sinuses, with intrinsic T1 hyperintense signal suggesting blood products. Bilateral mastoid effusions are similar. Asymmetric increased T2 signal within the left intraorbital/retrobulbar fat is similar to prior. Right orbit and globe are within normal limits. Visualized soft tissues of the scalp, face and skull base are unremarkable. MRA NECK: There is no significant stenosis of the left common carotid artery. There is also no significant narrowing involving the left carotid bifurcation. Left cervical ICA demonstrates mild narrowing proximally but without flow-limiting stenosis There is no significant stenosis of the right common carotid artery or the right carotid bifurcation. There is mild narrowing of the proximal right cervical ICA but no flow-limiting stenosis Left vertebral artery appears within normal limits. There is mild focal narrowing of the proximal right vertebral artery MRA BRAIN: RIGHT INTERNAL CAROTID ARTERY: No filling defect or aneurysmal dilation. Mild focal stenosis involving the distal right supraclinoid ICA LEFT INTERNAL CAROTID ARTERY: Suggestion of significant focal stenosis involving the junction of the petrous and cavernous segments (see series 308, image 12). Vessel returns to normal caliber without additional areas of narrowing. RIGHT ANTERIOR CEREBRAL ARTERY: No filling defect, significant stenosis or aneurysmal dilation. LEFT ANTERIOR CEREBRAL ARTERY: No filling defect, stenosis or aneurysmal dilation. RIGHT MIDDLE CEREBRAL ARTERY: No filling defect, stenosis or aneurysmal dilatation LEFT MIDDLE CEREBRAL ARTERY: No filling defect, stenosis or aneurysmal dilatation RIGHT VERTEBRAL ARTERY:No filling defect, stenosis or aneurysmal dilation. LEFT VERTEBRAL ARTERY: No filling defect, stenosis or aneurysmal dilation. BASILAR ARTERY: Note is made of incidental focal fenestration of the mid basilar artery No filling defect, stenosis or aneurysmal dilation. RIGHT POSTERIOR CEREBRAL ARTERY: No filling defect, stenosis or aneurysmal dilation. LEFT POSTERIOR CEREBRAL ARTERY: No filling defect, stenosis or aneurysmal dilation.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Moderate biapical predominant centrilobular emphysema with biapical pleural-parenchymal scarring. 5 mm noncalcified nodule is seen within the lateral right upper lobe (series 501 image 98). 4 mm nodule within the anterior left upper lobe (series 401 image 127). Lungs are otherwise clear without hematoma or pneumothorax. 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: No abnormality. PANCREAS: Normal. SPLEEN: Normal. Several accessory spleens are noted. ADRENALS: Normal. KIDNEYS: No hydroureteronephrosis or radiopaque urinary tract calculi bilaterally. Simple cysts of the posterior interlobar left kidney. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Air surrounding stool on series 501 image 439 is likely intraluminal but difficult to track back in this area. PERITONEUM / MESENTERY: No free intraperitoneal air or fluid. RETROPERITONEUM: Ill-defined periaortic retroperitoneum hematoma adjacent to site of L3 vertebral body fracture. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Incomplete burst fracture of the L3 vertebral body with resultant retropulsion and moderate to severe narrowing of the central spinal canal. Fractures extend into the right lamina/spinous process without evidence of involvement of the bilateral pedicles or facet joints. Questionable nondisplaced fracture of the inferior portion of the L5 spinous process versus congenital change in this area. Bone island of the right ischium.
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MR Breast Screening wo+w contrast CLINICAL INFORMATION: 58-year-old woman with elevated lifetime risk for development of breast cancer. This is a high risk screening exam. TECHNIQUE: T1 axial, FSE T2 fat sat axial, pre and post contrast vibrant sequence with 3D reconstructions. This is an abbreviated protocol. A dedicated 8 channel breast imaging coil was utilized. Patient weight: 206 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: Most recent breast MRI: 12/22/2020. Most recent mammogram: 7/6/2021. MRI FINDINGS: This bilateral breast MRI exam demonstrates minimal background enhancement. There is scattered fibroglandular tissue. RIGHT BREAST:No suspicious enhancing mass or nonmass enhancement. No architectural distortion. LEFT BREAST:No suspicious enhancing mass or nonmass enhancement. No architectural distortion. LYMPH NODES:No axillary 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: No MRI evidence of occult breast malignancy.. BI-RADS 1: Negative. OVERALL BI-RADS ASSESSMENT:BI-RADS 1: Negative. 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 scattered fibroglandular tissue. RIGHT BREAST:No suspicious enhancing mass or nonmass enhancement. No architectural distortion. LEFT BREAST:No suspicious enhancing mass or nonmass enhancement. No architectural distortion. LYMPH NODES:No axillary 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: No MRI evidence of occult breast malignancy.. BI-RADS 1: Negative. OVERALL BI-RADS ASSESSMENT:BI-RADS 1: Negative. 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: Moderate biapical predominant centrilobular emphysema with biapical pleural-parenchymal scarring. 5 mm noncalcified nodule is seen within the lateral right upper lobe (series 501 image 98). 4 mm nodule within the anterior left upper lobe (series 401 image 127). Lungs are otherwise clear without hematoma or pneumothorax. 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: No abnormality. PANCREAS: Normal. SPLEEN: Normal. Several accessory spleens are noted. ADRENALS: Normal. KIDNEYS: No hydroureteronephrosis or radiopaque urinary tract calculi bilaterally. Simple cysts of the posterior interlobar left kidney. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Air surrounding stool on series 501 image 439 is likely intraluminal but difficult to track back in this area. PERITONEUM / MESENTERY: No free intraperitoneal air or fluid. RETROPERITONEUM: Ill-defined periaortic retroperitoneum hematoma adjacent to site of L3 vertebral body fracture. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Incomplete burst fracture of the L3 vertebral body with resultant retropulsion and moderate to severe narrowing of the central spinal canal. Fractures extend into the right lamina/spinous process without evidence of involvement of the bilateral pedicles or facet joints. Questionable nondisplaced fracture of the inferior portion of the L5 spinous process versus congenital change in this area. Bone island of the right ischium.
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MR Breast Diagnostic Bil wo+w contrast CLINICAL INFORMATION: History of left breast invasive ductal carcinoma 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: 197 lbs. IV contrast: ProHance, 18 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 minimal background enhancement. There is scattered fibroglandular tissue. RIGHT BREAST:No suspicious enhancing mass or nonmass enhancement. No architectural distortion. Specifically no enhancement is seen in the mildly suspicious right 11:00 breast mass or the probably benign 2:00 breast mass. LEFT BREAST: 1. The dominant left breast heterogeneously enhancing spiculated mass measures 4.6 x 4.0 x 4.0 cm (series 400, image 165 and series 7, image 75) in the upper outer quadrant, middle depth. Associated nipple retraction and enhancement to the level of the skin and nipple areolar complex is seen. Susceptibility artifact within the center of the lesion consistent with biopsy marker. 2. Similar smaller peripherally enhancing spiculated mass measuring 2.0 x 2.3 x 2.4 cm is seen in the upper outer quadrant, posterior depth (series 400 image 181, series 7 image 73). Susceptibility artifact within the center of the lesion consistent with biopsy marker. This mass is 18 mm from the pectoralis muscle. Nonmass enhancement extends to the pectoralis muscle without definitive fat plane. No enhancement of the pectoralis muscle is identified to suggest pectoralis muscle invasion. LYMPH NODES:A few, greater than four, morphologically abnormal lymph nodes are seen in the level I left axilla with cortical thickening (series 7, image 65). Susceptibility artifact from prior biopsy marker is visualized adjacent to a smaller level I left axillary lymph node measuring 5 x 7 x 5 (series 4 image 303, series 7 image 66). ADDITIONAL FINDINGS: The liver is cirrhotic in morphology. IMPRESSION AND RECOMMENDATIONS: RIGHT BREAST: No MRI evidence of occult breast malignancy. BI-RADS 1, negative. LEFT BREAST: 1-2. Invasive ductal carcinoma in the upper outer quadrant with probable involvement of the skin and nipple areolar complex. BI-RADS 6, known malignancy. LYMPH NODES: Greater than four morphologically abnormal level one left axillary lymph nodes. One has been biopsied demonstrating metastasis. BI-RADS 6: Biopsy proven malignancy. Recommend surgical excision when clinically appropriate. 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. In the lateral aspect of the left pectoralis muscle there is a focal area of enhancement measuring 7 x 5 x 3 mm (series 400 image 160, series 7 image 76. There is associated T2 hyperintensity consistent with edema. This is nonspecific but could represent a metastatic deposit. Attention on follow-up is recommended.
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FINDINGS: This bilateral breast MRI exam demonstrates minimal background enhancement. There is scattered fibroglandular tissue. RIGHT BREAST:No suspicious enhancing mass or nonmass enhancement. No architectural distortion. Specifically no enhancement is seen in the mildly suspicious right 11:00 breast mass or the probably benign 2:00 breast mass. LEFT BREAST: 1. The dominant left breast heterogeneously enhancing spiculated mass measures 4.6 x 4.0 x 4.0 cm (series 400, image 165 and series 7, image 75) in the upper outer quadrant, middle depth. Associated nipple retraction and enhancement to the level of the skin and nipple areolar complex is seen. Susceptibility artifact within the center of the lesion consistent with biopsy marker. 2. Similar smaller peripherally enhancing spiculated mass measuring 2.0 x 2.3 x 2.4 cm is seen in the upper outer quadrant, posterior depth (series 400 image 181, series 7 image 73). Susceptibility artifact within the center of the lesion consistent with biopsy marker. This mass is 18 mm from the pectoralis muscle. Nonmass enhancement extends to the pectoralis muscle without definitive fat plane. No enhancement of the pectoralis muscle is identified to suggest pectoralis muscle invasion. LYMPH NODES:A few, greater than four, morphologically abnormal lymph nodes are seen in the level I left axilla with cortical thickening (series 7, image 65). Susceptibility artifact from prior biopsy marker is visualized adjacent to a smaller level I left axillary lymph node measuring 5 x 7 x 5 (series 4 image 303, series 7 image 66). ADDITIONAL FINDINGS: The liver is cirrhotic in morphology. IMPRESSION AND RECOMMENDATIONS: RIGHT BREAST: No MRI evidence of occult breast malignancy. BI-RADS 1, negative. LEFT BREAST: 1-2. Invasive ductal carcinoma in the upper outer quadrant with probable involvement of the skin and nipple areolar complex. BI-RADS 6, known malignancy. LYMPH NODES: Greater than four morphologically abnormal level one left axillary lymph nodes. One has been biopsied demonstrating metastasis. BI-RADS 6: Biopsy proven malignancy. Recommend surgical excision when clinically appropriate. 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. In the lateral aspect of the left pectoralis muscle there is a focal area of enhancement measuring 7 x 5 x 3 mm (series 400 image 160, series 7 image 76. There is associated T2 hyperintensity consistent with edema. This is nonspecific but could represent a metastatic deposit. Attention on follow-up is recommended.
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Findings: CT C-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 Lumbar Spine wo+w contrast 1/22/2022 3:25 PM CLINICAL INFORMATION: lower ext weakness COMPARISON: MRI of the lumbar spine dated 4/2/2021. TECHNIQUE: Sagittal T1/T2/STIR, axial T1/T2, contrast axial and sagittal fat-sat T1. Patient weight: 310 lbs. IV contrast: ProHance, 10 ml, per protocol. FINDINGS: Rotatory levoscoliosis with multilevel advanced spondylosis is again noted. Interval decompressive laminectomy changes are seen at L2-L3, L3-L4, L4-L5 and L5-S1. At L4-L5, there is continued moderate-to-severe spinal canal stenosis due to laminectomy related dorsal fluid collection. Persistent severe spinal canal stenosis remains at T12-L1 and L1-L2. The cauda equina shows edematous nerve root thickening with mild increased enhancement. There is no evidence of epidural hemorrhage/abscess, spondylodiscitis or paraspinal cellulitis. IMPRESSION: 1. Status post decompressive laminectomy at L2-L3, L3-L4, L4-L5 and L5-S1. 2. Small epidural fluid collection causing moderate-to-severe spinal canal stenosis at L4-L5. 3. Persistent severe spinal canal stenosis at T12-L1 and L1-L2, and nerve root edema.
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FINDINGS: Rotatory levoscoliosis with multilevel advanced spondylosis is again noted. Interval decompressive laminectomy changes are seen at L2-L3, L3-L4, L4-L5 and L5-S1. At L4-L5, there is continued moderate-to-severe spinal canal stenosis due to laminectomy related dorsal fluid collection. Persistent severe spinal canal stenosis remains at T12-L1 and L1-L2. The cauda equina shows edematous nerve root thickening with mild increased enhancement. There is no evidence of epidural hemorrhage/abscess, spondylodiscitis or paraspinal cellulitis.
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FINDINGS: THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: Incomplete burst fracture of the L3 vertebral body with resultant retropulsion and moderate to severe narrowing of the central spinal canal. Fractures extend into the right lamina without evidence of involvement of the bilateral pedicles or facet joints. Chronic appearing nondisplaced fracture of the inferior portion of the L5 spinous process DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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EXAM: MR Abdomen wo+w contrast, MR Cholangiopancreatography MRCP CLINICAL INFORMATION: Bile duct injury status post laparoscopic cholecystectomy. COMPARISON: Outside ERCP dated 1/19/2022 and 1/9/2022. CT dated 1/22/2022. TECHNIQUE: MR Abdomen wo+w contrast, MR Cholangiopancreatography MRCP Patient weight: 233 lbs. IV contrast: Eovist, 10 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: Complex right pleural effusion. Dependent atelectasis. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Normal. BILIARY TRACT: Evaluation of the biliary tree is limited given patient motion and air within the bile duct. There is minimal prominence of the intrahepatic biliary ductal system in both lobes of the liver. No definite defect is identified. On prior ERCP, opacification of a bile duct extending cranially is noted adjacent to the leak, which appears to correlate with the bile duct on today's exam draining the right hepatic lobe anterior sector. GALLBLADDER: Absent. Unchanged fluid collection in the gallbladder fossa that measures 8.3 x 6.0 cm on series 301, image 15. This collection contains a surgical drain. 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: Abdominal wall edema. Otherwise normal. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Unchanged appearance of gallbladder fossa fluid collection without definite localization of the bile duct injury given limitations as described above. Given the appearance on ERCP and MRI, this could represent a injury to the posterior right hepatic duct near its confluence with the anterior right hepatic duct, but this is not certain. The findings were discussed with Dr. Sheikh by Dr. Sam Galgano via telephone on 1/22/2022 3:52 PM.
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FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: Complex right pleural effusion. Dependent atelectasis. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Normal. BILIARY TRACT: Evaluation of the biliary tree is limited given patient motion and air within the bile duct. There is minimal prominence of the intrahepatic biliary ductal system in both lobes of the liver. No definite defect is identified. On prior ERCP, opacification of a bile duct extending cranially is noted adjacent to the leak, which appears to correlate with the bile duct on today's exam draining the right hepatic lobe anterior sector. GALLBLADDER: Absent. Unchanged fluid collection in the gallbladder fossa that measures 8.3 x 6.0 cm on series 301, image 15. This collection contains a surgical drain. 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: Abdominal wall edema. Otherwise normal. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: Incomplete burst fracture of the L3 vertebral body with resultant retropulsion and moderate to severe narrowing of the central spinal canal. Fractures extend into the right lamina without evidence of involvement of the bilateral pedicles or facet joints. Chronic appearing nondisplaced fracture of the inferior portion of the L5 spinous process DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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EXAM: MR Abdomen wo+w contrast, MR Cholangiopancreatography MRCP CLINICAL INFORMATION: Bile duct injury status post laparoscopic cholecystectomy. COMPARISON: Outside ERCP dated 1/19/2022 and 1/9/2022. CT dated 1/22/2022. TECHNIQUE: MR Abdomen wo+w contrast, MR Cholangiopancreatography MRCP Patient weight: 233 lbs. IV contrast: Eovist, 10 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: Complex right pleural effusion. Dependent atelectasis. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Normal. BILIARY TRACT: Evaluation of the biliary tree is limited given patient motion and air within the bile duct. There is minimal prominence of the intrahepatic biliary ductal system in both lobes of the liver. No definite defect is identified. On prior ERCP, opacification of a bile duct extending cranially is noted adjacent to the leak, which appears to correlate with the bile duct on today's exam draining the right hepatic lobe anterior sector. GALLBLADDER: Absent. Unchanged fluid collection in the gallbladder fossa that measures 8.3 x 6.0 cm on series 301, image 15. This collection contains a surgical drain. 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: Abdominal wall edema. Otherwise normal. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Unchanged appearance of gallbladder fossa fluid collection without definite localization of the bile duct injury given limitations as described above. Given the appearance on ERCP and MRI, this could represent a injury to the posterior right hepatic duct near its confluence with the anterior right hepatic duct, but this is not certain. The findings were discussed with Dr. Sheikh by Dr. Sam Galgano via telephone on 1/22/2022 3:52 PM.
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FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: Complex right pleural effusion. Dependent atelectasis. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Normal. BILIARY TRACT: Evaluation of the biliary tree is limited given patient motion and air within the bile duct. There is minimal prominence of the intrahepatic biliary ductal system in both lobes of the liver. No definite defect is identified. On prior ERCP, opacification of a bile duct extending cranially is noted adjacent to the leak, which appears to correlate with the bile duct on today's exam draining the right hepatic lobe anterior sector. GALLBLADDER: Absent. Unchanged fluid collection in the gallbladder fossa that measures 8.3 x 6.0 cm on series 301, image 15. This collection contains a surgical drain. 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: Abdominal wall edema. Otherwise normal. 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: Normal. SINUSES: Mucosal thickening of the ethmoid air cells and left-sided nasal passage. MASTOIDS: Clear. SOFT TISSUE: Small right frontal scalp hematoma. MAXILLOFACIAL: No fracture. Patient is edentulous
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MR Femur Right wo contrast TECHNIQUE: Multiplanar multisequence MRI of the right femur was obtained. Due to patient's severe claustrophobia, the study was terminated early after only obtaining a single axial PD sequence. CLINICAL INFORMATION: injury with severe right thigh pain, M79.659 Pain in unspecified thigh, R10.30 Lower abdominal pain, unspecified COMPARISON: None FINDINGS: Trace marrow edema seen within the mid femoral diaphysis. Additionally, there is a thin hypointense line extending anteriorly from the anterior cortex possibly representing periosteal reaction. Trace edema within the right vastus intermedius muscle. The remaining muscles and tendons are grossly unremarkable allowing for study limitations. CONCLUSION: 1. Limited study. Findings most likely represent traumatic stress reaction of the mid femoral diaphysis with associated reactive edema within the vastus intermedius. No fracture line is identified. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: Trace marrow edema seen within the mid femoral diaphysis. Additionally, there is a thin hypointense line extending anteriorly from the anterior cortex possibly representing periosteal reaction. Trace edema within the right vastus intermedius muscle. The remaining muscles and tendons are grossly unremarkable allowing for study limitations.
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Findings: CT C-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 Brain wo+w contrast Clinical Information: 68-year-old male follow-up lymphoma. Comparison: MR brain dated 12/8/2021 and 11/1/2021. Technique: Multiplanar, multisequence MR images of the brain with and without contrast. Patient weight: 112 lbs. IV contrast: ProHance, 11 ml, per protocol. Findings: The previously seen enhancing parenchymal lesions in the left frontal and right centrum semiovale have resolved. There is chronic encephalomalacia at the left frontal lobe. No residual enhancement or new enhancing lesions are identified. Small developmental venous anomaly in the left posterior cingulate gyrus and multifocal right temporoparietal subcortical encephalomalacia are unchanged. No mass effect, midline shift, or hydrocephalus. Orbits appear normal. Paranasal sinuses are clear. Small right mastoid effusion. Major proximal intracranial flow voids are intact. No aggressive osseous lesion. Conclusion: Interval resolution of the left frontal and right centrum semiovale masses. Residual peripheral diffusion signal abnormality is felt to be treatment related change. 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 previously seen enhancing parenchymal lesions in the left frontal and right centrum semiovale have resolved. There is chronic encephalomalacia at the left frontal lobe. No residual enhancement or new enhancing lesions are identified. Small developmental venous anomaly in the left posterior cingulate gyrus and multifocal right temporoparietal subcortical encephalomalacia are unchanged. No mass effect, midline shift, or hydrocephalus. Orbits appear normal. Paranasal sinuses are clear. Small right mastoid effusion. Major proximal intracranial flow voids are intact. No aggressive osseous lesion.
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FINDINGS: There is no evidence of acute ischemia, intracranial hemorrhage, or intracranial mass. The ventricles and basal cisterns are unremarkable. Complete opacification of the right frontal and maxillary sinuses with near complete opacification of the right ethmoid air cells. There are extensive erosive changes involving the medial maxillary sinus wall, lamina papyracea and orbital floor. Inflammatory stranding is seen along the medial margin of the extraconal fat with extension into the intraconal fat and likely involving the optic nerve at its insertion upon the globe (axial series 201, image 27). There is mild right-sided proptosis. The globe appears intact. Asymmetric thickening of the right medial rectus. Partial opacification of the left maxillary sinus and anterior ethmoid air cells. The mastoid air cells are clear.
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MR Breast Screening wo+w contrast CLINICAL INFORMATION: 27-year-old with elevated lifetime risk for development of breast cancer. This is a high risk screening exam. TECHNIQUE: T1 axial, FSE T2 fat sat axial, pre and post contrast vibrant sequence with 3D reconstructions. This is an abbreviated protocol. A dedicated 8 channel breast imaging coil was utilized. Patient weight: 135 lbs. IV contrast: ProHance, 12 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: Most recent breast MRI: 12/19/2020. Most recent mammogram: None. MRI FINDINGS: This bilateral breast MRI exam demonstrates minimal background enhancement. There is extreme fibroglandular tissue. Postcontrast images are limited by motion. RIGHT BREAST: T2 hyperintense enhancing focus in the lower outer quadrant measuring 3 x 3 mm (series 400, image 160). LEFT BREAST: No suspicious enhancing mass or nonmass enhancement. No architectural distortion. LYMPH NODES: No axillary adenopathy. ADDITIONAL FINDINGS: None IMPRESSION AND RECOMMENDATIONS: Motion limited exam. RIGHT BREAST: Probably benign T2 hyperintense enhancing focus in the lower outer quadrant. BI-RADS 3: Probably benign. LEFT BREAST: No MRI evidence of occult breast malignancy.. BI-RADS 1: Negative. OVERALL BI-RADS ASSESSMENT: BI-RADS 3: Follow-up MRI in 6 months is recommended. 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. Postcontrast images are limited by motion. RIGHT BREAST: T2 hyperintense enhancing focus in the lower outer quadrant measuring 3 x 3 mm (series 400, image 160). LEFT BREAST: No suspicious enhancing mass or nonmass enhancement. No architectural distortion. LYMPH NODES: No axillary adenopathy. ADDITIONAL FINDINGS: None IMPRESSION AND RECOMMENDATIONS: Motion limited exam. RIGHT BREAST: Probably benign T2 hyperintense enhancing focus in the lower outer quadrant. BI-RADS 3: Probably benign. LEFT BREAST: No MRI evidence of occult breast malignancy.. BI-RADS 1: Negative. OVERALL BI-RADS ASSESSMENT: BI-RADS 3: Follow-up MRI in 6 months is recommended. 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 PE OVERALL DIAGNOSTIC QUALITY: Mildly suboptimal quality with incomplete evaluation of subsegmental pulmonary arteries. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus. The main pulmonary artery is normal in caliber, measuring up to 26 mm (series 2, image 54). LUNGS / AIRWAYS / PLEURA: Diffuse nodular airspace opacities scattered throughout both lungs. No pleural effusion or pneumothorax. The central tracheobronchial tree is patent and clear. HEART / OTHER VESSELS: Normal heart size without pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Partially imaged soft tissue nodularity in the right axilla subcutaneous fat measuring approximately 1.4 x 1.1 cm (series 2, image 1). Multiple bilateral mildly enlarged hilar lymph nodes. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Diffuse hepatic steatosis. Mild splenomegaly. The visualized upper abdomen is otherwise unremarkable for examination technique. MUSCULOSKELETAL: No significant abnormality.
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MR Breast Screening wo+w contrast CLINICAL INFORMATION: History of unilateral nipple discharge status post biopsy of left breast mass with benign pathology.. 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: 196 lbs. IV contrast: ProHance, 18 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: Most recent breast MRI: None. Most recent mammogram: 12/21/2021. MRI FINDINGS: This bilateral breast MRI exam demonstrates minimal background enhancement. There is scattered fibroglandular tissue. RIGHT BREAST:No suspicious enhancing mass or nonmass enhancement. No architectural distortion. LEFT BREAST:No suspicious enhancing mass or nonmass enhancement. Postbiopsy changes are seen in the subareolar left breast with susceptibility artifact and T2 signal from hydromark biopsy marker. The biopsy marker is located within a dilated duct demonstrating T1 hyperintensity without suspicious enhancement.. LYMPH NODES:The level I left axillary lymph nodes are asymmetrically enlarged compared to the left with preservation of the fatty hila. ADDITIONAL FINDINGS: None. IMPRESSION AND RECOMMENDATIONS: RIGHT BREAST: No MRI evidence of occult breast malignancy. BI-RADS 1, negative. LEFT BREAST: Post procedural changes from left subareolar biopsy. No abnormal enhancement to suggest malignancy. The biopsy marker is located within a dilated duct demonstrating T1 hyperintensity which could represent blood products or proteinaceous debris. LYMPH NODES: Asymmetrically enlarged left axillary lymph nodes, likely reactive. Targeted ultrasound is recommended. BI-RADS 3, probably benign. OVERALL BI-RADS ASSESSMENT: BI-RADS 3, probably benign. 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 scattered fibroglandular tissue. RIGHT BREAST:No suspicious enhancing mass or nonmass enhancement. No architectural distortion. LEFT BREAST:No suspicious enhancing mass or nonmass enhancement. Postbiopsy changes are seen in the subareolar left breast with susceptibility artifact and T2 signal from hydromark biopsy marker. The biopsy marker is located within a dilated duct demonstrating T1 hyperintensity without suspicious enhancement.. LYMPH NODES:The level I left axillary lymph nodes are asymmetrically enlarged compared to the left with preservation of the fatty hila. ADDITIONAL FINDINGS: None. IMPRESSION AND RECOMMENDATIONS: RIGHT BREAST: No MRI evidence of occult breast malignancy. BI-RADS 1, negative. LEFT BREAST: Post procedural changes from left subareolar biopsy. No abnormal enhancement to suggest malignancy. The biopsy marker is located within a dilated duct demonstrating T1 hyperintensity which could represent blood products or proteinaceous debris. LYMPH NODES: Asymmetrically enlarged left axillary lymph nodes, likely reactive. Targeted ultrasound is recommended. BI-RADS 3, probably benign. OVERALL BI-RADS ASSESSMENT: BI-RADS 3, probably benign. 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 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: Vicarious excretion of contrast noted within the gallbladder. PANCREAS: Normal. SPLEEN: Redemonstrated grade 1 splenic laceration with decreased conspicuity when compared to prior. Persistent subtle increased attenuation/stranding adjacent to the inferior aspect of the spleen. No active extravasation. No pseudoaneurysm identified. ADRENALS: Normal. KIDNEYS: Simple left renal cyst. The kidneys are otherwise normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix and colon are normal. PERITONEUM / MESENTERY: Unchanged trace fluid and stranding adjacent to the inferior aspect of the spleen. RETROPERITONEUM: Normal. VESSELS: Small nonocclusive DVT in the left common iliac vein unchanged from prior. URINARY BLADDER: Partially collapsed around a Foley balloon. REPRODUCTIVE ORGANS: The uterus is present. No adnexal mass. BODY WALL: Scattered foci of gas in the anterior abdominal wall are likely related to injection. MUSCULOSKELETAL: Redemonstrated anterior left rib fractures. T12 and L1 Schmorl's nodes are redemonstrated.
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MR Lumbar Spine wo+w contrast, MR Thoracic Spine wo contrast 1/22/2022 6:48 PM Clinical information: 47 years Female patient with urinary incontinence x 2 (positive post-void residual), hx of back surgeries and with back pain and bilateral flank pain, UA wnl Comparison: Plain films of the lumbar spine dated 4/26/2021. Technique: Sagittal and axial T1, T2 and STIR images were obtained of the thoracic and lumbar spine, without intravenous contrast administration. Additionally, sagittal and axial T1 post contrast images of the lumbar spine were obtained. Patient weight: 160 lbs. IV contrast: ProHance, 15 ml, per protocol. IV contrast injection rate: 1 ml per sec. Findings: The sagittal images demonstrate preservation of the thoracic kyphosis and lumbar lordosis, without subluxations. Postsurgical posterior spinal fusion at L4-L5 is noted, with bilateral transpedicular screws and rod fixation, creating susceptibility artifact, limiting evaluation at these levels. The visualized vertebral bodies otherwise maintain normal height with scattered Modic type II changes, without abnormal enhancement. Mild disc desiccation at L5-S1 from decreased T2-weighted signal. 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 or abnormal enhancement. The tip of the conus medullaris terminates normally at L1. There is no significant spinal canal stenosis or neuroforaminal narrowing in the thoracic spine. L1-L2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-L3: Mild circumferential disc bulge. The spinal canal and neural foramina are patent. L3-4: Mild circumferential disc bulge and bilateral facet hypertrophy, resulting in mild spinal canal stenosis and mild left neuroforaminal narrowing. L4-5: Postsurgical decompressive left laminotomy, without significant neuroforaminal narrowing and decompressed spinal canal. L5-S1: Mild circumferential disc bulge and tiny left paracentral annular fissure, without significant spinal canal stenosis or neuroforaminal narrowing. The paraspinal soft tissues appear unremarkable, without organized fluid collections or abnormal enhancement. Incidental bilateral C6-C7 perineural cysts, measuring up to 5 mm respectively. Additionally 12 mm Tarlov cyst is noted posterior to the S2 vertebral body. Additionally, 8.6 mm circumscribed rounded, hyperintense T2-weighted signal nodule in the right anterior thyroid lobe, likely a colloid cyst. IMPRESSION: 1. No evidence of acute findings or abnormal enhancement in the thoracolumbar spine. In particular, no evidence of cauda equina syndrome. 2. Postsurgical posterior spinal fusion at L4-L5, with bilateral transpedicular screws and rod fixation, creating susceptibility artifact, limiting evaluation at these levels, without significant neuroforaminal narrowing and decompressed spinal canal. 3. Residual chronic multilevel degenerative changes as described, most significant at L3-L4, resulting in mild spinal canal stenosis and mild left neuroforaminal narrowing.
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Findings: The sagittal images demonstrate preservation of the thoracic kyphosis and lumbar lordosis, without subluxations. Postsurgical posterior spinal fusion at L4-L5 is noted, with bilateral transpedicular screws and rod fixation, creating susceptibility artifact, limiting evaluation at these levels. The visualized vertebral bodies otherwise maintain normal height with scattered Modic type II changes, without abnormal enhancement. Mild disc desiccation at L5-S1 from decreased T2-weighted signal. 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 or abnormal enhancement. The tip of the conus medullaris terminates normally at L1. There is no significant spinal canal stenosis or neuroforaminal narrowing in the thoracic spine. L1-L2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-L3: Mild circumferential disc bulge. The spinal canal and neural foramina are patent. L3-4: Mild circumferential disc bulge and bilateral facet hypertrophy, resulting in mild spinal canal stenosis and mild left neuroforaminal narrowing. L4-5: Postsurgical decompressive left laminotomy, without significant neuroforaminal narrowing and decompressed spinal canal. L5-S1: Mild circumferential disc bulge and tiny left paracentral annular fissure, without significant spinal canal stenosis or neuroforaminal narrowing. The paraspinal soft tissues appear unremarkable, without organized fluid collections or abnormal enhancement. Incidental bilateral C6-C7 perineural cysts, measuring up to 5 mm respectively. Additionally 12 mm Tarlov cyst is noted posterior to the S2 vertebral body. Additionally, 8.6 mm circumscribed rounded, hyperintense T2-weighted signal nodule in the right anterior thyroid lobe, likely a colloid cyst.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Mitral and aortic calcifications. Cardiomegaly with left atrial enlargement. He Otherwise unremarkable as imaged. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Decompressed. PANCREAS: Normal. SPLEEN: Normal. Small accessory splenule is seen in the anterior left upper quadrant. ADRENALS: Mild bilateral nodular change. KIDNEYS: Simple cyst of the anterior left lower pole. No hydroureteronephrosis or radiopaque urinary tract calculi bilaterally. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach is unremarkable for underdistention. Small bowel is normal in caliber and enhancement throughout. COLON / APPENDIX: Inflammatory change involving the sigmoid colon concerning for perforated diverticulitis. A tract/focus of perforation is noted in the left pelvis, just superior to the bladder (for example axial series 601 image 271. No clear fat plane is seen between this region and the adjacent bladder. There is a second area of suspected perforation more superiorly, closely approximating the adjacent small bowel loops (for example series 601 image 228). There is enhancement within the mucosa in this area, more on the venous phase, unclear if this reflects actual slow bleeding versus hyperemia due to inflammatory change. PERITONEUM / MESENTERY: Excessive mesenteric fat stranding the left lower quadrant adjacent to areas of inflamed sigmoid colon. Small foci of extraluminal gas are seen adjacent to these regions as above. Small volume free fluid is located in the left posterior pararenal space. RETROPERITONEUM: Normal. VESSELS: Advanced atherosclerotic calcifications of the abdominal aorta and bilateral iliac vasculature without aneurysmal dilatation. URINARY BLADDER: Small foci of air seen within the anterior bladder with associated wall thickening near the inflammatory change. REPRODUCTIVE ORGANS: Uterus is present. Bilateral adnexa appear unremarkable. BODY WALL: Small fat-containing periumbilical hernia. MUSCULOSKELETAL: No evidence of aggressive osseous lesion or acute fracture. Advanced bilateral facet arthropathy spanning L4-S1.
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MR Lumbar Spine wo+w contrast, MR Thoracic Spine wo contrast 1/22/2022 6:48 PM Clinical information: 47 years Female patient with urinary incontinence x 2 (positive post-void residual), hx of back surgeries and with back pain and bilateral flank pain, UA wnl Comparison: Plain films of the lumbar spine dated 4/26/2021. Technique: Sagittal and axial T1, T2 and STIR images were obtained of the thoracic and lumbar spine, without intravenous contrast administration. Additionally, sagittal and axial T1 post contrast images of the lumbar spine were obtained. Patient weight: 160 lbs. IV contrast: ProHance, 15 ml, per protocol. IV contrast injection rate: 1 ml per sec. Findings: The sagittal images demonstrate preservation of the thoracic kyphosis and lumbar lordosis, without subluxations. Postsurgical posterior spinal fusion at L4-L5 is noted, with bilateral transpedicular screws and rod fixation, creating susceptibility artifact, limiting evaluation at these levels. The visualized vertebral bodies otherwise maintain normal height with scattered Modic type II changes, without abnormal enhancement. Mild disc desiccation at L5-S1 from decreased T2-weighted signal. 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 or abnormal enhancement. The tip of the conus medullaris terminates normally at L1. There is no significant spinal canal stenosis or neuroforaminal narrowing in the thoracic spine. L1-L2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-L3: Mild circumferential disc bulge. The spinal canal and neural foramina are patent. L3-4: Mild circumferential disc bulge and bilateral facet hypertrophy, resulting in mild spinal canal stenosis and mild left neuroforaminal narrowing. L4-5: Postsurgical decompressive left laminotomy, without significant neuroforaminal narrowing and decompressed spinal canal. L5-S1: Mild circumferential disc bulge and tiny left paracentral annular fissure, without significant spinal canal stenosis or neuroforaminal narrowing. The paraspinal soft tissues appear unremarkable, without organized fluid collections or abnormal enhancement. Incidental bilateral C6-C7 perineural cysts, measuring up to 5 mm respectively. Additionally 12 mm Tarlov cyst is noted posterior to the S2 vertebral body. Additionally, 8.6 mm circumscribed rounded, hyperintense T2-weighted signal nodule in the right anterior thyroid lobe, likely a colloid cyst. IMPRESSION: 1. No evidence of acute findings or abnormal enhancement in the thoracolumbar spine. In particular, no evidence of cauda equina syndrome. 2. Postsurgical posterior spinal fusion at L4-L5, with bilateral transpedicular screws and rod fixation, creating susceptibility artifact, limiting evaluation at these levels, without significant neuroforaminal narrowing and decompressed spinal canal. 3. Residual chronic multilevel degenerative changes as described, most significant at L3-L4, resulting in mild spinal canal stenosis and mild left neuroforaminal narrowing.
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Findings: The sagittal images demonstrate preservation of the thoracic kyphosis and lumbar lordosis, without subluxations. Postsurgical posterior spinal fusion at L4-L5 is noted, with bilateral transpedicular screws and rod fixation, creating susceptibility artifact, limiting evaluation at these levels. The visualized vertebral bodies otherwise maintain normal height with scattered Modic type II changes, without abnormal enhancement. Mild disc desiccation at L5-S1 from decreased T2-weighted signal. 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 or abnormal enhancement. The tip of the conus medullaris terminates normally at L1. There is no significant spinal canal stenosis or neuroforaminal narrowing in the thoracic spine. L1-L2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-L3: Mild circumferential disc bulge. The spinal canal and neural foramina are patent. L3-4: Mild circumferential disc bulge and bilateral facet hypertrophy, resulting in mild spinal canal stenosis and mild left neuroforaminal narrowing. L4-5: Postsurgical decompressive left laminotomy, without significant neuroforaminal narrowing and decompressed spinal canal. L5-S1: Mild circumferential disc bulge and tiny left paracentral annular fissure, without significant spinal canal stenosis or neuroforaminal narrowing. The paraspinal soft tissues appear unremarkable, without organized fluid collections or abnormal enhancement. Incidental bilateral C6-C7 perineural cysts, measuring up to 5 mm respectively. Additionally 12 mm Tarlov cyst is noted posterior to the S2 vertebral body. Additionally, 8.6 mm circumscribed rounded, hyperintense T2-weighted signal nodule in the right anterior thyroid lobe, likely a colloid cyst.
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FINDINGS: BONES/JOINTS: There is improved alignment of the left femoral head fracture-subluxation, however, the distal fracture segment remains posteriorly subluxed. Previously described fractures of the right and left acetabulum are again demonstrated.. SOFT TISSUES: Separately described but unchanged.
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MR Facial Bones wo+w contrast 1/22/2022 9:52 PM Clinical information: 55 years Male patient with right eye blindness Spec Inst: cf frozen globe Comparison: CT of the face with and without contrast dated 1/22/2022 at 14:32 hours. Technique: Multiplanar, multisequence MRI of the face was performed before and after the administration of intravenous contrast. Patient weight: 143 lbs. IV contrast: ProHance, 7 ml, per protocol. FINDINGS: Cerebral parenchyma: The brain parenchyma volume is appropriate for patient's age. No abnormal enhancement, intracranial mass lesion, hemorrhage, or infarction. Ventricular system: No hydrocephalus or midline shift. Extra axial spaces: No epidural, subdural, or subarachnoid hemorrhage. No basal cistern effacement. Vascular system: No loss of the major vascular flow voids. Symmetric caliber and contrast appearance of the bilateral superior ophthalmic veins and cavernous sinuses. Visualized paranasal sinuses: Post surgical changes from bilateral antrostomies, uncinectomies, turbinectomies, ethmoidectomies and sphenoidotomies are again seen, with residual circumferential mucosal thickening, most pronounced at the dependent frontal sinuses and right ethmoid surgical bed. Visualized orbits: Unchanged right proptosis with stretching of the right optic nerve, demonstrating internal restricted diffusion, suggestion of retrobulbar intraconal fat stranding and ill-defined enhancement, concerning for acute right orbital compartment syndrome, without discrete fluid collections or masses identified. Unremarkable appearance of the left orbit. Calvarium and skull base: No osseous destruction. Unchanged postsurgical canal wall up right mastoidectomy with opacification of the mastoid bowl. The left mastoid air cells appear well aerated. Pituitary and Pineal Glands: No mass lesion. Soft tissues: No significant abnormality. IMPRESSION: 1. No acute intracranial process or abnormal enhancement identified. 2. Unchanged right proptosis with stretching of the right optic nerve, demonstrating internal restricted diffusion, suggestion of retrobulbar intraconal fat stranding and ill-defined enhancement, concerning for acute right orbital compartment syndrome and right optic nerve infarct, without discrete fluid collections, masses or evidence of cavernous sinus thrombosis. 3. Stable post surgical changes from bilateral antrostomies, uncinectomies, turbinectomies, ethmoidectomies and sphenoidotomies, with residual circumferential mucosal thickening, most pronounced at the dependent frontal sinuses and right ethmoid surgical bed. 4. Unchanged postsurgical canal wall up right mastoidectomy, with opacification of the mastoid bowl.
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FINDINGS: Cerebral parenchyma: The brain parenchyma volume is appropriate for patient's age. No abnormal enhancement, intracranial mass lesion, hemorrhage, or infarction. Ventricular system: No hydrocephalus or midline shift. Extra axial spaces: No epidural, subdural, or subarachnoid hemorrhage. No basal cistern effacement. Vascular system: No loss of the major vascular flow voids. Symmetric caliber and contrast appearance of the bilateral superior ophthalmic veins and cavernous sinuses. Visualized paranasal sinuses: Post surgical changes from bilateral antrostomies, uncinectomies, turbinectomies, ethmoidectomies and sphenoidotomies are again seen, with residual circumferential mucosal thickening, most pronounced at the dependent frontal sinuses and right ethmoid surgical bed. Visualized orbits: Unchanged right proptosis with stretching of the right optic nerve, demonstrating internal restricted diffusion, suggestion of retrobulbar intraconal fat stranding and ill-defined enhancement, concerning for acute right orbital compartment syndrome, without discrete fluid collections or masses identified. Unremarkable appearance of the left orbit. Calvarium and skull base: No osseous destruction. Unchanged postsurgical canal wall up right mastoidectomy with opacification of the mastoid bowl. The left mastoid air cells appear well aerated. Pituitary and Pineal Glands: No mass lesion. Soft tissues: No significant abnormality.
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Findings: CT of the head with and without contrast: There is no acute infarction, hemorrhage, or cerebral edema. The gray-white matter differentiation is maintained. The cerebral cortical volume is appropriate for patient's age. There is no space occupying intracranial lesion or hydrocephalus. No enhancing intracranial abnormality. There is no acute osseous or orbital abnormality. Postsurgical changes from left pterional craniotomy and MCA aneurysm clipping are redemonstrated. Complete opacification of the right frontal and maxillary sinus sinuses with patchy opacification of the right ethmoid air cells, similar prior exam. The other paranasal sinuses and mastoid air cells are clear. CT angiogram of the brain: RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Changes of prior left MCA aneurysm clipping, as above. Streak artifact limits evaluation for recurrence, however no new additional aneurysms are identified. There is no evidence of stenosis, occlusion, or aneurysmal dilation. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation.
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MR Angio Head wo contrast 1/22/2022 9:52 PM Clinical information: 55 years Male patient with right eye blindness Spec Inst: cf frozen globe TECHNIQUE: Time-of-flight MRA of the head was performed without intravenous contrast. COMPARISON: None. FINDINGS: Internal carotid arteries: No filling defect or hemodynamically significant stenosis. Anterior cerebral arteries: Hypoplastic left A1 segment. No filling defect or hemodynamically significant stenosis. Middle Cerebral arteries: No filling defect or hemodynamically significant stenosis. Vertebral arteries: The right vertebral artery is dominant. No filling defect or hemodynamically significant stenosis. Basilar artery: No filling defect or hemodynamically significant stenosis. Posterior cerebral arteries: No filling defect or hemodynamically significant stenosis. Aneurysm/Vascular malformation: No aneurysm or vascular malformation. IMPRESSION: 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: Hypoplastic left A1 segment. No filling defect or hemodynamically significant stenosis. Middle Cerebral arteries: No filling defect or hemodynamically significant stenosis. Vertebral arteries: The right vertebral artery is dominant. No filling defect or hemodynamically significant stenosis. Basilar artery: No filling defect or hemodynamically significant stenosis. Posterior cerebral arteries: No filling defect or hemodynamically significant stenosis. Aneurysm/Vascular malformation: No aneurysm or vascular malformation.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP LOWER NECK: Interval increase in scattered moderate-volume soft tissue emphysema in the bilateral cervical, bilateral paraspinal, and anterior shoulder regions. CHEST: LUNGS / AIRWAYS / PLEURA: Right pleural pigtail catheter appears retracted with distal tip coiled in the right anterior pectoralis musculature. Interval increase in volume of now small right anterior pneumothorax. Interval increase in trace bilateral pleural effusions. Improved bilateral lung aeration but persistent multifocal areas of confluent consolidation and groundglass opacities bilaterally. Improved patency of bilateral mainstem bronchi. Endotracheal tube terminates 4.9 cm above the carina. Trace tracheal secretions. HEART / VESSELS: Mild cardiomegaly. Trace pericardial effusion, unchanged. Normal thoracic aortic caliber. Borderline enlarged main pulmonary artery trunk up to 3.0 cm. Left IJ approach central venous catheter terminates in the upper right atrium. Right IJ approach ECMO cannula terminates in the mid SVC. MEDIASTINUM / ESOPHAGUS: Partially imaged esophagogastric tube. LYMPH NODES: None enlarged. CHEST WALL: Interval increase in moderate volume soft tissue emphysema in the bilateral anterior chest wall/breasts, right axillary, and right lateral chest wall regions. UPPER ABDOMEN: Partially imaged esophagogastric tube courses appropriately toward gastric body. Partially imaged IVC approach ECMO cannula terminates in the upper right atrium. MUSCULOSKELETAL: No aggressive osseous lesion.
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MR Cervical Spine wo contrast 1/23/2022 5:00 AM CLINICAL INFORMATION: 65 years Female trauma. C7 left transverse process/superior facet fracture. COMPARISON: CT C-spine 1/22/2022 TECHNIQUE: T1 sagittal and axial spin echo, sagittal STIR, T2 sagittal and axial fast spin echo. FINDINGS: ALIGNMENT: There is mild retrolisthesis of C5 on C6 No ligamentous edema at this level suggesting this is on degenerative basis. There is mild edema anterior to the C6 and C7 vertebral bodies. There is also mild asymmetric widening of the disc space at this level raising possibility of acute partial-thickness tear of the anterior longitudinal ligament. CRANIOCERVICAL JUNCTION: Alignment appears within normal limits. VERTEBRA: Redemonstrated C7 left transverse process fracture with involvement of the superior facet, better appreciated on the C-spine CT. Vertebral body height is preserved. There is slight reversal of the normal cervical lordosis in the lower cervical spine. DISC SPACES AND FACET JOINTS: Multilevel discogenic degenerative changes, most prominent in the lower cervical spine with disc desiccation and loss of disc height at both C5-C6 and C6-C7. Broad disc osteophyte complex at both levels with mild to moderate central canal narrowing at C5-C6 and mild central canal narrowing and C6-C7 there is moderate left and mild right neural foraminal narrowing at C5-C6. There is also moderate left and mild right neural foraminal narrowing at C6-C7. POSTERIOR FOSSA \T\ CORD: Visualized posterior fossa structures have a normal appearance. The spinal cord demonstrates normal intrinsic signal. No epidural collection. PARAVERTEBRAL SOFT TISSUES: Posterior paravertebral soft tissue edema at the C6-C7 level. No organized fluid collection. IMPRESSION: 1. Redemonstrated fracture of the left C7 transverse process and superior articular facet, better appreciated on the cervical spine CT. There is mild associated paravertebral soft tissue edema at this level. 2. There is mild edema anterior to the C6-C7 disc space which is also mildly widened anteriorly raising possibility of partial thickness tear of the anterior longitudinal ligament. No other ligamentous injury is identified. Mild retrolisthesis of C5 on C6 appears to be on degenerative basis. 3. No convincing abnormal cord signal. 4. Multilevel degenerative changes in the mid and lower cervical spine, most prominent at C5-C6 where there is mild to moderate spinal canal narrowing. There is also moderate neural foraminal narrowing on the left at both C5-C6 and C6-C7. 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: ALIGNMENT: There is mild retrolisthesis of C5 on C6 No ligamentous edema at this level suggesting this is on degenerative basis. There is mild edema anterior to the C6 and C7 vertebral bodies. There is also mild asymmetric widening of the disc space at this level raising possibility of acute partial-thickness tear of the anterior longitudinal ligament. CRANIOCERVICAL JUNCTION: Alignment appears within normal limits. VERTEBRA: Redemonstrated C7 left transverse process fracture with involvement of the superior facet, better appreciated on the C-spine CT. Vertebral body height is preserved. There is slight reversal of the normal cervical lordosis in the lower cervical spine. DISC SPACES AND FACET JOINTS: Multilevel discogenic degenerative changes, most prominent in the lower cervical spine with disc desiccation and loss of disc height at both C5-C6 and C6-C7. Broad disc osteophyte complex at both levels with mild to moderate central canal narrowing at C5-C6 and mild central canal narrowing and C6-C7 there is moderate left and mild right neural foraminal narrowing at C5-C6. There is also moderate left and mild right neural foraminal narrowing at C6-C7. POSTERIOR FOSSA \T\ CORD: Visualized posterior fossa structures have a normal appearance. The spinal cord demonstrates normal intrinsic signal. No epidural collection. PARAVERTEBRAL SOFT TISSUES: Posterior paravertebral soft tissue edema at the C6-C7 level. No organized fluid collection.
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Findings: There is no evidence of acute intracranial hemorrhage, infarction, brain edema, mass effect or hydrocephalus. Stable dense calcifications bilateral globus pallidi and dentate nuclei. Moderate white matter microangiopathic changes are seen, slightly progressed compared to prior. Mild diffuse brain volume loss. The visualized paranasal sinuses, mastoid air cells and middle ear cavities are clear. Both orbits appear normal.
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MR Cervical Spine wo contrast 1/23/2022 6:30 AM CLINICAL INFORMATION: 64 years Male trauma COMPARISON: CT C-spine 1/23/2022 TECHNIQUE: Multisequence, multiplanar images of the cervical spine were obtained without the use of IV contrast. FINDINGS: VERTEBRA: No acute fracture. Chronic displaced type II odontoid fracture without associated osseous edema. There is no prevertebral soft tissue swelling The Minimally displaced fractures of the posterior arch of C1 are better appreciated on CT C-spine from earlier same day, however, there is no associated osseous edema to suggest acuity. Vertebral body height and alignment are preserved throughout the cervical spine. CRANIOCERVICAL JUNCTION: Craniocervical articulations are preserved. DISC SPACES AND FACET JOINTS: No significant degenerative disc change. There is multilevel significant upper and mid cervical spine facet arthropathy bilaterally. No significant spinal canal narrowing. Multilevel mild neural foraminal narrowing POSTERIOR FOSSA \T\ CORD: Visualized posterior fossa structures have a normal appearance. There is moderate narrowing of the uppermost cervical spinal canal resulting in flattening of the cervical spinal cord. Canal measures approximately 7 mm in AP dimension. The spinal cord demonstrates normal intrinsic signal. PARAVERTEBRAL SOFT TISSUES: No paravertebral soft tissue edema. No evidence of ligamentous injury. IMPRESSION: 1. No MRI evidence of acute cervical spine fracture or ligamentous injury. 2. Chronic fractures of C1 and C2, better appreciated on CT C-spine from earlier same day. There is posterior retrolisthesis of C1 on C2 and posterior displacement of the odontoid process resulting in moderate narrowing of the uppermost cervical spinal canal with mild flattening of the cervical spinal cord but no abnormal cord signal 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: No acute fracture. Chronic displaced type II odontoid fracture without associated osseous edema. There is no prevertebral soft tissue swelling The Minimally displaced fractures of the posterior arch of C1 are better appreciated on CT C-spine from earlier same day, however, there is no associated osseous edema to suggest acuity. Vertebral body height and alignment are preserved throughout the cervical spine. CRANIOCERVICAL JUNCTION: Craniocervical articulations are preserved. DISC SPACES AND FACET JOINTS: No significant degenerative disc change. There is multilevel significant upper and mid cervical spine facet arthropathy bilaterally. No significant spinal canal narrowing. Multilevel mild neural foraminal narrowing POSTERIOR FOSSA \T\ CORD: Visualized posterior fossa structures have a normal appearance. There is moderate narrowing of the uppermost cervical spinal canal resulting in flattening of the cervical spinal cord. Canal measures approximately 7 mm in AP dimension. The spinal cord demonstrates normal intrinsic signal. PARAVERTEBRAL SOFT TISSUES: No paravertebral soft tissue edema. No evidence of ligamentous injury.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Multifocal bilateral upper lobe and right middle lobe predominantly peripheral groundglass densities. Bibasilar subsegmental atelectasis. No pleural effusion or pneumothorax. Trace tracheal secretions. HEART / VESSELS: Right atrial and ventricular dilation. Mild aortic and mitral annular calcification. No pericardial effusion. Mild multivessel coronary artery atherosclerotic calcifications. Normal thoracic aorta and main pulmonary artery caliber. Is relatively linear hypodensity within the main pulmonary arteries extending into their lobar branches. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Bilateral gynecomastia. Diffuse mild body wall subcutaneous fat stranding/edema. UPPER ABDOMEN: Postsurgical changes related to prior cholecystectomy and gastric bypass. Splenomegaly. MUSCULOSKELETAL: Multilevel cervicothoracic spine degenerative changes. Flowing anterior osteophytosis, suggestive of DISH-related changes. No aggressive osseous lesion.
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MR Lumbar Spine wo+w contrast 1/23/2022 7:28 AM CLINICAL INFORMATION: 46 years Male Low back pain, cauda equina syndrome suspected COMPARISON: None available. TECHNIQUE: Multisequence multiplanar images of the lumbar spine were obtained before and after the administration of IV contrast. Patient weight: 168 lbs. IV contrast: ProHance, 15 ml, per protocol. IV contrast injection rate: 1 ml per sec. FINDINGS: VERTEBRA: No acute fracture. Lumbar spine alignment is normal. There are numerous enhancing T1 hypointense, STIR hyperintense lesions scattered throughout the lumbosacral spine. Lesions are overall mildly T2 hypointense with few areas of iso to minimally hyperintense T2 signal and few of the soft tissues tissue components. Lesions with extraosseous soft tissue/breakthrough of posterior vertebral body cortex tissue at the L4 and S1 levels extending into the anterior epidural space extradural space resulting in mild canal narrowing at S1 as well as narrowing of the right greater than left S1 neural foramina. Extraosseous soft tissue component at L4 results in moderately severe left lateral recess narrowing. DISC SPACES AND FACET JOINTS: Disc spaces are preserved. SPINAL CORD: Conus medullaris terminates at the L1-L2 vertebral level. The spinal cord and cauda equina nerve roots demonstrate normal intrinsic signal. PARAVERTEBRAL SOFT TISSUES: Normal. RETROPERITONEUM: Enlarged retroperitoneal lymph nodes including an aortocaval node measuring 1.4 cm in maximal short axis. IMPRESSION: 1. Numerous enhancing lesions within the lumbosacral spine and imaged pelvis mass consistent with osteoblastic bony metastasis. Extraosseous lesional soft tissue components at L4 and S1 resulting in moderately severe narrowing of the left lateral recess at L4 and narrowing of the right greater than left S1 neural foramina. 2. Retroperitoneal lymphadenopathy concerning for nodal metastasis Preliminary findings were discussed with Dr. Ferguson by David Maxwell Galambos MD via telephone at 1/23/2022 8:57 AM 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: No acute fracture. Lumbar spine alignment is normal. There are numerous enhancing T1 hypointense, STIR hyperintense lesions scattered throughout the lumbosacral spine. Lesions are overall mildly T2 hypointense with few areas of iso to minimally hyperintense T2 signal and few of the soft tissues tissue components. Lesions with extraosseous soft tissue/breakthrough of posterior vertebral body cortex tissue at the L4 and S1 levels extending into the anterior epidural space extradural space resulting in mild canal narrowing at S1 as well as narrowing of the right greater than left S1 neural foramina. Extraosseous soft tissue component at L4 results in moderately severe left lateral recess narrowing. DISC SPACES AND FACET JOINTS: Disc spaces are preserved. SPINAL CORD: Conus medullaris terminates at the L1-L2 vertebral level. The spinal cord and cauda equina nerve roots demonstrate normal intrinsic signal. PARAVERTEBRAL SOFT TISSUES: Normal. RETROPERITONEUM: Enlarged retroperitoneal lymph nodes including an aortocaval node measuring 1.4 cm in maximal short axis.
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FINDINGS: There has been no significant change in the large 6 x 2.5 cm right basal ganglia hematoma. Adjacent surrounding edema. There has been no significant change in approximate 10 mm leftward midline shift. There is continued evolution of multifocal infarcts in the right temporal, left frontal, parietal and occipital lobe infarcts. There is linear encephalomalacia in the left frontal lobe. There is no hydrocephalus. Scattered opacification of the mastoid air cells. Mild to moderate mucosal thickening in the ethmoid and bilateral sphenoid sinuses. No acute osseous findings. Patient is intubated.
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MR Cervical Spine wo contrast 1/23/2022 12:48 PM Clinical Information: C spine fracture Comparison: 10 hours prior CT C-spine. Technique: Axial T1/T2 and sagittal T1/T2/STIR. Findings: Widened anterior intervertebral disc space with T2 hyperintensity and indistinctive delineation of the anterior longitudinal ligament at C6-C7 are concerning for hyperextension disc injury with ligament tear. The posterior longitudinal ligament and ligamentum flavum are intact. There is no evidence of epidural hemorrhage or cervical cord contusion. The alignment and vertebral body height of the cervicothoracic spine are normally maintained. The posterior column integrity and atlantoaxial/atlantooccipital joints are intact. The spinal canal is capacious. Uncovertebral hypertrophy causes severe neural foraminal stenosis at C5-C6 on the right. Impression: Hyperextension disc injury with ALL tear at C6-C7.
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Findings: Widened anterior intervertebral disc space with T2 hyperintensity and indistinctive delineation of the anterior longitudinal ligament at C6-C7 are concerning for hyperextension disc injury with ligament tear. The posterior longitudinal ligament and ligamentum flavum are intact. There is no evidence of epidural hemorrhage or cervical cord contusion. The alignment and vertebral body height of the cervicothoracic spine are normally maintained. The posterior column integrity and atlantoaxial/atlantooccipital joints are intact. The spinal canal is capacious. Uncovertebral hypertrophy causes severe neural foraminal stenosis at C5-C6 on the right.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: No acute abnormality. 4 mm lingular nodule. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal aside from a small cyst in the central hepatic dome. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. Small splenule ADRENALS: Normal. KIDNEYS: Obstructing 4 mm stone at the right UVJ with mild right hydroureteronephrosis. No left hydronephrosis or additional radiopaque urinary tract stones. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Nondilated. Prominent submucosal fat deposition within the distal and terminal ileum. COLON / APPENDIX: A few noninflamed colonic diverticula. No acute abnormality. Appendix is normal. PERITONEUM / MESENTERY: No free fluid or free air. 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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MR Cervical Spine wo contrast, MR Thoracic Spine wo contrast 1/23/2022 3:45 PM Clinical Information: MVC with neuro deficits Comparison: Same day CT C-spine. Technique: MRI of the cervical and thoracic spine including noncontrast axial T1/T2 and sagittal T1/T2/STIR. Findings: Fracture involving the right C2 pedicle and articular pillar, and right atlantooccipital subluxation are noted. Widening of the left atlantodental interval is associated with partial tear of the left transverse ligament. The tectorial membrane and atlantooccipital ligament are intact. There is no epidural hemorrhage or cervical cord contusion. The vertebral arteries are patently visualized. The right C4 transverse process fracture is not well visualized. There are multilevel endplate compressions with marrow contusion at C7, T1, T2, T3, T4, and T5. Small retropulsion is noted at T4. There is no thoracic cord compression or spinal canal stenosis. There is no evidence of acute traumatic disc herniation. The middle thoracic spine and thoracolumbar junction are unremarkable. Bilateral lung contusions are additionally noted. Impression: 1. Right C2 pedicle and articular pillar fracture with right atlantooccipital subluxation. 2. Atlantodental subluxation with left transverse ligament partial tear. 3. Multilevel endplate compressions with marrow contusion at C7, T1, T2, T3, T4, and T5. 4. Small retropulsion at T4.
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Findings: Fracture involving the right C2 pedicle and articular pillar, and right atlantooccipital subluxation are noted. Widening of the left atlantodental interval is associated with partial tear of the left transverse ligament. The tectorial membrane and atlantooccipital ligament are intact. There is no epidural hemorrhage or cervical cord contusion. The vertebral arteries are patently visualized. The right C4 transverse process fracture is not well visualized. There are multilevel endplate compressions with marrow contusion at C7, T1, T2, T3, T4, and T5. Small retropulsion is noted at T4. There is no thoracic cord compression or spinal canal stenosis. There is no evidence of acute traumatic disc herniation. The middle thoracic spine and thoracolumbar junction are unremarkable. Bilateral lung contusions are additionally noted.
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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: Normal. SINUSES: Normal. MASTOIDS: Clear. SOFT TISSUE: Unremarkable.
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MR Cervical Spine wo contrast, MR Thoracic Spine wo contrast 1/23/2022 3:45 PM Clinical Information: MVC with neuro deficits Comparison: Same day CT C-spine. Technique: MRI of the cervical and thoracic spine including noncontrast axial T1/T2 and sagittal T1/T2/STIR. Findings: Fracture involving the right C2 pedicle and articular pillar, and right atlantooccipital subluxation are noted. Widening of the left atlantodental interval is associated with partial tear of the left transverse ligament. The tectorial membrane and atlantooccipital ligament are intact. There is no epidural hemorrhage or cervical cord contusion. The vertebral arteries are patently visualized. The right C4 transverse process fracture is not well visualized. There are multilevel endplate compressions with marrow contusion at C7, T1, T2, T3, T4, and T5. Small retropulsion is noted at T4. There is no thoracic cord compression or spinal canal stenosis. There is no evidence of acute traumatic disc herniation. The middle thoracic spine and thoracolumbar junction are unremarkable. Bilateral lung contusions are additionally noted. Impression: 1. Right C2 pedicle and articular pillar fracture with right atlantooccipital subluxation. 2. Atlantodental subluxation with left transverse ligament partial tear. 3. Multilevel endplate compressions with marrow contusion at C7, T1, T2, T3, T4, and T5. 4. Small retropulsion at T4.
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Findings: Fracture involving the right C2 pedicle and articular pillar, and right atlantooccipital subluxation are noted. Widening of the left atlantodental interval is associated with partial tear of the left transverse ligament. The tectorial membrane and atlantooccipital ligament are intact. There is no epidural hemorrhage or cervical cord contusion. The vertebral arteries are patently visualized. The right C4 transverse process fracture is not well visualized. There are multilevel endplate compressions with marrow contusion at C7, T1, T2, T3, T4, and T5. Small retropulsion is noted at T4. There is no thoracic cord compression or spinal canal stenosis. There is no evidence of acute traumatic disc herniation. The middle thoracic spine and thoracolumbar junction are unremarkable. Bilateral lung contusions are additionally noted.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Bilateral thyroid nodules. CHEST: LUNGS / AIRWAYS / PLEURA: Large right pneumothorax without mediastinal shift. Groundglass and centrilobular nodularity within the dependent right lower lobe. Additional areas of ground glass opacity along the lateral right upper lobe are noted. Left lung is clear. Central airways are patent. HEART / VESSELS: Cardiac chambers and great vessels are normal in size. No pericardial effusion. No central PE. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Subcentimeter hypoattenuating lesion in the inferior right hepatic lobe is too small to characterize by CT, likely cyst. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No free intraperitoneal air or fluid. RETROPERITONEUM: Presacral fluid VESSELS: Mild aortoiliac atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Mildly displaced fracture of the distal sacrum (sagittal image 94) THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Advanced right facet arthropathy at L4-L5. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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MR Brain wo+w contrast 1/23/2022 3:45 PM Clinical Information: MVC with acute neurologic symptoms Comparison: None. Technique: Sagittal T1, axial T2, FLAIR, DWI with ADC map and SWI, postcontrast axial, coronal and sagittal T1. Patient weight: 187 lbs. IV contrast: ProHance, 18 ml, per protocol. Findings: There are multiple microhemorrhages involving the bilateral superior frontal, right frontotemporal and left medial occipital subcortical areas, and right inferior cerebellum. The left superior frontal gyrus shows focal diffusion restriction. The corpus callosum and brainstem are spared. No cerebral contusion, diffuse cerebral edema or vascular territory ischemia is noted. No abnormal intracranial contrast enhancement is appreciated. Impression: Bilateral traumatic axonal (shear) injury without cerebral contusion.
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Findings: There are multiple microhemorrhages involving the bilateral superior frontal, right frontotemporal and left medial occipital subcortical areas, and right inferior cerebellum. The left superior frontal gyrus shows focal diffusion restriction. The corpus callosum and brainstem are spared. No cerebral contusion, diffuse cerebral edema or vascular territory ischemia is noted. No abnormal intracranial contrast enhancement is appreciated.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Bilateral thyroid nodules. CHEST: LUNGS / AIRWAYS / PLEURA: Large right pneumothorax without mediastinal shift. Groundglass and centrilobular nodularity within the dependent right lower lobe. Additional areas of ground glass opacity along the lateral right upper lobe are noted. Left lung is clear. Central airways are patent. HEART / VESSELS: Cardiac chambers and great vessels are normal in size. No pericardial effusion. No central PE. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Subcentimeter hypoattenuating lesion in the inferior right hepatic lobe is too small to characterize by CT, likely cyst. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No free intraperitoneal air or fluid. RETROPERITONEUM: Presacral fluid VESSELS: Mild aortoiliac atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Mildly displaced fracture of the distal sacrum (sagittal image 94) THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Advanced right facet arthropathy at L4-L5. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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MR Lumbar Spine wo contrast 1/23/2022 12:21 PM CLINICAL INFORMATION: 56 years Female Lumbar radiculopathy, > 6 wks, M54.32 Sciatica, left side COMPARISON: None available TECHNIQUE: Multiplanar, multisequence images of the lumbar spine were obtained without the use of IV contrast. FINDINGS: VERTEBRA: Vertebral body height and anterior/posterior alignment are preserved throughout the lumbar spine. There is dextroscoliotic curvature of the thoracolumbar spine. Vertebra demonstrate normal marrow signal. DISC SPACES AND FACET JOINTS: Intervertebral disc spaces are preserved without significant degenerative change. Vertebral levels are discussed individually below. SPINAL CORD: Conus medullaris terminates at the L1 vertebral level. The spinal cord and cauda equina nerve roots demonstrate normal intrinsic signal. PARAVERTEBRAL SOFT TISSUES: Normal. RETROPERITONEUM: Visualized retroperitoneal structures are unremarkable for technique. VERTEBRAL LEVELS: T12-L1: No significant spinal canal or neural foraminal narrowing. L1-L2: No significant spinal canal or neural foraminal narrowing. L2-L3: No significant spinal canal or neural foraminal narrowing. L3-L4: No significant spinal canal or neural foraminal narrowing. L4-L5: No significant spinal canal or neural foraminal narrowing. L5-S1: No significant spinal canal or neural foraminal narrowing. IMPRESSION: 1. S-shaped scoliosis. 2. No significant degenerative change, disc bulge or herniation seen in the lumbar spine. 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. There is dextroscoliotic curvature of the thoracolumbar spine. Vertebra demonstrate normal marrow signal. DISC SPACES AND FACET JOINTS: Intervertebral disc spaces are preserved without significant degenerative change. Vertebral levels are discussed individually below. SPINAL CORD: Conus medullaris terminates at the L1 vertebral level. The spinal cord and cauda equina nerve roots demonstrate normal intrinsic signal. PARAVERTEBRAL SOFT TISSUES: Normal. RETROPERITONEUM: Visualized retroperitoneal structures are unremarkable for technique. VERTEBRAL LEVELS: T12-L1: No significant spinal canal or neural foraminal narrowing. L1-L2: No significant spinal canal or neural foraminal narrowing. L2-L3: No significant spinal canal or neural foraminal narrowing. L3-L4: No significant spinal canal or neural foraminal narrowing. L4-L5: No significant spinal canal or neural foraminal narrowing. L5-S1: No significant spinal canal or neural foraminal narrowing.
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Findings: CT C-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 Brain wo contrast 1/23/2022 12:00 PM Clinical Information: stroke protocol Comparison: Same day head CT. Technique: Sagittal T1, axial T2, FLAIR, DWI with ADC map and SWI. Findings: There is no evidence of acute lacunar infarction or vascular territory cerebral ischemia. Susceptibility weighted imaging demonstrates numerously scattered variable sized signal blooming foci throughout the bilateral supratentorial brain. Pronounced periventricular leukoaraiosis and evidence of hemorrhagic old lacunar infarcts involving the bilateral basal ganglia are also noted. There is no intracranial hemorrhage, mass or mass effect. The ventricles are symmetric and age-appropriate. Impression: 1. No evidence of acute cerebral infarction. 2. Cerebral microhemorrhages suggesting hypertensive microangiopathy.
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Findings: There is no evidence of acute lacunar infarction or vascular territory cerebral ischemia. Susceptibility weighted imaging demonstrates numerously scattered variable sized signal blooming foci throughout the bilateral supratentorial brain. Pronounced periventricular leukoaraiosis and evidence of hemorrhagic old lacunar infarcts involving the bilateral basal ganglia are also noted. There is no intracranial hemorrhage, mass or mass effect. The ventricles are symmetric and age-appropriate.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Bilateral thyroid nodules. CHEST: LUNGS / AIRWAYS / PLEURA: Large right pneumothorax without mediastinal shift. Groundglass and centrilobular nodularity within the dependent right lower lobe. Additional areas of ground glass opacity along the lateral right upper lobe are noted. Left lung is clear. Central airways are patent. HEART / VESSELS: Cardiac chambers and great vessels are normal in size. No pericardial effusion. No central PE. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Subcentimeter hypoattenuating lesion in the inferior right hepatic lobe is too small to characterize by CT, likely cyst. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No free intraperitoneal air or fluid. RETROPERITONEUM: Presacral fluid VESSELS: Mild aortoiliac atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Mildly displaced fracture of the distal sacrum (sagittal image 94) THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Advanced right facet arthropathy at L4-L5. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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MRI brain with and without Indication: seizure, syncope Comparison: 1/22/2022 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: 191 lbs. IV contrast: ProHance, 10 ml, per protocol. IV contrast injection rate: 0.50 ml per sec. Findings: There is no restricted diffusion. There is a small T2 hyperintense signal with FLAIR hyperintense rim in the left frontal corona radiata, likely chronic lacunar infarct. The supratentorial brain parenchyma is within normal limits. There are scattered microangiopathic changes in the periventricular white matter. Postcontrast images demonstrate no abnormal enhancement in the brain parenchyma. Incidental note is made of DVA in the right cerebellum. Impression: No acute intracranial process. No pathologic enhancement is appreciated.
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Findings: There is no restricted diffusion. There is a small T2 hyperintense signal with FLAIR hyperintense rim in the left frontal corona radiata, likely chronic lacunar infarct. The supratentorial brain parenchyma is within normal limits. There are scattered microangiopathic changes in the periventricular white matter. Postcontrast images demonstrate no abnormal enhancement in the brain parenchyma. Incidental note is made of DVA in the right cerebellum.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Bilateral thyroid nodules. CHEST: LUNGS / AIRWAYS / PLEURA: Large right pneumothorax without mediastinal shift. Groundglass and centrilobular nodularity within the dependent right lower lobe. Additional areas of ground glass opacity along the lateral right upper lobe are noted. Left lung is clear. Central airways are patent. HEART / VESSELS: Cardiac chambers and great vessels are normal in size. No pericardial effusion. No central PE. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Subcentimeter hypoattenuating lesion in the inferior right hepatic lobe is too small to characterize by CT, likely cyst. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No free intraperitoneal air or fluid. RETROPERITONEUM: Presacral fluid VESSELS: Mild aortoiliac atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Mildly displaced fracture of the distal sacrum (sagittal image 94) THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic changes. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Advanced right facet arthropathy at L4-L5. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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MR Lumbar Spine wo contrast 1/23/2022 4:49 PM CLINICAL INFORMATION: worsening back pain after fall Spec Inst: RLE weakness, urinary incontinence COMPARISON: Same day L-spine CT. TECHNIQUE: Sagittal T1/T2/STIR, and axial T1/T2 on 1.5T MRI scanner. FINDINGS: Large urinary bladder distention is noted. The conus medullaris shows intramedullary T2 hyperintensity. There is no conus compressive lesion or perimedullary vascular engorgement. Posterior disc bulge mildly indents the ventral thecal sac at T10-T11. The conus terminus is seen at T12 level. The cauda equina nerve roots are not thickened. There are mild-to-moderate spinal canal stenosis at L4-L5 and mild stenosis at L3-L4 secondary to disc bulge with annular fissure and pronounced ligamentum flavum hypertrophy. Epidural lipomatosis within the lumbosacral canal is also noted. The vertebral marrow signal is within normal limits. The neural foramina are patent. IMPRESSION: 1. Large urinary bladder distention. 2. Nonspecific intramedullary T2 hyperintensity in the conus medullaris. Possible etiology may include myelitis, cord ischemia and spinal AVF.
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FINDINGS: Large urinary bladder distention is noted. The conus medullaris shows intramedullary T2 hyperintensity. There is no conus compressive lesion or perimedullary vascular engorgement. Posterior disc bulge mildly indents the ventral thecal sac at T10-T11. The conus terminus is seen at T12 level. The cauda equina nerve roots are not thickened. There are mild-to-moderate spinal canal stenosis at L4-L5 and mild stenosis at L3-L4 secondary to disc bulge with annular fissure and pronounced ligamentum flavum hypertrophy. Epidural lipomatosis within the lumbosacral canal is also noted. The vertebral marrow signal is within normal limits. The neural foramina are patent.
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Findings: CT C-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 Thoracic Spine wo contrast 1/23/2022 5:23 PM Clinical information: 68 years Female patient with worsening back pain after fall Spec Inst: RLE weakness, urinary incontinence Comparison: CT thoracic spine without contrast dated 1/23/2022 at 13:40 hours. Technique: Sagittal and axial T1, T2 and STIR images of the thoracic spine were obtained, without intravenous contrast administration. Findings: The sagittal images demonstrate persistent mild dextrocurvature of the upper thoracic spine, with accentuation of the thoracic kyphosis, without subluxations. The vertebral bodies maintain normal height, with scattered prominent Schmorl nodes and Modic type II changes. The intervertebral discs appear desiccated from decreased T2-weighted signal, with associated mild multilevel disc height loss. Diffuse expansion and abnormal confluent hyperintense T2-weighted spinal cord signal is noted, extending from the level of C6-C7 to the conus medullaris. Note is made of T3-T4,T4-T5, T6-T7, T7-T8 and T8-T9 central disc protrusions, with multilevel facet hypertrophy, resulting in mild T6-7spinal canal stenosis, without significant neuroforaminal narrowing. The paraspinal soft tissues appear unremarkable, without organized fluid collections. IMPRESSION: 1. Diffuse expansion and abnormal confluent hyperintense T2-weighted spinal cord signal, extending from the level of C6-C7 to the conus medullaris. Diagnostic possibilities include transverse myelitis, cord ischemia, less likely spinal AVF. 2. Chronic multilevel degenerative changes as described, most significant at T6-T7, resulting in mild spinal canal stenosis, without significant neuroforaminal narrowing.
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Findings: The sagittal images demonstrate persistent mild dextrocurvature of the upper thoracic spine, with accentuation of the thoracic kyphosis, without subluxations. The vertebral bodies maintain normal height, with scattered prominent Schmorl nodes and Modic type II changes. The intervertebral discs appear desiccated from decreased T2-weighted signal, with associated mild multilevel disc height loss. Diffuse expansion and abnormal confluent hyperintense T2-weighted spinal cord signal is noted, extending from the level of C6-C7 to the conus medullaris. Note is made of T3-T4,T4-T5, T6-T7, T7-T8 and T8-T9 central disc protrusions, with multilevel facet hypertrophy, resulting in mild T6-7spinal canal stenosis, without significant neuroforaminal narrowing. The paraspinal soft tissues appear unremarkable, without organized fluid collections.
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Findings: There is no evidence of acute intracranial hemorrhage, infarction, brain edema, mass effect or hydrocephalus. New mucosal thickening and frothy secretions in the right greater than left maxillary sinuses and scattered mucosal thickening in the ethmoid air cells. No acute calvarial fracture.
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EXAM:MR Shoulder Left wo contrast CLINICAL INFORMATION:Left shoulder pain and limited mobility COMPARISON: Prior left shoulder MRI dated 7/13/2016. Radiographs dated 11/4/2021.. TECHNIQUE:Multiplanar multisequence images were obtained through the left shoulder Findings: There is an intermediate grade bursal surface tear of the anterior margin of the supraspinatus insertion. The tear extends through approximately 50% of the tendon thickness, and there is overlying fluid in the subacromial/subdeltoid bursa. There is tendinosis of the infraspinatus without focal tear. Teres minor and subscapularis are unremarkable. The long head biceps tendon is intact and properly positioned within the bicipital groove. There is a moderate amount of debris around the tendon. The glenoid labrum is unremarkable. There is edema in the soft tissues of the rotator interval and tracking along the posterior glenohumeral joint capsule. There are moderate degenerative changes of the acromioclavicular joint. The type II acromion shows no abnormal downsloping. Impression: 1. Mild glenohumeral capsulitis. 2. Intermediate grade bursal surface tear of the anterior supraspinatus. 3. Fluid and synovial debris around the long head biceps tendon in the bicipital groove suggesting tenosynovitis.
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Findings: There is an intermediate grade bursal surface tear of the anterior margin of the supraspinatus insertion. The tear extends through approximately 50% of the tendon thickness, and there is overlying fluid in the subacromial/subdeltoid bursa. There is tendinosis of the infraspinatus without focal tear. Teres minor and subscapularis are unremarkable. The long head biceps tendon is intact and properly positioned within the bicipital groove. There is a moderate amount of debris around the tendon. The glenoid labrum is unremarkable. There is edema in the soft tissues of the rotator interval and tracking along the posterior glenohumeral joint capsule. There are moderate degenerative changes of the acromioclavicular joint. The type II acromion shows no abnormal downsloping.
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FINDINGS: There is no acute territorial loss of gray-white differentiation. There are left greater than right periventricular and corona radiata white matter hypodensities. There is no intracranial hemorrhage or extra-axial collection. There is no intracranial mass effect or midline shift. Mild central predominant chronic parenchymal volume loss with associated ventricular prominence. Basal cisterns are patent. Bilateral lens replacement. The visualized paranasal sinuses are clear. The mastoid air cells are clear. No calvarial fracture is appreciated.
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Clinical Information: Evaluation for stroke Comparison: Brain CT and CT angiogram neck dated 1/24/2022 Technique: Diffusion weighted series, sagittal T1, axial SWI, axial FLAIR, axial T2 FS, axial T1 postcontrast, and axial and coronal T1 FS postcontrast sequences were acquired of the brain. Patient weight: 200 lbs. IV contrast: ProHance, 10 ml, per protocol. Findings: There is diffuse cerebral volume loss, secondary to atrophic changes. There are also confluent areas of periventricular and deep white matter T2 FLAIR hyper signal intensity likely due to microangiopathic changes. There is a focus of diffusion restriction in the posterior aspect of right parietal lobe, suggesting of a tiny acute infarction. There is evidence of leptomeningeal T2 FLAIR hyperintensity within the left frontoparietal lobe compatible with subarachnoid hemorrhage, with associated susceptibility artifact and diffusion restriction in the left precentral gyrus. Prominent perivascular spaces is noted around the bilateral basal ganglia. Evidence of diffuse pachymeningeal enhancement is noted. Mucosal thickening but in bilateral maxillary sinuses, right sphenoid and bilateral ethmoid air cells is noted.. No acute osseous or soft tissue abnormality. Impression: 1. Evidence of left frontoparietal lobe subarachnoid hemorrhage. Trace intraventricular hemorrhage. 2. Diffuse cerebral volume loss due to atrophic changes with associated microangiopathic changes. 3.A focus of diffusion restriction in the posterior aspect of right parietal lobe, suggesting of a tiny acute/subacute infarction. 4. Mild pachymeningeal enhancement of unknown etiology but could be related to intracranial hypotension. 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 diffuse cerebral volume loss, secondary to atrophic changes. There are also confluent areas of periventricular and deep white matter T2 FLAIR hyper signal intensity likely due to microangiopathic changes. There is a focus of diffusion restriction in the posterior aspect of right parietal lobe, suggesting of a tiny acute infarction. There is evidence of leptomeningeal T2 FLAIR hyperintensity within the left frontoparietal lobe compatible with subarachnoid hemorrhage, with associated susceptibility artifact and diffusion restriction in the left precentral gyrus. Prominent perivascular spaces is noted around the bilateral basal ganglia. Evidence of diffuse pachymeningeal enhancement is noted. Mucosal thickening but in bilateral maxillary sinuses, right sphenoid and bilateral ethmoid air cells is noted.. No acute osseous or soft tissue abnormality.
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FINDINGS: BONES/JOINTS: Healing left distal femur fracture in stable alignment status post ORIF without interval complication. Right total knee arthroplasty projects in stable position without interval complication. Mildly displaced fracture of the superior pole of the patella. Probable associated injury to the distal quadriceps tendon. Degenerative changes at the proximal tibiofibular joint. SOFT TISSUES: Moderate hemarthrosis. Soft tissue swelling/contusion is present throughout the distal thigh and knee.
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15,267 |
MR Brain wo+w contrast 1/23/2022 5:33 PM Clinical information: 54 years Male patient with To evaluate for Empyema Spec Inst: STAT mri to evaluate for empyema Comparison: CT head without contrast dated 1/23/2022. Technique: Multiplanar, multisequence MRI of the brain was performed without the administration of intravenous contrast. Patient weight: 134 lbs. IV contrast: ProHance, 12 ml, per protocol. FINDINGS: Please note postcontrast and T2-weighted images are nondiagnostic due to severe motion artifacts. Cerebral parenchyma: The brain parenchyma volume is appropriate for patient's age. Minimal subcortical white matter long TR hyperintense signal foci, likely sequela of chronic migraine headaches. No intracranial mass lesion, hemorrhage, or infarction. Tiny cavum septum present. Ventricular system: No hydrocephalus or midline shift. Extra axial spaces: Thin left cerebral convexity subdural fluid collection demonstrates scattered internal areas of restricted diffusion with suspected peripheral enhancement, concerning for subdural empyema. Lack of complete CSF suppression along the left cerebral sulci likely secondary to meningitis. Vascular system: No loss of the major vascular flow voids. Visualized paranasal sinuses: No mucosal thickening. Visualized orbits: No ocular or retrobulbar pathology. Calvarium and skull base: No osseous destruction. Persistent left mastoid air cell opacification. The right mastoid air cells appear well aerated. Pituitary and Pineal Glands: No mass lesion. Soft tissues: No significant abnormality. IMPRESSION: 1. Nondiagnostic postcontrast and T2-weighted images due to severe motion artifacts. 2. Thin left cerebral convexity subdural fluid collection demonstrates scattered internal areas of restricted diffusion with suspected peripheral enhancement, concerning for subdural empyema. 3. Lack of complete CSF suppression along the left cerebral sulci, most likely secondary to meningitis. 4. Persistent opacification of the left mastoid air cells.
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FINDINGS: Please note postcontrast and T2-weighted images are nondiagnostic due to severe motion artifacts. Cerebral parenchyma: The brain parenchyma volume is appropriate for patient's age. Minimal subcortical white matter long TR hyperintense signal foci, likely sequela of chronic migraine headaches. No intracranial mass lesion, hemorrhage, or infarction. Tiny cavum septum present. Ventricular system: No hydrocephalus or midline shift. Extra axial spaces: Thin left cerebral convexity subdural fluid collection demonstrates scattered internal areas of restricted diffusion with suspected peripheral enhancement, concerning for subdural empyema. Lack of complete CSF suppression along the left cerebral sulci likely secondary to meningitis. Vascular system: No loss of the major vascular flow voids. Visualized paranasal sinuses: No mucosal thickening. Visualized orbits: No ocular or retrobulbar pathology. Calvarium and skull base: No osseous destruction. Persistent left mastoid air cell opacification. The right mastoid air cells appear well aerated. Pituitary and Pineal Glands: No mass lesion. Soft tissues: No significant abnormality.
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FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Small left anterior ethmoid sinus osteoma 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 Brain wo contrast 1/25/2022 5:01 PM Clinical information: 14 days Male patient with Increased tone Spec Inst: HIE Comparison: None available. Technique: Multiplanar, multisequence MRI of the brain was performed without the administration of intravenous contrast. FINDINGS: Cerebral parenchyma: Tiny foci of weak restricted diffusion, T1 shortening and SWI susceptibility artifact are noted along the subependymal surface of the right ventricular body and atrium, suggestive of small amount of subacute germinal matrix hemorrhage. The brain parenchyma volume is appropriate for patient's age. No intracranial mass lesion or infarction. Ventricular system: No hydrocephalus or midline shift. Extra axial spaces: No epidural, subdural, or subarachnoid hemorrhage. No basal cistern effacement. Vascular system: No loss of the major vascular flow voids. Visualized paranasal sinuses: Appropriate for patient's age. Visualized orbits: No ocular or retrobulbar pathology. Calvarium and skull base: No osseous destruction. Pituitary and Pineal Glands: No mass lesion. Soft tissues: Large left posterior parietal scalp cephalohematoma, measuring approximately 16 x 47.4 mm. IMPRESSION: 1. Tiny foci of weak restricted diffusion, T1 shortening and SWI susceptibility artifact along the subependymal surface of the right ventricular body and atrium, suggestive of small amount of subacute germinal matrix hemorrhage. 2. Large left posterior parietal scalp cephalohematoma, measuring approximately 16 x 47.4 mm.
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FINDINGS: Cerebral parenchyma: Tiny foci of weak restricted diffusion, T1 shortening and SWI susceptibility artifact are noted along the subependymal surface of the right ventricular body and atrium, suggestive of small amount of subacute germinal matrix hemorrhage. The brain parenchyma volume is appropriate for patient's age. No intracranial mass lesion or infarction. Ventricular system: No hydrocephalus or midline shift. Extra axial spaces: No epidural, subdural, or subarachnoid hemorrhage. No basal cistern effacement. Vascular system: No loss of the major vascular flow voids. Visualized paranasal sinuses: Appropriate for patient's age. Visualized orbits: No ocular or retrobulbar pathology. Calvarium and skull base: No osseous destruction. Pituitary and Pineal Glands: No mass lesion. Soft tissues: Large left posterior parietal scalp cephalohematoma, measuring approximately 16 x 47.4 mm.
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FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Small left anterior ethmoid sinus osteoma 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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Clinical history:Assess cerebellar mass Comparison:CT head performed 1/22/2022 Technique: Multiplanar multisequence noncontrast MRI images of the brain were obtained. After uneventful administration of intravenous contrast, postcontrast images were obtained. Patient weight: 210 lbs. IV contrast: ProHance, 20 ml, per protocol. Findings: There are multiple enhancing lesions involving the bilateral cerebellar hemispheres. The largest lesion measures approximately 3.5 x 2.9 x 2.7 cm and is centered on the vermis. These lesions demonstrate associated foci of magnetic susceptibility, consistent with foci of hemorrhage. There is also a 1.5 cm enhancing lesion in the medial left parietal lobe (series 16 image 199). Smaller lesion in the medial left frontal lobe. There is associated T2/FLAIR hyperintensity. Some of these lesions demonstrate restricted diffusion. There is mass effect with partial effacement of the fourth ventricle. There is no upstream hydrocephalus. In addition to these, there is increased bulk of left greater than right inferior rectus muscle with associated soft tissue stranding. The intracranial vascular flow voids are present. Minor scattered paranasal mucosal thickening. There is a small amount of fluid in the left mastoid air cells. No suspicious calvarial lesion is noted. Impression: 1. Multiple enhancing lesions involving predominantly the bilateral cerebellar hemisphere, with lesions in the supratentorial brain as well. Largest lesion in the vermis. Lesions demonstrate associated foci of magnetic susceptibility just increased foci of hemorrhage. Associated mass effect on the fourth ventricle, however no upstream hydrocephalus. 2. Also increased bulk of the left greater than right inferior rectus muscles with associated soft tissue swelling. Constellation of findings are worrisome for tumor involvement, with imaging pattern suggesting multifocal lymphoma. There is also mid ependymal enhancement along the right temporal horn (series 15 image 92, series 16 image 126).
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Findings: There are multiple enhancing lesions involving the bilateral cerebellar hemispheres. The largest lesion measures approximately 3.5 x 2.9 x 2.7 cm and is centered on the vermis. These lesions demonstrate associated foci of magnetic susceptibility, consistent with foci of hemorrhage. There is also a 1.5 cm enhancing lesion in the medial left parietal lobe (series 16 image 199). Smaller lesion in the medial left frontal lobe. There is associated T2/FLAIR hyperintensity. Some of these lesions demonstrate restricted diffusion. There is mass effect with partial effacement of the fourth ventricle. There is no upstream hydrocephalus. In addition to these, there is increased bulk of left greater than right inferior rectus muscle with associated soft tissue stranding. The intracranial vascular flow voids are present. Minor scattered paranasal mucosal thickening. There is a small amount of fluid in the left mastoid air cells. No suspicious calvarial lesion is noted.
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FINDINGS: There is no acute territorial loss of gray-white differentiation. There is no intracranial hemorrhage or extra-axial collection. There is no intracranial mass effect or midline shift. The ventricular caliber and configuration are within normal limits. Basal cisterns are patent. Imaged portions of the orbits are grossly unremarkable. Mild scattered paranasal mucosal thickening. The mastoid air cells are clear. No calvarial fracture is appreciated. Patient is intubated.
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Clinical history:Lost vision in the left eye Comparison:MRI 1/22/2022, CT 1/22/2022 Technique: Multiplanar multisequence MRI images of the brain and orbits were obtained before and after intravenous contrast administration. Patient weight: 143 lbs. IV contrast: ProHance, 7 ml, per protocol. IV contrast injection rate: 2 ml per sec. Patient weight: 143 lbs. IV contrast: ProHance, 7 ml, per protocol. IV contrast injection rate: 2 ml per sec. Findings: Bilateral maxillary antrostomy, ethmoidectomy, sphenoidotomy, nasal turbinectomy and septoplasty changes are noted. There is T2/STIR hyperintense, nonenhancing material in the posterior and lateral aspect of the right maxillary sinus. This is favored to be postsurgical debris. Interval decreased thickness, suspect due to resection/necrosis of the mucosa of the posterior superior right maxillary sinus (series 301 image 14, series 701 image 18,19). However, there is infiltrative nonenhancing soft tissue involving the right inferior rectus and adjacent to the lateral rectus muscles which also involves the intraorbital fat (series 901 image 59-61). Increased bulk of the right lateral rectus muscle again noted. There is increased conspicuity of restricted diffusion involving the intra-orbital right optic nerve. Mild asymmetric right proptosis. Impression: 1. Infiltrative nonenhancing soft tissue involving the right inferior rectus and adjacent to the lateral rectus muscles which also involves the intraorbital fat. Findings are highly worrisome invasive fungus with involvement of these extra ocular muscles. 2. Increased conspicuity restricted diffusion involving the intra-orbital right optic nerve, suspected be related to fungal infection. 3. Interval decreased thickness, suspect due to resection/necrosis of the mucosa of the posterior superior right maxillary sinus.
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Findings: Bilateral maxillary antrostomy, ethmoidectomy, sphenoidotomy, nasal turbinectomy and septoplasty changes are noted. There is T2/STIR hyperintense, nonenhancing material in the posterior and lateral aspect of the right maxillary sinus. This is favored to be postsurgical debris. Interval decreased thickness, suspect due to resection/necrosis of the mucosa of the posterior superior right maxillary sinus (series 301 image 14, series 701 image 18,19). However, there is infiltrative nonenhancing soft tissue involving the right inferior rectus and adjacent to the lateral rectus muscles which also involves the intraorbital fat (series 901 image 59-61). Increased bulk of the right lateral rectus muscle again noted. There is increased conspicuity of restricted diffusion involving the intra-orbital right optic nerve. Mild asymmetric right proptosis.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: There is a large area of consolidation within the inferior right upper lobe with close proximity to the right hilum with air bronchograms. Extent is difficult to measure with a more rounded area of consolidation located superiorly measuring approximately 3.2 x 2.9 cm. A small noncalcified nodule is seen more laterally measuring 0.6 x 0.6 cm) series and one image 47). Extensive surrounding interlobular septal thickening around this region. Moderate biapical predominant centrilobular emphysema. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Enlarged right pretracheal lymph node measures 2.1 x 1.4 cm (series 201 image 47). Enlarged subcarinal node measures 2.8 x 1.7 cm) series and one image 57). Several additional prominent superior mediastinal nodes are also noted. No supraclavicular or axillary lymphadenopathy. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Imaged portions of superior abdomen demonstrate: Lithiasis without cholecystitis. Otherwise unremarkable for unenhanced technique. MUSCULOSKELETAL: No evidence of aggressive osseous lesion or acute fracture.
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MRI brain without Indication: Dizziness, non-specific Comparison: 1/23/2022 Technique: Multiple T1 and T2-weighted MR sequence images of the brain were obtained in the sagittal axial and coronal planes without administration of intravenous contrast per departmental protocol. Findings: There is no restricted diffusion. There are chronic encephalomalacia involving the left occipital lobe. There is subtle T2/flair hyperintense signal in the right occipital lobe, likely chronic ischemic changes. There are T-2/flair hyperintense signal in the right centrum semiovale and extending along the lateral aspect of the right frontal lobe, likely chronic changes. Remaining brain parenchyma is within normal limits. There is no hydrocephalus. There are increased susceptibility in the right occipital lobe, likely chronic microhemorrhages. There are scattered increased susceptibility in the right frontal and left parietal lobes. Posterior fossa and midline structures are within normal limits. Bilateral IACs and inner ear structures are within normal limits, given the limitation of the technique. There is diffuse opacification of the left maxillary sinus, likely chronic sinusitis. Impression: 1. No acute intracranial process is identified. No definite MRI lesion to explain patient's symptoms, given the limitation of noncontrast technique. See comment for multiple chronic ischemic changes in the bilateral occipital lobes, left greater than right and right frontal centrum semiovale as described above. 2. Chronic left maxillary sinusitis.
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Findings: There is no restricted diffusion. There are chronic encephalomalacia involving the left occipital lobe. There is subtle T2/flair hyperintense signal in the right occipital lobe, likely chronic ischemic changes. There are T-2/flair hyperintense signal in the right centrum semiovale and extending along the lateral aspect of the right frontal lobe, likely chronic changes. Remaining brain parenchyma is within normal limits. There is no hydrocephalus. There are increased susceptibility in the right occipital lobe, likely chronic microhemorrhages. There are scattered increased susceptibility in the right frontal and left parietal lobes. Posterior fossa and midline structures are within normal limits. Bilateral IACs and inner ear structures are within normal limits, given the limitation of the technique. There is diffuse opacification of the left maxillary sinus, likely chronic sinusitis.
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FINDINGS: STRUCTURED REPORT: CTA Abdomen Pelvis VASCULATURE: DISTAL DESCENDING THORACIC AORTA: No significant abnormality. ABDOMINAL AORTA: No significant abnormality. CELIAC AXIS: No significant abnormality. SMA: No significant abnormality. RIGHT RENAL: No significant abnormality. LEFT RENAL: No significant abnormality. IMA: No significant abnormality. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. ------------------------------------------------------------- LOWER CHEST: LUNG BASES / PLEURA: Partially imaged extensive groundglass opacities with interlobular septal thickening of the bilateral lung bases. Small left pleural effusion. There is increasing gas within a hypoattenuating collection in the anterior/mid left pleural space measuring approximately 7.0 x 3.5 cm, somewhat branching in appearance with areas of tracking into the chest wall. CHEST WALL: New soft tissue gas in the lateral left chest wall/axillary region. Similar appearance of left lateral chest wall intramuscular hematoma. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Small pericardial effusion. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Surgically absent. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube is looped within the mid gastric body. Stomach and small bowel otherwise unremarkable throughout. COLON / APPENDIX: Hyperdense material is seen throughout the colon without colonic wall thickening or pericolonic fat stranding. PERITONEUM / MESENTERY: Trace pelvic ascites. No free intraperitoneal air. RETROPERITONEUM: Normal. OTHER VESSELS: Left common femoral vein ECMO cannula with tip terminating at the inferior cavoatrial junction. A right common femoral vein central venous catheter is seen with tip terminating at the proximal right common iliac vein. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Increasing size of left rectus sheath hematoma the inferior portion with new hematocrit level. There is a slightly prominent vessel tracking through this area which appears to become slightly more conspicuous on portal venous phase. Questionable trace extravasation on series 10 image 186. Hematoma measures approximately 6.1 x 4.6 x 5.8 cm (series 6 image 215 and series 12 image 160). MUSCULOSKELETAL: No evidence of aggressive osseous lesion or acute fracture. Unchanged appearance of left rib fractures with associated fixation hardware. Chronic left L1-L5 left transverse process fractures are unchanged.
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MRI brain without Indication: Left sided weakness Comparison: CT head from 1/23/2022 Technique: Multiple T1 and T2-weighted MR sequence images of the brain were obtained in the sagittal axial and coronal planes without administration of intravenous contrast per departmental protocol. Findings: There is no restricted diffusion. There is no acute hemorrhage or mass effect. There are scattered T-2/flair hyperintense foci in the bilateral periventricular white matter, likely microangiopathic changes. There is mild diffuse cerebral atrophy. Posterior fossa and midline structures are within normal limits. Pituitary gland is unremarkable. Intracranial vascular flow voids are well preserved. Incidental note is made of right maxillary sinus mucus retention cyst. Impression: No acute intracranial process.
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Findings: There is no restricted diffusion. There is no acute hemorrhage or mass effect. There are scattered T-2/flair hyperintense foci in the bilateral periventricular white matter, likely microangiopathic changes. There is mild diffuse cerebral atrophy. Posterior fossa and midline structures are within normal limits. Pituitary gland is unremarkable. Intracranial vascular flow voids are well preserved. Incidental note is made of right maxillary sinus mucus retention cyst.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DIST2AL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. KIDNEYS: Excreted contrast within both renal collecting systems limits evaluation for small stone. Mild asymmetric distention of the right renal pelvis and calyces is present related to normal excretion. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No free intraperitoneal air. Trace free fluid in the pelvis, likely physiologic in a patient of this age. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is present. Bilateral ovaries appear unremarkable. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous lesion or acute fracture. Posterior lumbosacral fusion hardware spanning L5-S1.
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MR Brain wo contrast 1/25/2022 12:31 PM Clinical Information: Left-sided weakness Comparison: CT angiogram head dated 1/23/2022 Technique: Diffusion weighted series, sagittal T1, axial SWI, axial FLAIR, and axial T2 FS sequences were acquired of the brain without the use of intravenous contrast. Findings: There is diffuse cerebral volume loss with associated ex vacuo dilatation of ventricular system, secondary to atrophic changes. There is also scattered areas of T2 FLAIR hyper signal intensity in the periventricular and deep white matter, suggesting microangiopathic changes. There are scattered foci of diffusion restriction in the right and left cerebellar hemispheres. Left posterior occipital lobe and right medial temporal lobe adjacent to insular cortex. There are also scattered foci of diffusion restriction in bilateral frontoparietal gyri, which most of them do not show corresponding changes on ADC value, but the one in the posterior aspect of right parietal lobe seems to be real, these lesions are located in the multiple arterial territory mostly compatible with a thromboembolic source. No Intracranial mass, mass effect, edema, hemorrhage, hydrocephalus is noted. The visualized paranasal sinuses and mastoid air cells are clear. No acute osseous or soft tissue abnormality. Impression: 1. Diffuse cerebral volume loss associated with microangiopathic changes. 2. Evidence of acute/early subacute tiny infarcts in bilateral cerebellar hemispheres, left posterior occipital and right medial temporal lobe, mostly compatible with a thromboembolic source. Most prominent infarct is present in the right posterior insula. 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 diffuse cerebral volume loss with associated ex vacuo dilatation of ventricular system, secondary to atrophic changes. There is also scattered areas of T2 FLAIR hyper signal intensity in the periventricular and deep white matter, suggesting microangiopathic changes. There are scattered foci of diffusion restriction in the right and left cerebellar hemispheres. Left posterior occipital lobe and right medial temporal lobe adjacent to insular cortex. There are also scattered foci of diffusion restriction in bilateral frontoparietal gyri, which most of them do not show corresponding changes on ADC value, but the one in the posterior aspect of right parietal lobe seems to be real, these lesions are located in the multiple arterial territory mostly compatible with a thromboembolic source. No Intracranial mass, mass effect, edema, hemorrhage, hydrocephalus is noted. The visualized paranasal sinuses and mastoid air cells are clear. No acute osseous or soft tissue abnormality.
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FINDINGS: When measured in similar fashion, there has been no significant change in 7.9 x 4.6 x 4.5 cm large hematoma centered on the left basal ganglia. Unchanged 9 mm rightward midline shift (coronal image 44). Also medialization of the uncus is again noted. Mild increase surrounding parenchymal edema. There is no new hemorrhage. Again noted partial effacement of the left lateral ventricle, without frank hydrocephalus. Bilateral small maxillary mucus retention cysts. Following fluid in the left mastoid air cells. No foreign bodies in bilateral external auditory canal. There is no acute osseous finding.
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15,274 |
EXAM: MR Orbit wo+w contrast, MR Brain wo+w contrast CLINICAL INFORMATION: Longitudinally extensive myelopathy. COMPARISON: None. TECHNIQUE: MR Orbit wo+w contrast, MR Brain wo+w contrast. Patient weight: 197 lbs. IV contrast: ProHance, 19 ml, per protocol. FINDINGS: Scattered relatively symmetric appearing regions of white matter restricted diffusion involving the bilateral occipital lobes, bilateral centrum semiovale as well as a portion of the bilateral posterior limb of the internal capsules. These regions show associated increased T2/FLAIR signal as well as mild contrast enhancement.. . No abnormal susceptibility signal dropout. Brainstem is unremarkable. Craniocervical junction appears unremarkable. No extra-axial collection. The ventricles are within normal size limits and there is no midline shift. T2 vascular flow voids are normal. No abnormal bone marrow signal. Mucus retention cysts within the inferior right maxillary sinus. The remaining paranasal sinuses and mastoid air cells are clear. The globes are normal. There is no abnormal increased T2/FLAIR signal involving the prechiasmatic optic nerves as well as no abnormal optic nerve enhancement although images are degraded by motion artifact. No abnormal lymph nodes or significant soft tissue abnormality. CONCLUSION: 01. Symmetric regions of restricted diffusion, increased FLAIR signal, and mild contrast enhancement involving the white matter of the bilateral parietal occipital lobes as well as the posterior limbs of the bilateral internal capsules. These findings are nonspecific and may represent demyelination Vasculitis or lymphoma are additional possibilities.. 02. No abnormality of the optic nerves or optic chiasm. 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: Scattered relatively symmetric appearing regions of white matter restricted diffusion involving the bilateral occipital lobes, bilateral centrum semiovale as well as a portion of the bilateral posterior limb of the internal capsules. These regions show associated increased T2/FLAIR signal as well as mild contrast enhancement.. . No abnormal susceptibility signal dropout. Brainstem is unremarkable. Craniocervical junction appears unremarkable. No extra-axial collection. The ventricles are within normal size limits and there is no midline shift. T2 vascular flow voids are normal. No abnormal bone marrow signal. Mucus retention cysts within the inferior right maxillary sinus. The remaining paranasal sinuses and mastoid air cells are clear. The globes are normal. There is no abnormal increased T2/FLAIR signal involving the prechiasmatic optic nerves as well as no abnormal optic nerve enhancement although images are degraded by motion artifact. No abnormal lymph nodes or significant soft tissue abnormality.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Unchanged partial consolidation of the left lower lobe. Mild right basilar dependent atelectasis. DISTAL ESOPHAGUS: Concentric distal esophageal wall thickening, which is similar in appearance to prior and can be seen in the setting of gastroesophageal reflux. HEART / VESSELS: The heart size is normal without pericardial effusion. ABDOMEN and PELVIS: LIVER: Normal configuration. A few subcentimeter hypoattenuating lesions are too small to characterize. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Large irregular region of hypoattenuation within the splenic parenchyma, similar to prior. ADRENALS: Normal. KIDNEYS: Symmetric bilateral enhancement without hydroureteronephrosis. Small amount of retained contrast is seen within the bilateral collecting systems. Punctate nonobstructing calculus in the left lower and right upper pole. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The colon is unremarkable. Normal appendix. PERITONEUM / MESENTERY: No intraperitoneal free fluid or free air. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Bilateral hydroceles and/or scrotal wall thickening. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: Focal erosive changes are again seen along the inferior endplate of T9 and superior endplate of T10, better appreciated on same day MRI thoracic spine. Partially visualized post median sternotomy changes.
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EXAM: MR Orbit wo+w contrast, MR Brain wo+w contrast CLINICAL INFORMATION: Longitudinally extensive myelopathy. COMPARISON: None. TECHNIQUE: MR Orbit wo+w contrast, MR Brain wo+w contrast. Patient weight: 197 lbs. IV contrast: ProHance, 19 ml, per protocol. FINDINGS: Scattered relatively symmetric appearing regions of white matter restricted diffusion involving the bilateral occipital lobes, bilateral centrum semiovale as well as a portion of the bilateral posterior limb of the internal capsules. These regions show associated increased T2/FLAIR signal as well as mild contrast enhancement.. . No abnormal susceptibility signal dropout. Brainstem is unremarkable. Craniocervical junction appears unremarkable. No extra-axial collection. The ventricles are within normal size limits and there is no midline shift. T2 vascular flow voids are normal. No abnormal bone marrow signal. Mucus retention cysts within the inferior right maxillary sinus. The remaining paranasal sinuses and mastoid air cells are clear. The globes are normal. There is no abnormal increased T2/FLAIR signal involving the prechiasmatic optic nerves as well as no abnormal optic nerve enhancement although images are degraded by motion artifact. No abnormal lymph nodes or significant soft tissue abnormality. CONCLUSION: 01. Symmetric regions of restricted diffusion, increased FLAIR signal, and mild contrast enhancement involving the white matter of the bilateral parietal occipital lobes as well as the posterior limbs of the bilateral internal capsules. These findings are nonspecific and may represent demyelination Vasculitis or lymphoma are additional possibilities.. 02. No abnormality of the optic nerves or optic chiasm. 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: Scattered relatively symmetric appearing regions of white matter restricted diffusion involving the bilateral occipital lobes, bilateral centrum semiovale as well as a portion of the bilateral posterior limb of the internal capsules. These regions show associated increased T2/FLAIR signal as well as mild contrast enhancement.. . No abnormal susceptibility signal dropout. Brainstem is unremarkable. Craniocervical junction appears unremarkable. No extra-axial collection. The ventricles are within normal size limits and there is no midline shift. T2 vascular flow voids are normal. No abnormal bone marrow signal. Mucus retention cysts within the inferior right maxillary sinus. The remaining paranasal sinuses and mastoid air cells are clear. The globes are normal. There is no abnormal increased T2/FLAIR signal involving the prechiasmatic optic nerves as well as no abnormal optic nerve enhancement although images are degraded by motion artifact. No abnormal lymph nodes or significant soft tissue abnormality.
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Findings: Evolving left cerebral parenchymal hemorrhage with extensive surrounding vasogenic edema, mass effect and stable rightward midline shift by 3 mm. Ischemic infarction in left temporal lobe shows temporal evolution. There is also evolving infarction in the right inferior cerebellum. Remaining brain shows no acute change. No new hemorrhage. The visualized paranasal sinuses, mastoid air cells and middle ear cavities are clear. Both orbits appear normal.
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15,276 |
EXAM: MR Thoracic Spine with contrast, MR Cervical Spine wo+w contrast CLINICAL INFORMATION: Concern for longitudinally extensive transverse myelitis. COMPARISON: MR thoracic spine dated 1/23/2022. TECHNIQUE: Axial and coronal T1 postcontrast images of the thoracic spine were obtained. Multisequence multiplanar MR the cervical spine before and after the administration of intravenous contrast was also obtained.. Patient weight: 197 lbs. IV contrast: ProHance, 19 ml, per protocol. FINDINGS: CERVICAL SPINE: No acute displaced fracture or depression deformity. No abnormal bone marrow signal. No spondylolisthesis. Mild discogenic degenerative change throughout the cervical spine. Heterogeneous increased T2 signal and cord expansion previously noted on the recent thoracic spine MR is redemonstrated and begins at the C6-C7 disc level. There is associated patchy regions of mild contrast enhancement. There is however patchy T2 hyperintense signal within the upper cervical spinal cord from C3 to C5 primarily involving the lateral tracts.. There is also suggestion of faint enhancement within the brainstem, better seen on current exam compared to MRI of the brain which was significantly degraded by motion artifact C2-C3: No significant disc bulge, spinal canal, or left foraminal narrowing. Mild right uncovertebral hypertrophy resulting in mild right foraminal narrowing. C3-C4: Mild broad-based disc bulge with extension into the subarticular and foraminal regions. Mild spinal canal narrowing with indentation of the anterior cord. No abnormal cord signal at this level. There is mild right neural foraminal narrowing. There is no left foraminal narrowing.. C4-C5: Broad-based disc bulge most pronounced centrally with mild associated uncovertebral hypertrophy. There is associated moderate spinal canal narrowing with anterior indentation on the cord. There is mild bilateral neural foraminal narrowing. C5-C6: Mild broad-based disc bulge without spinal canal narrowing. No abnormal foraminal narrowing. C6-C7: Mild broad-based disc bulge without significant spinal canal or left foraminal narrowing. Mild right uncovertebral hypertrophy with mild right foraminal narrowing. C7-T1: No significant disc bulge, spinal canal, or foraminal narrowing. No significant soft tissue abnormality. THORACIC SPINE: Limited postcontrast T1 sequences show redemonstration of the heterogeneous thoracic cord expansion extending from the level of C6-C7 to the inferior aspect of T12. There is associated heterogeneous contrast enhancement throughout the cord with multiple foci of enhancement noted laterally with relative sparing of the central gray matter. CONCLUSION: 01. Redemonstrated heterogeneous thoracic cord expansion shows patchy regions of contrast enhancement suggestive of active demyelination. Enhancement is preferentially lateral possibly involving the lateral corticospinal tract and possibly rubrospinal tract 02. There is also abnormal T2 signal and enhancement within the cervical spinal cord and also involving the inferior brainstem. Enhancement is again predominantly involving lateral tracts 03. Multilevel mild degenerative disc disease within the cervical spine. There are also mild to moderate degenerative disc changes within the thoracic spine described in more detail on prior thoracic spine MRI report 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: CERVICAL SPINE: No acute displaced fracture or depression deformity. No abnormal bone marrow signal. No spondylolisthesis. Mild discogenic degenerative change throughout the cervical spine. Heterogeneous increased T2 signal and cord expansion previously noted on the recent thoracic spine MR is redemonstrated and begins at the C6-C7 disc level. There is associated patchy regions of mild contrast enhancement. There is however patchy T2 hyperintense signal within the upper cervical spinal cord from C3 to C5 primarily involving the lateral tracts.. There is also suggestion of faint enhancement within the brainstem, better seen on current exam compared to MRI of the brain which was significantly degraded by motion artifact C2-C3: No significant disc bulge, spinal canal, or left foraminal narrowing. Mild right uncovertebral hypertrophy resulting in mild right foraminal narrowing. C3-C4: Mild broad-based disc bulge with extension into the subarticular and foraminal regions. Mild spinal canal narrowing with indentation of the anterior cord. No abnormal cord signal at this level. There is mild right neural foraminal narrowing. There is no left foraminal narrowing.. C4-C5: Broad-based disc bulge most pronounced centrally with mild associated uncovertebral hypertrophy. There is associated moderate spinal canal narrowing with anterior indentation on the cord. There is mild bilateral neural foraminal narrowing. C5-C6: Mild broad-based disc bulge without spinal canal narrowing. No abnormal foraminal narrowing. C6-C7: Mild broad-based disc bulge without significant spinal canal or left foraminal narrowing. Mild right uncovertebral hypertrophy with mild right foraminal narrowing. C7-T1: No significant disc bulge, spinal canal, or foraminal narrowing. No significant soft tissue abnormality. THORACIC SPINE: Limited postcontrast T1 sequences show redemonstration of the heterogeneous thoracic cord expansion extending from the level of C6-C7 to the inferior aspect of T12. There is associated heterogeneous contrast enhancement throughout the cord with multiple foci of enhancement noted laterally with relative sparing of the central gray matter.
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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: Small left lateral periorbital contusion. No evidence of orbital soft tissue injury. SINUSES: Normal.
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15,277 |
EXAM: MR Thoracic Spine with contrast, MR Cervical Spine wo+w contrast CLINICAL INFORMATION: Concern for longitudinally extensive transverse myelitis. COMPARISON: MR thoracic spine dated 1/23/2022. TECHNIQUE: Axial and coronal T1 postcontrast images of the thoracic spine were obtained. Multisequence multiplanar MR the cervical spine before and after the administration of intravenous contrast was also obtained.. Patient weight: 197 lbs. IV contrast: ProHance, 19 ml, per protocol. FINDINGS: CERVICAL SPINE: No acute displaced fracture or depression deformity. No abnormal bone marrow signal. No spondylolisthesis. Mild discogenic degenerative change throughout the cervical spine. Heterogeneous increased T2 signal and cord expansion previously noted on the recent thoracic spine MR is redemonstrated and begins at the C6-C7 disc level. There is associated patchy regions of mild contrast enhancement. There is however patchy T2 hyperintense signal within the upper cervical spinal cord from C3 to C5 primarily involving the lateral tracts.. There is also suggestion of faint enhancement within the brainstem, better seen on current exam compared to MRI of the brain which was significantly degraded by motion artifact C2-C3: No significant disc bulge, spinal canal, or left foraminal narrowing. Mild right uncovertebral hypertrophy resulting in mild right foraminal narrowing. C3-C4: Mild broad-based disc bulge with extension into the subarticular and foraminal regions. Mild spinal canal narrowing with indentation of the anterior cord. No abnormal cord signal at this level. There is mild right neural foraminal narrowing. There is no left foraminal narrowing.. C4-C5: Broad-based disc bulge most pronounced centrally with mild associated uncovertebral hypertrophy. There is associated moderate spinal canal narrowing with anterior indentation on the cord. There is mild bilateral neural foraminal narrowing. C5-C6: Mild broad-based disc bulge without spinal canal narrowing. No abnormal foraminal narrowing. C6-C7: Mild broad-based disc bulge without significant spinal canal or left foraminal narrowing. Mild right uncovertebral hypertrophy with mild right foraminal narrowing. C7-T1: No significant disc bulge, spinal canal, or foraminal narrowing. No significant soft tissue abnormality. THORACIC SPINE: Limited postcontrast T1 sequences show redemonstration of the heterogeneous thoracic cord expansion extending from the level of C6-C7 to the inferior aspect of T12. There is associated heterogeneous contrast enhancement throughout the cord with multiple foci of enhancement noted laterally with relative sparing of the central gray matter. CONCLUSION: 01. Redemonstrated heterogeneous thoracic cord expansion shows patchy regions of contrast enhancement suggestive of active demyelination. Enhancement is preferentially lateral possibly involving the lateral corticospinal tract and possibly rubrospinal tract 02. There is also abnormal T2 signal and enhancement within the cervical spinal cord and also involving the inferior brainstem. Enhancement is again predominantly involving lateral tracts 03. Multilevel mild degenerative disc disease within the cervical spine. There are also mild to moderate degenerative disc changes within the thoracic spine described in more detail on prior thoracic spine MRI report 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: CERVICAL SPINE: No acute displaced fracture or depression deformity. No abnormal bone marrow signal. No spondylolisthesis. Mild discogenic degenerative change throughout the cervical spine. Heterogeneous increased T2 signal and cord expansion previously noted on the recent thoracic spine MR is redemonstrated and begins at the C6-C7 disc level. There is associated patchy regions of mild contrast enhancement. There is however patchy T2 hyperintense signal within the upper cervical spinal cord from C3 to C5 primarily involving the lateral tracts.. There is also suggestion of faint enhancement within the brainstem, better seen on current exam compared to MRI of the brain which was significantly degraded by motion artifact C2-C3: No significant disc bulge, spinal canal, or left foraminal narrowing. Mild right uncovertebral hypertrophy resulting in mild right foraminal narrowing. C3-C4: Mild broad-based disc bulge with extension into the subarticular and foraminal regions. Mild spinal canal narrowing with indentation of the anterior cord. No abnormal cord signal at this level. There is mild right neural foraminal narrowing. There is no left foraminal narrowing.. C4-C5: Broad-based disc bulge most pronounced centrally with mild associated uncovertebral hypertrophy. There is associated moderate spinal canal narrowing with anterior indentation on the cord. There is mild bilateral neural foraminal narrowing. C5-C6: Mild broad-based disc bulge without spinal canal narrowing. No abnormal foraminal narrowing. C6-C7: Mild broad-based disc bulge without significant spinal canal or left foraminal narrowing. Mild right uncovertebral hypertrophy with mild right foraminal narrowing. C7-T1: No significant disc bulge, spinal canal, or foraminal narrowing. No significant soft tissue abnormality. THORACIC SPINE: Limited postcontrast T1 sequences show redemonstration of the heterogeneous thoracic cord expansion extending from the level of C6-C7 to the inferior aspect of T12. There is associated heterogeneous contrast enhancement throughout the cord with multiple foci of enhancement noted laterally with relative sparing of the central gray matter.
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FINDINGS: HEAD: BRAIN PARENCHYMVA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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MRI brain: Partial study: History: Lacunar infarct involving the left pons. Technique: Axial DWI, axial FLAIR and axial T2 weighted images were obtained. Comparison: 1/23/2022 Findings/ impression: The diagnostic utility images is significantly reduced by movement artifacts. There is no definite restricted diffusion in the brain to suggest acute infarct. Remaining images are nondiagnostic. There is chronic sinusitis involving the right maxillary sinus. Please repeat the study, whenever feasible.
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Findings/ impression: The diagnostic utility images is significantly reduced by movement artifacts. There is no definite restricted diffusion in the brain to suggest acute infarct. Remaining images are nondiagnostic. There is chronic sinusitis involving the right maxillary sinus. Please repeat the study, whenever feasible.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Trace biapical pleural-parenchymal scarring. No focal consolidations, pleural effusion or pneumothorax. There is a small calcified granuloma in the right lower lobe. Central airways are patent.. HEART / VESSELS: Cardiac chambers and great vessels are normal in size. No central PE. No pericardial effusion. Trace LAD calcifications. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Technically indeterminate subcentimeter hypoattenuating right hepatic dome lesion measuring approximately 9 mm (series 501 image 284) is too small to characterize by CT, likely a cyst. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No acute abnormality. Noninflamed diverticula. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Small left pelvic sidewall hematoma. VESSELS: Minimal atherosclerosis of the aorta. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Enlarged with median lobe hypertrophy. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Minimally displaced fractures of the left superior pubic ramus extending into the pubic acetabular junction, and nondisplaced left inferior pubic ramus fracture. Minimally displaced fracture of the posterolateral aspect of the left seventh rib. No aggressive osseous lesion. Small bone island of the right iliac bone. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No traumatic malalignment. LUMBAR SPINE: VERTEBRA: No fracture. Congenital nonunion of the bilateral L1 transverse processes. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No traumatic malalignment.
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MRI Brain W/O CONTRAST HISTORY: Left-sided weakness TECHNIQUE: Multiplanar and multisequence magnetic resonance imaging of the brain was performed without intravenous contrast. COMPARISON: CT dated 1/24/2022 FINDINGS: Diffusion restriction is noted in right temporoparietal lobes. There is also scattered areas of diffusion restriction adjacent to the right insular cortex and superficial part of right temporal lobe. Associated mild T2/FLAIR hyperintensity. No evidence of hemorrhagic conversion. Small focus of magnetic susceptibility in the right sylvian fissure, possibly related to intraluminal thrombus, better seen on CTA. There is chronic encephalomalacia in the left frontal lobe. There is mild diffuse cerebral volume loss with associated mild ex vacuo ventricular dilatation, secondary to atrophic changes. There is bilateral periventricular and deep white matter FLAIR hyper signal intensity, suggesting of microangiopathic changes. Mild paranasal mucosal thickening. Small fluid in the left mastoid air cells. The orbits are unremarkable. IMPRESSION: Multifocal moderate size infarcts in the posterior right middle cerebral artery territory. No evidence of hemorrhagic conversion. 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: Diffusion restriction is noted in right temporoparietal lobes. There is also scattered areas of diffusion restriction adjacent to the right insular cortex and superficial part of right temporal lobe. Associated mild T2/FLAIR hyperintensity. No evidence of hemorrhagic conversion. Small focus of magnetic susceptibility in the right sylvian fissure, possibly related to intraluminal thrombus, better seen on CTA. There is chronic encephalomalacia in the left frontal lobe. There is mild diffuse cerebral volume loss with associated mild ex vacuo ventricular dilatation, secondary to atrophic changes. There is bilateral periventricular and deep white matter FLAIR hyper signal intensity, suggesting of microangiopathic changes. Mild paranasal mucosal thickening. Small fluid in the left mastoid air cells. The orbits are unremarkable.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Trace biapical pleural-parenchymal scarring. No focal consolidations, pleural effusion or pneumothorax. There is a small calcified granuloma in the right lower lobe. Central airways are patent.. HEART / VESSELS: Cardiac chambers and great vessels are normal in size. No central PE. No pericardial effusion. Trace LAD calcifications. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Technically indeterminate subcentimeter hypoattenuating right hepatic dome lesion measuring approximately 9 mm (series 501 image 284) is too small to characterize by CT, likely a cyst. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No acute abnormality. Noninflamed diverticula. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Small left pelvic sidewall hematoma. VESSELS: Minimal atherosclerosis of the aorta. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Enlarged with median lobe hypertrophy. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Minimally displaced fractures of the left superior pubic ramus extending into the pubic acetabular junction, and nondisplaced left inferior pubic ramus fracture. Minimally displaced fracture of the posterolateral aspect of the left seventh rib. No aggressive osseous lesion. Small bone island of the right iliac bone. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No traumatic malalignment. LUMBAR SPINE: VERTEBRA: No fracture. Congenital nonunion of the bilateral L1 transverse processes. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No traumatic malalignment.
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Clinical history:Seizure Comparison:CT head 1/23/2022, 5/17/2021 Technique: Multiplanar multisequence noncontrast MRI images of the brain were obtained. After uneventful administration of intravenous contrast, postcontrast images were obtained. Patient weight: 128 lbs. IV contrast: ProHance, 6 ml, per protocol. Findings: There is no enhancing intracranial mass or abnormal enhancement. There is no restricted diffusion to suggest an acute infarct. There is no evidence of acute hemorrhage on the susceptibility weighted images. There is unchanged moderate dilatation of the ventricular system and compared to the sulci, consistent with moderate hydrocephalus. There is trans-ependymal CSF flow related signal along the occipital horns. Prominent left occipital arachnoid granulation. There are moderate periventricular and deep white matter predominant chronic microangiopathic changes. The intracranial vascular flow voids are present. Minor scattered paranasal mucosal thickening. Mastoid air cells are clear. The orbits are within normal limits. No suspicious calvarial lesion is noted. Impression: 1. No acute infarcts, or abnormal intracranial enhancement. 2. Moderate hydrocephalus is unchanged. Also associated transependymal CSF signal.
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Findings: There is no enhancing intracranial mass or abnormal enhancement. There is no restricted diffusion to suggest an acute infarct. There is no evidence of acute hemorrhage on the susceptibility weighted images. There is unchanged moderate dilatation of the ventricular system and compared to the sulci, consistent with moderate hydrocephalus. There is trans-ependymal CSF flow related signal along the occipital horns. Prominent left occipital arachnoid granulation. There are moderate periventricular and deep white matter predominant chronic microangiopathic changes. The intracranial vascular flow voids are present. Minor scattered paranasal mucosal thickening. Mastoid air cells are clear. The orbits are within normal limits. No suspicious calvarial lesion is noted.
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FINDINGS: HEAD: BRAIN PARENCHYMVA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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MRI OF THE CERVICAL SPINE WITHOUT AND WITH CONTRAST CLINICAL INDICATION: Assess for myelopathy TECHNIQUE: Multiplanar multisequence MRI images of the cervical spine were obtained before and after intravenous contrast administration. COMPARISON: CT cervical spine 1/23/2022, 5/17/2021 FINDINGS: Submitted images are degraded due to involuntary patient motion. There is trace anterolisthesis of C3 over C4. The vertebral body heights are maintained. Multilevel disc degenerative changes, most notable moderate disc height loss at C5-C6. There is no suspicious bone marrow signal abnormality. Continued the limitation of motion, there is no definite cord signal abnormality. No mass or abnormal fluid collection is present within the cervical spinal canal. The paravertebral soft tissues are unremarkable. Best possible assessment, accounting for motion degradation. Moderate degenerative changes at C1-C2. At C2-C3, right uncovertebral and facet hypertrophy results in moderate right neuroforaminal stenosis. No significant spinal canal stenosis. At C3-C4, combination of bilateral moderate uncovertebral and facet hypertrophy results in bilateral moderate neuroforaminal stenosis. Also disc bulge and ligamentum flavum hypertrophy, without significant spinal canal stenosis At C4-C5, combination of bilateral uncovertebral, severe right and moderate left facet hypertrophy results in moderate to severe right and mild left neuroforaminal stenosis. Mild ligamentum flavum hypertrophy, without significant spinal canal stenosis. At C5-C6, combination of disc bulge, right greater than left uncovertebral hypertrophy, and severe right and moderate left facet hypertrophy results in severe right and moderate left neuroforaminal stenosis. Also ligamentum flavum hypertrophy with mild spinal canal narrowing. At C6-C7, asymmetric left disc bulge, left greater than right uncovertebral facet hypertrophy results in moderate to severe left and mild-to-moderate right neuroforaminal narrowing. At C7-T1, mild uncovertebral facet hypertrophy without significant spinal canal or neuroforaminal stenosis. There is small amount of enhancement adjacent to the left C7-T1 facet joint which involves the lateral pillars, and extends into the neural foramina, which is favored to be degenerative in nature. IMPRESSION: Multilevel cervical spine spondylosis, most pronounced at C5-C6, with severe right and moderate left neuroforaminal stenosis. Also mild spinal canal narrowing at this level. No definite cord signal abnormality on the motion degraded study. Also advanced neuroforaminal stenosis at right C4-C5 and right C6-C7. Likely degenerative enhancement adjacent to the right C7-T1 facet joint which also involves the lateral pillars, and extends into the neural foramina. Please refer to the report for detailed level by level assessment.
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FINDINGS: Submitted images are degraded due to involuntary patient motion. There is trace anterolisthesis of C3 over C4. The vertebral body heights are maintained. Multilevel disc degenerative changes, most notable moderate disc height loss at C5-C6. There is no suspicious bone marrow signal abnormality. Continued the limitation of motion, there is no definite cord signal abnormality. No mass or abnormal fluid collection is present within the cervical spinal canal. The paravertebral soft tissues are unremarkable. Best possible assessment, accounting for motion degradation. Moderate degenerative changes at C1-C2. At C2-C3, right uncovertebral and facet hypertrophy results in moderate right neuroforaminal stenosis. No significant spinal canal stenosis. At C3-C4, combination of bilateral moderate uncovertebral and facet hypertrophy results in bilateral moderate neuroforaminal stenosis. Also disc bulge and ligamentum flavum hypertrophy, without significant spinal canal stenosis At C4-C5, combination of bilateral uncovertebral, severe right and moderate left facet hypertrophy results in moderate to severe right and mild left neuroforaminal stenosis. Mild ligamentum flavum hypertrophy, without significant spinal canal stenosis. At C5-C6, combination of disc bulge, right greater than left uncovertebral hypertrophy, and severe right and moderate left facet hypertrophy results in severe right and moderate left neuroforaminal stenosis. Also ligamentum flavum hypertrophy with mild spinal canal narrowing. At C6-C7, asymmetric left disc bulge, left greater than right uncovertebral facet hypertrophy results in moderate to severe left and mild-to-moderate right neuroforaminal narrowing. At C7-T1, mild uncovertebral facet hypertrophy without significant spinal canal or neuroforaminal stenosis. There is small amount of enhancement adjacent to the left C7-T1 facet joint which involves the lateral pillars, and extends into the neural foramina, which is favored to be degenerative in nature.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Trace biapical pleural-parenchymal scarring. No focal consolidations, pleural effusion or pneumothorax. There is a small calcified granuloma in the right lower lobe. Central airways are patent.. HEART / VESSELS: Cardiac chambers and great vessels are normal in size. No central PE. No pericardial effusion. Trace LAD calcifications. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Technically indeterminate subcentimeter hypoattenuating right hepatic dome lesion measuring approximately 9 mm (series 501 image 284) is too small to characterize by CT, likely a cyst. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No acute abnormality. Noninflamed diverticula. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Small left pelvic sidewall hematoma. VESSELS: Minimal atherosclerosis of the aorta. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Enlarged with median lobe hypertrophy. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Minimally displaced fractures of the left superior pubic ramus extending into the pubic acetabular junction, and nondisplaced left inferior pubic ramus fracture. Minimally displaced fracture of the posterolateral aspect of the left seventh rib. No aggressive osseous lesion. Small bone island of the right iliac bone. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No traumatic malalignment. LUMBAR SPINE: VERTEBRA: No fracture. Congenital nonunion of the bilateral L1 transverse processes. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No traumatic malalignment.
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Lumbar MRI without and with contrast Clinical information: Worsening lower extremity weakness. Prior L2-L4 laminectomy and fusion. Comparison: MRI of the lumbar spine 6/26/2021, CT of the lumbar spine 1/23/2022 and 6/25/2021 Technique: Multiplanar multisequence MRI of the lumbar spine were obtained in the axial and sagittal plane without and after the administration of intravenous contrast per protocol. Patient weight: 119 lbs. IV contrast: ProHance, 11 ml, per protocol. IV contrast injection rate: 2 ml per sec. Findings: Five nonrib-bearing lumbovertebral bodies. Sagittal imaging demonstrates the vertebral body heights, and alignment to be maintained. The marrow signal appears maintained. The conus terminates at the level of T12-L1 interspace. Prior L2-L4 posterior approach fusion with L2-3 laminectomy changes. Mild retrolisthesis of L2 on L3. Axial images are evaluated on a level by level basis: T12-L1: No significant disc bulge. No significant spinal canal or foraminal narrowing. L1-2: No significant disc bulge. No significant spinal canal or foraminal narrowing.. L2-3: Susceptibility artifact limited evaluation. No significant central canal stenosis. Mild right and mild-to-moderate left neuroforaminal stenosis suspected related to left broad-based eccentric disc osteophyte complex. . L3-4: Minimal bilateral neuroforaminal narrowing secondary to tiny protrusions without significant mass effect on the exiting L3 nerve root. No central canal stenosis.. L4-5: Moderate bilateral neuroforaminal stenosis secondary to facet hypertrophy. Suspected mild flattening of the exiting left L4 nerve root.. L5-S1: No significant disc bulge. Minimal bilateral neuroforaminal narrowing. No significant spinal canal or foraminal narrowing. The visualized paraspinal structures appear otherwise within normal limits. The remaining visualized osseous and soft tissue structures demonstrate normal MR signal characteristics. Anterior and posterior ligamentous complexes are intact Lack of T1 weighted precontrast fat saturated images limits contrast evaluation somewhat. Within these limitations, minimal enhancement is suspected in the paraspinal soft tissues related to prior L2-4 laminectomy. Likely denervation related enhancement of the bilateral paraspinal musculature inferiorly. CONCLUSION: 1. Prior L2-L4 posterior approach fusion with L2-3 laminectomy. Multilevel neuroforaminal stenosis as detailed above. This is suspected worst on the left at L4-5, where there is mild flattening of the exiting L4 nerve root. 2. No significant central canal stenosis. 3. Expected enhancement given postsurgical changes. Paraspinal musculature enhancement likely related to postsurgical denervation. Notably, findings detailed in initial report demonstrate minimal to no change compared to lumbar spine MRI 6/26/2021.
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Findings: Five nonrib-bearing lumbovertebral bodies. Sagittal imaging demonstrates the vertebral body heights, and alignment to be maintained. The marrow signal appears maintained. The conus terminates at the level of T12-L1 interspace. Prior L2-L4 posterior approach fusion with L2-3 laminectomy changes. Mild retrolisthesis of L2 on L3. Axial images are evaluated on a level by level basis: T12-L1: No significant disc bulge. No significant spinal canal or foraminal narrowing. L1-2: No significant disc bulge. No significant spinal canal or foraminal narrowing.. L2-3: Susceptibility artifact limited evaluation. No significant central canal stenosis. Mild right and mild-to-moderate left neuroforaminal stenosis suspected related to left broad-based eccentric disc osteophyte complex. . L3-4: Minimal bilateral neuroforaminal narrowing secondary to tiny protrusions without significant mass effect on the exiting L3 nerve root. No central canal stenosis.. L4-5: Moderate bilateral neuroforaminal stenosis secondary to facet hypertrophy. Suspected mild flattening of the exiting left L4 nerve root.. L5-S1: No significant disc bulge. Minimal bilateral neuroforaminal narrowing. No significant spinal canal or foraminal narrowing. The visualized paraspinal structures appear otherwise within normal limits. The remaining visualized osseous and soft tissue structures demonstrate normal MR signal characteristics. Anterior and posterior ligamentous complexes are intact Lack of T1 weighted precontrast fat saturated images limits contrast evaluation somewhat. Within these limitations, minimal enhancement is suspected in the paraspinal soft tissues related to prior L2-4 laminectomy. Likely denervation related enhancement of the bilateral paraspinal musculature inferiorly.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Trace biapical pleural-parenchymal scarring. No focal consolidations, pleural effusion or pneumothorax. There is a small calcified granuloma in the right lower lobe. Central airways are patent.. HEART / VESSELS: Cardiac chambers and great vessels are normal in size. No central PE. No pericardial effusion. Trace LAD calcifications. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Technically indeterminate subcentimeter hypoattenuating right hepatic dome lesion measuring approximately 9 mm (series 501 image 284) is too small to characterize by CT, likely a cyst. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No acute abnormality. Noninflamed diverticula. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Small left pelvic sidewall hematoma. VESSELS: Minimal atherosclerosis of the aorta. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Enlarged with median lobe hypertrophy. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Minimally displaced fractures of the left superior pubic ramus extending into the pubic acetabular junction, and nondisplaced left inferior pubic ramus fracture. Minimally displaced fracture of the posterolateral aspect of the left seventh rib. No aggressive osseous lesion. Small bone island of the right iliac bone. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No traumatic malalignment. LUMBAR SPINE: VERTEBRA: No fracture. Congenital nonunion of the bilateral L1 transverse processes. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: No traumatic malalignment.
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MR Cervical Spine wo contrast 1/24/2022 7:09 AM Clinical Information: C1-C2 fractures Comparison: 1/23/2022 Technique: T2 sagittal and axial fast spin spin echo, sagittal GRE, coronal PD, T1 sagittal spin echo, sagittal STIR, axial T2* gradient echo. Findings: Redemonstration of the comminuted and displaced fractures involving the C1 ring, consistent with Jefferson fractures, better appreciated on prior CT. There is also vertical orientation of the fracture involving the C2 which extends posteriorly to the right lamina/posterior lateral mass, better appreciated on prior CT. There is mild rotatory subluxation of the C1 in relation to the C2. There is mild posterior subluxation of the left atlantooccipital joint without definite edema in the joint space or capsule. There is moderate soft tissue density in the retrodental region, resulting in moderate narrowing of the craniocervical junction without significant cord compression. The tectorial membrane is intact. There is mild posterior subluxation of the clivus in relation to the posterior margin of the dens. Atlantoaxial joint is intact. There is large prevertebral soft tissue edema extending from the clivus to C5-6 level. There is also moderate soft tissue edema/contusion involving the posterior superior aspect of the neck extending from the occiput to C5 level. There is increased T2 hyperintensity within the C2 and C3 posterior elements, likely interspinous ligament and supraspinous ligament strain/injury. There is mild anterolisthesis of C3 on C4, C5 on C6, C6 on C7 and C7 on T1. C2-3: Mild diffuse disc bulge without significant central canal or neural foraminal narrowing. C3-4: Moderate diffuse disc bulge and ligamentum flavum thickening, resulting in moderate central canal stenosis and indentation of the spinal cord. There is subtle T2 hyperintense signal within the spinal cord, likely focal contusion. No definite abnormal signal is identified on sagittal GRE to suggest hemorrhage. C4-5: Mild diffuse disc bulge without significant central canal stenosis. There is mild bilateral neural foraminal narrowing. C5-6: Moderate diffuse disc bulge and bilateral facet joint DJD, resulting in mild thecal indentation without significant cord compression. There is mild to moderate bilateral neural foraminal narrowing. C6-7: Intervertebral disc spaces significantly narrowed with mild diffuse disc bulge without significant central canal stenosis. There is moderate bilateral neural foraminal narrowing. C7-T1: Mild diffuse disc bulge without significant central canal or neural foraminal narrowing. Impression: 1. Multiple comminuted fractures involving the C1 drained and vertical oriented fracture involving the C2 vertebral body and extending into the right lamina is again noted and better evaluated on prior CT cervical spine. 2. Mild rotatory subluxation of the C1 lateral masses in relation to the C2. Mild posterior subluxation of the left atlantooccipital joint. Moderate heterogeneous soft tissue density in the retrodens region, resulting in moderate indentation of the anterior portion of the spinal canal without significant mass effect. Mild posterior subluxation of the clivus in relation to the dens. Tectorial membrane is intact. Moderate prevertebral soft tissue edema extending from the clivus to the C5-6. Posterior neck soft tissue abnormal signal intensity and increased signal at C2-3 interspinous ligament as well as superior spinous ligament, likely strain/injury. 3. Moderate degenerative changes at C3-4 and associated ligamentum flavum thickening, resulting in moderate central canal stenosis with cord indentation with possible subtle cord contusion without definite intramedullary hemorrhage. See comment for other findings.
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Findings: Redemonstration of the comminuted and displaced fractures involving the C1 ring, consistent with Jefferson fractures, better appreciated on prior CT. There is also vertical orientation of the fracture involving the C2 which extends posteriorly to the right lamina/posterior lateral mass, better appreciated on prior CT. There is mild rotatory subluxation of the C1 in relation to the C2. There is mild posterior subluxation of the left atlantooccipital joint without definite edema in the joint space or capsule. There is moderate soft tissue density in the retrodental region, resulting in moderate narrowing of the craniocervical junction without significant cord compression. The tectorial membrane is intact. There is mild posterior subluxation of the clivus in relation to the posterior margin of the dens. Atlantoaxial joint is intact. There is large prevertebral soft tissue edema extending from the clivus to C5-6 level. There is also moderate soft tissue edema/contusion involving the posterior superior aspect of the neck extending from the occiput to C5 level. There is increased T2 hyperintensity within the C2 and C3 posterior elements, likely interspinous ligament and supraspinous ligament strain/injury. There is mild anterolisthesis of C3 on C4, C5 on C6, C6 on C7 and C7 on T1. C2-3: Mild diffuse disc bulge without significant central canal or neural foraminal narrowing. C3-4: Moderate diffuse disc bulge and ligamentum flavum thickening, resulting in moderate central canal stenosis and indentation of the spinal cord. There is subtle T2 hyperintense signal within the spinal cord, likely focal contusion. No definite abnormal signal is identified on sagittal GRE to suggest hemorrhage. C4-5: Mild diffuse disc bulge without significant central canal stenosis. There is mild bilateral neural foraminal narrowing. C5-6: Moderate diffuse disc bulge and bilateral facet joint DJD, resulting in mild thecal indentation without significant cord compression. There is mild to moderate bilateral neural foraminal narrowing. C6-7: Intervertebral disc spaces significantly narrowed with mild diffuse disc bulge without significant central canal stenosis. There is moderate bilateral neural foraminal narrowing. C7-T1: Mild diffuse disc bulge without significant central canal or neural foraminal narrowing.
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FINDINGS: HEAD: BRAIN PARENCHYMVA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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RADIOLOGIC EXAM: MR Brain wo+w contrast CLINICAL INFORMATION: Oligodendroglioma. Per chart review, history of right temporal grade 2 oligodendroglioma presenting with new-onset seizures in June 2016, status post partial surgical resection and chemoradiation. COMPARISON: MRI brain dated 8/2/2021, 2/1/2021, 7/27/2020. 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 Brain wo+w contrast Patient weight: 285 lbs. IV contrast: ProHance, 10 ml, per protocol. FINDINGS: Stable postsurgical changes of right frontotemporal craniotomy and partial tumor resection with right frontotemporal encephalomalacia/gliosis and chronic blood products. Associated dural thickening/enhancement underlying the craniotomy flap, overall unchanged. No new or focal masslike enhancement. No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, space-occupying lesion, or mass effect. Punctate focus of susceptibility artifact in the left frontal white matter and medial temporal lobe, unchanged, likely chronic microhemorrhage. Extensive confluent right frontotemporal T2/FLAIR signal abnormality as well as multifocal left-sided subcortical, deep cerebral, and periventricular hyperintensities, overall unchanged, likely postsurgical changes with superimposed chronic microangiopathic disease. Stable ex vacuo dilatation of the right lateral and third ventricles, likely postsurgical changes from chronic encephalomalacia. The basal cisterns are clear. The visualized proximal cerebrovascular flow voids appear normal. The visualized extracranial osseous and soft tissue structures otherwise demonstrate normal signal characteristics. Trace mucosal thickening of the anterior ethmoid sinuses bilaterally. Trace right mastoid effusion. The paranasal sinuses and mastoid air cells are otherwise clear. Both orbits are unremarkable. CONCLUSION: 1. No acute intracranial process. 2. Stable postsurgical changes of right frontotemporal craniotomy and partial tumor resection. No findings to suggest enlarging residual or recurrent tumor. 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 of right frontotemporal craniotomy and partial tumor resection with right frontotemporal encephalomalacia/gliosis and chronic blood products. Associated dural thickening/enhancement underlying the craniotomy flap, overall unchanged. No new or focal masslike enhancement. No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, space-occupying lesion, or mass effect. Punctate focus of susceptibility artifact in the left frontal white matter and medial temporal lobe, unchanged, likely chronic microhemorrhage. Extensive confluent right frontotemporal T2/FLAIR signal abnormality as well as multifocal left-sided subcortical, deep cerebral, and periventricular hyperintensities, overall unchanged, likely postsurgical changes with superimposed chronic microangiopathic disease. Stable ex vacuo dilatation of the right lateral and third ventricles, likely postsurgical changes from chronic encephalomalacia. The basal cisterns are clear. The visualized proximal cerebrovascular flow voids appear normal. The visualized extracranial osseous and soft tissue structures otherwise demonstrate normal signal characteristics. Trace mucosal thickening of the anterior ethmoid sinuses bilaterally. Trace right mastoid effusion. The paranasal sinuses and mastoid air cells are otherwise clear. Both orbits are unremarkable.
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Findings: Unchanged left cerebellar and right precentral gyrus acute infarcts without hemorrhagic transformation. Mild local mass effect on the 4th ventricle. There is no frank herniation. Unchanged encephalomalacia of left occipital lobe and chronic lacunar infarcts of left basal ganglia and right thalamus. No new territorial infarct, hemorrhage, midline shift, or hydrocephalus. Normal bones, clear paranasal sinuses, and unremarkable orbits.
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RADIOLOGIC EXAM: MR Brain wo+w contrast CLINICAL INFORMATION: Astrocytoma/oligodendroglioma, monitor. Per chart review, history of diffuse astrocytoma status post left craniotomy tumor resection on 5/26/2021. COMPARISON: MRI brain dated 10/18/2021, 5/27/2021, 5/25/2021. 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. MR Brain wo+w contrast Patient weight: 249 lbs. IV contrast: ProHance, 20 ml, per protocol. FINDINGS: Stable postsurgical changes of prior left temporal craniotomy and partial tumor resection with left temporal pole chronic encephalomalacia/gliosis with chronic blood products and adjacent residual lesion with FLAIR hyperintensity. Associated dural thickening/enhancement underlying the craniotomy flap, overall unchanged. No new or focal masslike enhancement. No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, or extra-axial collection. Multiple punctate T2/FLAIR hyperintense foci in the periventricular as well as posterior subcortical and deep cerebral white matter bilaterally, unchanged, likely chronic microangiopathic changes. Stable focal ex vacuo dilatation of the left temporal horn, likely postsurgical changes from chronic encephalomalacia. The ventricular system is otherwise normal in caliber. The basal cisterns are clear. The visualized proximal cerebrovascular flow voids appear normal. The visualized extracranial osseous and soft tissue structures otherwise demonstrate normal signal characteristics. Trace mucosal thickening of the anterior ethmoid sinuses bilaterally. The paranasal sinuses and mastoid air cells are otherwise clear. Bilateral ocular lens replacements. CONCLUSION: 1. No significant change. Stable postsurgical changes of prior left temporal craniotomy and partial tumor resection with stable residual medial temporal lobe T2/FLAIR hyperintensity 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: Stable postsurgical changes of prior left temporal craniotomy and partial tumor resection with left temporal pole chronic encephalomalacia/gliosis with chronic blood products and adjacent residual lesion with FLAIR hyperintensity. Associated dural thickening/enhancement underlying the craniotomy flap, overall unchanged. No new or focal masslike enhancement. No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, or extra-axial collection. Multiple punctate T2/FLAIR hyperintense foci in the periventricular as well as posterior subcortical and deep cerebral white matter bilaterally, unchanged, likely chronic microangiopathic changes. Stable focal ex vacuo dilatation of the left temporal horn, likely postsurgical changes from chronic encephalomalacia. The ventricular system is otherwise normal in caliber. The basal cisterns are clear. The visualized proximal cerebrovascular flow voids appear normal. The visualized extracranial osseous and soft tissue structures otherwise demonstrate normal signal characteristics. Trace mucosal thickening of the anterior ethmoid sinuses bilaterally. The paranasal sinuses and mastoid air cells are otherwise clear. Bilateral ocular lens replacements.
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FINDINGS: VERTEBRA: No acute fracture. Postsurgical changes from L5-S1 posterior fusion and L5 laminectomy. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative changes and disc space narrowing at L5-S1. Bilateral L5-S1 facet arthropathy. No significant neuroforaminal narrowing. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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Lumbar MRI without contrast - Clinical indication: Lumbar Radiculopathy, M54.16 Radiculopathy, lumbar region. - 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 lumbar spine protocol. - Comparison: 1/8/2021. - Findings: There is loss of lumbar lordosis with reversal of the curvature at L2-3. There is type I Modic endplate changes at L2-3. Bone marrow shows normal signal intensity on all pulse sequences. Conus ends at L1. Cauda equina is within normal limits. T12-L1: Minimal diffuse disc bulge and mild bilateral facet joint DJD, without significant central canal or neural foraminal narrowing. L1-2: Moderate diffuse disc bulge, resulting in mild indentation of the anterior thecal sac without significant cauda equina compression. There is moderate bilateral facet joint DJD, resulting in mild bilateral neural foraminal narrowing without nerve root indentation. L2-3: There is diffuse narrowing of the intervertebral disc space with minimal focal kyphosis at this level. There is moderate posterior disc bulge and left subarticular protrusion, resulting in moderate indentation of the thecal sac. There is moderate bilateral facet joint DJD, resulting in severe left lateral recess stenosis with possible indentation of the traversing left L3 nerve root. There is mild to moderate bilateral neural foraminal narrowing, left greater than right. There is mild indentation of the cauda equina. L3-4: There is moderate narrowing of intervertebral disc space and mild diffuse disc bulge and moderate bilateral facet joint DJD, resulting in mild to moderate bilateral neural foraminal narrowing without nerve root indentation. There is no significant central canal stenosis. L4-5: Moderate diffuse disc bulge with left paracentral disc protrusion and bilateral facet joint DJD, posterior osteophytes, resulting in moderate left lateral recess stenosis and bilateral neural foraminal narrowing, right greater than left. There is no definite nerve root indentation is identified. There is no significant central canal narrowing. L5-S1: Moderate posterior disc protrusion with mild indentation of the anterior thecal sac without significant cauda equina compression. There is moderate bilateral facet joint DJD, resulting in mild neural foraminal narrowing without nerve root indentation. Pre and paravertebral soft tissues are within normal limits. Visualized kidneys and abdominal aorta are within normal limits. - Impression: Multilevel moderate to advanced degenerative changes of the lumbar spine, predominantly at L2-3 with left subarticular disc protrusion, resulting in moderate central canal stenosis with mild indentation of the thecal sac there is also moderate to severe left lateral recess stenosis at this level, resulting in indentation of the traversing left L3 nerve root. These changes are slightly advanced when compared to prior study from January 2021. Please see comment for other findings. -
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Findings: There is loss of lumbar lordosis with reversal of the curvature at L2-3. There is type I Modic endplate changes at L2-3. Bone marrow shows normal signal intensity on all pulse sequences. Conus ends at L1. Cauda equina is within normal limits. T12-L1: Minimal diffuse disc bulge and mild bilateral facet joint DJD, without significant central canal or neural foraminal narrowing. L1-2: Moderate diffuse disc bulge, resulting in mild indentation of the anterior thecal sac without significant cauda equina compression. There is moderate bilateral facet joint DJD, resulting in mild bilateral neural foraminal narrowing without nerve root indentation. L2-3: There is diffuse narrowing of the intervertebral disc space with minimal focal kyphosis at this level. There is moderate posterior disc bulge and left subarticular protrusion, resulting in moderate indentation of the thecal sac. There is moderate bilateral facet joint DJD, resulting in severe left lateral recess stenosis with possible indentation of the traversing left L3 nerve root. There is mild to moderate bilateral neural foraminal narrowing, left greater than right. There is mild indentation of the cauda equina. L3-4: There is moderate narrowing of intervertebral disc space and mild diffuse disc bulge and moderate bilateral facet joint DJD, resulting in mild to moderate bilateral neural foraminal narrowing without nerve root indentation. There is no significant central canal stenosis. L4-5: Moderate diffuse disc bulge with left paracentral disc protrusion and bilateral facet joint DJD, posterior osteophytes, resulting in moderate left lateral recess stenosis and bilateral neural foraminal narrowing, right greater than left. There is no definite nerve root indentation is identified. There is no significant central canal narrowing. L5-S1: Moderate posterior disc protrusion with mild indentation of the anterior thecal sac without significant cauda equina compression. There is moderate bilateral facet joint DJD, resulting in mild neural foraminal narrowing without nerve root indentation. Pre and paravertebral soft tissues are within normal limits. Visualized kidneys and abdominal aorta are within normal limits. -
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FINDINGS: Three no significant change in the size of the large 5.8 cm left frontal parietal hematoma. Mild increase surrounding edema. Relatively unchanged 6 mm rightward midline shift. Again noted medialization of the temporal lobe. Continued evolution of the subacute infarcts in the left temporal lobe and right inferior cerebellum. Partial effacement of the posterior left lateral ventricle. There is no hydrocephalus. Imaged portions of the orbits are grossly unremarkable. Scattered paranasal mucosal thickening. There is a nasoenteric tube in place. The mastoid air cells are clear. No calvarial fracture is appreciated.
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EXAM:MR Shoulder Right wo contrast CLINICAL INFORMATION:Shoulder pain COMPARISON:Radiographs dated 1/23/2019 TECHNIQUE:Multiplanar multisequence images were obtained through the right shoulder STRUCTURED REPORT: MRI SHOULDERv5/23//2019 FINDINGS: There is minimal tendinosis of the supraspinatus and infraspinatus without focal tear. There is atrophy of the teres minor, but no nerve compression is seen in the axillary recess. Subscapularis is unremarkable. There is severe osteoarthrosis of the glenohumeral joint. There is complete loss of articular cartilage. A large inferomedial humeral head osteophyte is impacted upon the inferior glenoid. There is a small glenohumeral joint effusion with a small amount of debris in the joint. The long head biceps tendon is intact. There is a large amount of fluid around the biceps tendon within the bicipital groove. There is circumferential fraying of the glenoid labrum, greatest superiorly and inferiorly. There are moderate AC joint degenerative changes with a small joint effusion. Impression: 1. Severe osteoarthrosis of the glenohumeral joint including circumferential tearing of the glenoid labrum. 2. Moderate AC joint degenerative change with small joint effusion. 3. Fluid around the long head biceps tendon is likely related to the glenohumeral degenerative changes but can be seen with tenosynovitis. 4. No rotator cuff tear seen.
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FINDINGS: There is minimal tendinosis of the supraspinatus and infraspinatus without focal tear. There is atrophy of the teres minor, but no nerve compression is seen in the axillary recess. Subscapularis is unremarkable. There is severe osteoarthrosis of the glenohumeral joint. There is complete loss of articular cartilage. A large inferomedial humeral head osteophyte is impacted upon the inferior glenoid. There is a small glenohumeral joint effusion with a small amount of debris in the joint. The long head biceps tendon is intact. There is a large amount of fluid around the biceps tendon within the bicipital groove. There is circumferential fraying of the glenoid labrum, greatest superiorly and inferiorly. There are moderate AC joint degenerative changes with a small joint effusion.
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Findings: Evolving left MCA territory infarction no evidence of hemorrhagic transformation. Partial effacement of temporal horn of left lateral ventricle. No new infarct. No extra-axial collection, hydrocephalus, or intracranial mass. No midline shift. No aggressive osseous lesion. Clear paranasal sinuses and mastoid air cells. Unremarkable orbits.
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15,288 |
CV MR Brain wo+w contrast Clinical Information: tumor This examination was performed in the Boshell Building MRI Facility. To access the report, please look in the Documentation section of IMPACT/Cerner, Choose to list All, and the report will be found titled Radiology Reports-- Neurology Procedure Note on the date it was performed. ?Please call 934-9906 if you have any questions about this.
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This examination was performed in the Boshell Building MRI Facility. To access the report, please look in the Documentation section of IMPACT/Cerner, Choose to list All, and the report will be found titled Radiology Reports-- Neurology Procedure Note on the date it was performed. ?Please call 934-9906 if you have any questions about this.
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FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Severe, upper lobe predominant centrilobular emphysema. Scattered subtle peripheral glass opacities in both lungs. No pleural effusions or pneumothorax. HEART / OTHER VESSELS: Cardiac chambers and great vessels are normal in size. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Postsurgical changes of Roux-en-Y gastric bypass. Otherwise unremarkable LYMPH NODES: Enlarged right hilar node measuring 15 mm in short axis on image 57, series 501. CHEST WALL: No significant abnormality. UPPER ABDOMEN: No acute abnormality MUSCULOSKELETAL: No aggressive osseous lesion or acute fracture.
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15,289 |
CV MR Brain wo+w contrast Clinical Information: tumor This examination was performed in the Boshell Building MRI Facility. To access the report, please look in the Documentation section of IMPACT/Cerner, Choose to list All, and the report will be found titled Radiology Reports-- Neurology Procedure Note on the date it was performed. ?Please call 934-9906 if you have any questions about this.
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This examination was performed in the Boshell Building MRI Facility. To access the report, please look in the Documentation section of IMPACT/Cerner, Choose to list All, and the report will be found titled Radiology Reports-- Neurology Procedure Note on the date it was performed. ?Please call 934-9906 if you have any questions about this.
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FINDINGS: There is no acute territorial loss of gray-white differentiation. There has been no significant change in 2.4 cm posterior pontine hemorrhage. Stable partial effacement of the fourth ventricle, without upstream hydrocephalus. There is no new hemorrhage within the limits of streak artifact. There is no midline shift. Basal cisterns are patent. Imaged portions of the orbits are grossly unremarkable. There is layering fluid in the left maxillary sinus. Additional scattered paranasal mucosal thickening. The mastoid air cells are clear. No acute osseous process. Patient is intubated.
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15,290 |
CV MR Brain wo+w contrast Clinical Information: tumor This examination was performed in the Boshell Building MRI Facility. To access the report, please look in the Documentation section of IMPACT/Cerner, Choose to list All, and the report will be found titled Radiology Reports-- Neurology Procedure Note on the date it was performed. ?Please call 934-9906 if you have any questions about this.
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This examination was performed in the Boshell Building MRI Facility. To access the report, please look in the Documentation section of IMPACT/Cerner, Choose to list All, and the report will be found titled Radiology Reports-- Neurology Procedure Note on the date it was performed. ?Please call 934-9906 if you have any questions about this.
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Findings: There is no evidence of acute intracranial hemorrhage, infarction, brain edema, mass effect or hydrocephalus. Diffuse brain volume loss with ex vacuo ventricular dilatation and moderate white matter microangiopathic changes. Hyperdensity along the falx is likely calcification. Chronic lacunar infarct in right cerebellum. The visualized paranasal sinuses, mastoid air cells and middle ear cavities are clear. Both orbits appear normal.
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EXAM: CV MR Cardiac w contrast DATE OF STUDY: 1/24/2022 11:04 AM - REFERRING MD: Joanna Joly PATIENT DATA Height: 171 cm. Patient weight: 74 kg. BSA: 1.87483 Blood Pressure: 115/74 Heart Rate: 61 bpm. EGFR 60. The patient's creatinine was 1.1 on 10/28/2021. The patient received 14 cc's of Gadavist at a rate of 2 ml per second without immediate complication. INDICATION: Patient studied for evaluation of: cad, I25.111 Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm HISTORY: 59-year-old male with history of ischemic cardiomyopathy, CAD status post CABG, diabetes, and former smoker undergoing evaluation of heart failure with reduced ejection fraction. COMPARISON TO: Chest radiographs 10/28/2021 IMAGING DATA Imaging System: GE 1.5T Overall Image Quality: Excellent CARDIOVASCULAR MRI TECHNIQUE: Views: Axial Two chamber Four chamber Short axis LV LVOT Ascending aorta Sequences: FSE 2IR SSFP FGRE ET Additional views: Delayed Contrast Enhancement, Perfusion General: ECG gated: YES FINDINGS: CARDIAC MORPHOLOGY AND VENTRICULAR FUNCTION The right and left ventricular volumes and functions were compared to the reference values from "Kawel-Boehm et al. Journal of Cardiovascular Magnetic Resonance (2015) 17:29, DOI 10.1186/s12968-015-0111-7". A - LEFT VENTRICLE: Morphology and function: Normal left ventricular (LV) volumes. Perfusional defects of the apical septal and apical inferior segments (14 and 15). Mild myocardial thinning in the mid and apical lateral, inferior segments, and apical septal segment. Left Ventricle measurements: LV End Diastolic Dimension: 60 mm LV End Systolic Dimension: 47 mm LV Posterior Wall: 6 mm Interventricular Septum: 10 mm Left Ventricle Volumes (short axis): End Diastolic Volume: 154 mL - EDV Index = 83 mL/m2 End Systolic Volume: 88 mL - ESV Index = 47 mL/m2 Stroke Volume: 66 mL - SV Index = 35 mL/m2 Ejection Fraction: 42.9% LV Regional Wall Motion and Late Gadolinium Enhancement (LGE): Basal Anterior: Normokinetic / No LGE Anteroseptal: Normokinetic / No LGE Inferoseptal: Normokinetic / No LGE Inferior: Normokinetic / No LGE Inferolateral: Hypokinesis / Subendocardial LGE of 50% or less Anterolateral: Hypokinesis / Subendocardial LGE of 50% or less Mid-ventricle Anterior: Normokinetic / No LGE Anteroseptal: Hypokinesis / No LGE Inferoseptal: Hypokinesis / Subendocardial LGE of 50% or less Inferior: Hypokinesis / No LGE Inferolateral: Hypokinesis / Subendocardial LGE of 50% or less Anterolateral: Hypokinesis / Subendocardial LGE of 50% or less Apical Anterior: Normokinetic / No LGE Septal: Hypokinesis / Subendocardial LGE greater than 50% Inferior: Hypokinesis / Transmural LGE Lateral: Hypokinesis / Subendocardial LGE greater than 50% Apex: Hypokinesis / No LGE B - RIGHT VENTRICLE: Morphology and function: Normal right ventricular (RV) volumes and wall thickness. Normal right ventricular systolic function, with RV ejection fraction (EF) of 52.3 %, no evidence of regional wall motion abnormalities. No LV myocardial signal abnormality on edema sequences (T2 and triple IR). No evidence of RV myocardial abnormal signal intensity on all pulse sequences. Right Ventricle measurements: RV End Diastolic Dimension: 38 mm Right Ventricle Volumes (short axis): End Diastolic Volume: 111 mL - EDV Index = 60 mL/m2 End Systolic Volume: 53 mL - ESV Index = 28 mL/m2 Stroke Volume: 58 mL - SV Index = 31 mL/m2 Ejection Fraction: 52.3% C - ATRIA: Normal morphology atria. Left Atrium: 26 mm Right Atrium: 44 mm D - VALVES: No valvular thickening or evidence of regurgitation. E - GREAT ARTERIES: Left-sided aortic arch with normal branching pattern. The thoracic aorta and the main pulmonary arteries are normal in caliber. Vessel dimensions: Main Pulmonary Artery: 25 mm Right Pulmonary Artery: 16 mm Left Pulmonary Artery: 15 mm Aortic Root: 36 mm Aortic Arch: 22 [18-37] mm Ascending Aorta: 33 [19-37] mm Descending Aorta: 22 [16-29] mm Inferior Vena Cava: 24 mm F - PERICARDIUM: The pericardium is normal in thickness and SI. No evidence of pericardial effusion. G - LUNG, PLEURA AND OTHER NONCARDIOVASCULAR STRUCTURES: There is no pleural effusion. The visualized lungs are grossly unremarkable. Partially imaged T2 hyperintense right renal upper pole lesion, likely cyst. Susceptibility artifact from prior median sternotomy. CONCLUSIONS: 1. Hypokinesis of multiple mid and apical lateral, septal, and inferior segments with transmural and greater than 50% weight gadolinium enhancement involving the apical segments suggesting nonviability. Delayed gadolinium enhancement of less than 50% involving the mid ventricular segments. Findings are due to ischemic infarction in the LCx and RCA territories. 2. Probable nonenhancing area along the inferior apical segment may possibly be an area of microvascular obstruction or less likely small thrombus. Correlate with TEE if indicated. 3. Normal chamber sizes. 4. Mildly reduced left ventricular systolic function (LVEF: 43%). 5. Borderline normal right ventricular systolic function (RVEF: 53%). 6. No valvular regurgitation. Cardiac MRI Technologist: Trina Corbitt As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: CARDIAC MORPHOLOGY AND VENTRICULAR FUNCTION The right and left ventricular volumes and functions were compared to the reference values from "Kawel-Boehm et al. Journal of Cardiovascular Magnetic Resonance (2015) 17:29, DOI 10.1186/s12968-015-0111-7". A - LEFT VENTRICLE: Morphology and function: Normal left ventricular (LV) volumes. Perfusional defects of the apical septal and apical inferior segments (14 and 15). Mild myocardial thinning in the mid and apical lateral, inferior segments, and apical septal segment. Left Ventricle measurements: LV End Diastolic Dimension: 60 mm LV End Systolic Dimension: 47 mm LV Posterior Wall: 6 mm Interventricular Septum: 10 mm Left Ventricle Volumes (short axis): End Diastolic Volume: 154 mL - EDV Index = 83 mL/m2 End Systolic Volume: 88 mL - ESV Index = 47 mL/m2 Stroke Volume: 66 mL - SV Index = 35 mL/m2 Ejection Fraction: 42.9% LV Regional Wall Motion and Late Gadolinium Enhancement (LGE): Basal Anterior: Normokinetic / No LGE Anteroseptal: Normokinetic / No LGE Inferoseptal: Normokinetic / No LGE Inferior: Normokinetic / No LGE Inferolateral: Hypokinesis / Subendocardial LGE of 50% or less Anterolateral: Hypokinesis / Subendocardial LGE of 50% or less Mid-ventricle Anterior: Normokinetic / No LGE Anteroseptal: Hypokinesis / No LGE Inferoseptal: Hypokinesis / Subendocardial LGE of 50% or less Inferior: Hypokinesis / No LGE Inferolateral: Hypokinesis / Subendocardial LGE of 50% or less Anterolateral: Hypokinesis / Subendocardial LGE of 50% or less Apical Anterior: Normokinetic / No LGE Septal: Hypokinesis / Subendocardial LGE greater than 50% Inferior: Hypokinesis / Transmural LGE Lateral: Hypokinesis / Subendocardial LGE greater than 50% Apex: Hypokinesis / No LGE B - RIGHT VENTRICLE: Morphology and function: Normal right ventricular (RV) volumes and wall thickness. Normal right ventricular systolic function, with RV ejection fraction (EF) of 52.3 %, no evidence of regional wall motion abnormalities. No LV myocardial signal abnormality on edema sequences (T2 and triple IR). No evidence of RV myocardial abnormal signal intensity on all pulse sequences. Right Ventricle measurements: RV End Diastolic Dimension: 38 mm Right Ventricle Volumes (short axis): End Diastolic Volume: 111 mL - EDV Index = 60 mL/m2 End Systolic Volume: 53 mL - ESV Index = 28 mL/m2 Stroke Volume: 58 mL - SV Index = 31 mL/m2 Ejection Fraction: 52.3% C - ATRIA: Normal morphology atria. Left Atrium: 26 mm Right Atrium: 44 mm D - VALVES: No valvular thickening or evidence of regurgitation. E - GREAT ARTERIES: Left-sided aortic arch with normal branching pattern. The thoracic aorta and the main pulmonary arteries are normal in caliber. Vessel dimensions: Main Pulmonary Artery: 25 mm Right Pulmonary Artery: 16 mm Left Pulmonary Artery: 15 mm Aortic Root: 36 mm Aortic Arch: 22 [18-37] mm Ascending Aorta: 33 [19-37] mm Descending Aorta: 22 [16-29] mm Inferior Vena Cava: 24 mm F - PERICARDIUM: The pericardium is normal in thickness and SI. No evidence of pericardial effusion. G - LUNG, PLEURA AND OTHER NONCARDIOVASCULAR STRUCTURES: There is no pleural effusion. The visualized lungs are grossly unremarkable. Partially imaged T2 hyperintense right renal upper pole lesion, likely cyst. Susceptibility artifact from prior median sternotomy.
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FINDINGS: Focal fluid collection adjacent to a left mandibular molar measuring approximately 0.7 x 0.5 cm (axial series 302, image 34; sagittal series 307, image 44). There are surrounding inflammatory changes and edema involving the left mandibular soft tissues. Evaluation is somewhat limited due to dental amalgam. The orbits are normal. The paranasal sinuses and mastoid air cells are clear. No acute osseous abnormality. Visualized portions of the brain demonstrate no acute intracranial abnormality. The nasopharynx and oropharynx are normal in appearance. The base of the tongue and lymphoid tissue within Waldeyer's ring are unremarkable. The hypopharynx and larynx appear normal. A few prominent left submandibular lymph nodes are likely reactive. The parotid, submandibular, and thyroid glands appear normal.
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15,292 |
CV MR Brain wo+w contrast Clinical Information: tumor This examination was performed in the Boshell Building MRI Facility. To access the report, please look in the Documentation section of IMPACT/Cerner, Choose to list All, and the report will be found titled Radiology Reports-- Neurology Procedure Note on the date it was performed. ?Please call 934-9906 if you have any questions about this.
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This examination was performed in the Boshell Building MRI Facility. To access the report, please look in the Documentation section of IMPACT/Cerner, Choose to list All, and the report will be found titled Radiology Reports-- Neurology Procedure Note on the date it was performed. ?Please call 934-9906 if you have any questions about this.
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FINDINGS: Focal fluid collection adjacent to a left mandibular molar measuring approximately 0.7 x 0.5 cm (axial series 302, image 34; sagittal series 307, image 44). There are surrounding inflammatory changes and edema involving the left mandibular soft tissues. Evaluation is somewhat limited due to dental amalgam. The orbits are normal. The paranasal sinuses and mastoid air cells are clear. No acute osseous abnormality. Visualized portions of the brain demonstrate no acute intracranial abnormality. The nasopharynx and oropharynx are normal in appearance. The base of the tongue and lymphoid tissue within Waldeyer's ring are unremarkable. The hypopharynx and larynx appear normal. A few prominent left submandibular lymph nodes are likely reactive. The parotid, submandibular, and thyroid glands appear normal.
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EXAM: CV MR Cardiac w contrast DATE OF STUDY: 1/24/2022 1:31 PM - REFERRING MD: Efstathia Andrikopoulou PATIENT DATA Height: 179 cm. Patient weight: 76 kg. BSA: 1.95 Blood Pressure: 119/70 Heart Rate: 80 bpm. EGFR 60. The patient's creatinine was 0.8 on 11/16/2021. The patient received 14 cc's of Gadavist at a rate of 2 ml per second without immediate complication. INDICATION: Patient studied for evaluation of: HF, I50.9 Heart failure, unspecified HISTORY: 45-year-old female, palpitations. History of Covid vaccination. COMPARISON TO: None. IMAGING DATA Imaging System: GE 1.5T Overall Image Quality: Excellent CARDIOVASCULAR MRI TECHNIQUE: Views: Axial Two chamber Four chamber Short axis LV LVOT Ascending aorta Short AX T2 Sequences: FSE 2IR FSE 3IR SSFP FGRE ET Additional views: Delayed Contrast Enhancement, Perfusion General: ECG gated: YES FINDINGS: CARDIAC MORPHOLOGY AND VENTRICULAR FUNCTION The right and left ventricular volumes and functions were compared to the reference values from "Kawel-Boehm et al. Journal of Cardiovascular Magnetic Resonance (2015) 17:29, DOI 10.1186/s12968-015-0111-7". A - LEFT VENTRICLE: Morphology and function: Normal left ventricular (LV) volumes and wall thickness. Normal left ventricular systolic function, with LV ejection fraction (EF) of %, no evidence of regional wall motion abnormalities. No LV myocardial signal abnormality on edema sequences (T2 and triple IR). No evidence of LV myocardial persistent perfusion defect on first pass rest perfusion images or enhancement on late gadolinium enhancement (LGE) images. Left Ventricle measurements: LV End Diastolic Dimension: 57 mm LV End Systolic Dimension: 45 mm LV Posterior Wall: 7 mm Interventricular Septum: 8 mm Left Ventricle Volumes (short axis): End Diastolic Volume: 161 mL - EDV Index = 83 mL/m2 End Systolic Volume: 85 mL - ESV Index = 44 mL/m2 Stroke Volume: 76 mL - SV Index = 39 mL/m2 Ejection Fraction: 47.2% LV Regional Wall Motion and Late Gadolinium Enhancement (LGE): Basal Anterior: Normokinetic / No LGE Anteroseptal: Normokinetic / No LGE Inferoseptal: Normokinetic / No LGE Inferior: Normokinetic / No LGE Inferolateral: Normokinetic / No LGE Anterolateral: Normokinetic / No LGE Mid-ventricle Anterior: Normokinetic / No LGE Anteroseptal: Normokinetic / No LGE Inferoseptal: Normokinetic / No LGE Inferior: Normokinetic / No LGE Inferolateral: Normokinetic / No LGE Anterolateral: Normokinetic / No LGE Apical Anterior: Normokinetic / No LGE Septal: Normokinetic / No LGE Inferior: Normokinetic / No LGE Lateral: Normokinetic / No LGE Apex: Normokinetic / No LGE B - RIGHT VENTRICLE: Morphology and function: Normal right ventricular (RV) volumes and wall thickness. Normal right ventricular systolic function, with RV ejection fraction (EF) of %, no evidence of regional wall motion abnormalities. No LV myocardial signal abnormality on edema sequences (T2 and triple IR). No evidence of RV myocardial abnormal signal intensity on all pulse sequences. Right Ventricle measurements: RV End Diastolic Dimension: 37 mm Right Ventricle Volumes (short axis): End Diastolic Volume: 112 mL - EDV Index = 58 mL/m2 End Systolic Volume: 43 mL - ESV Index = 22 mL/m2 Stroke Volume: 69 mL - SV Index = 35 mL/m2 Ejection Fraction: 61.6% C - ATRIA: Normal in size. Left Atrium: 25 mm Right Atrium: 37 mm D - VALVES: Aortic: Normal AV Regurgitation: None Mitral: Normal MV Regurgitation: Mild Tricuspid: Normal TV Regurgitation: None Pulmonic: Normal PV Regurgitation: None E - GREAT ARTERIES: Left-sided aortic arch with normal branching pattern. The thoracic aorta and the main pulmonary arteries are normal in caliber. Vessel dimensions: Main Pulmonary Artery: 20 mm Right Pulmonary Artery: 13 mm Left Pulmonary Artery: 12 mm Aortic Root: 30 mm Aortic Arch: 22 [18-37] mm Ascending Aorta: 27 [19-37] mm Descending Aorta: 19 [16-29] mm Inferior Vena Cava: 29 mm F - PERICARDIUM: The pericardium is normal in thickness and SI. No evidence of pericardial effusion. G - LUNG, PLEURA AND OTHER NONCARDIOVASCULAR STRUCTURES: There is no pleural effusion. The visualized lungs are grossly unremarkable. CONCLUSIONS: 1. No wall motion abnormality. 2. Normal chamber sizes. 3. Mildly reduced left ventricular systolic function (LVEF: 47%). 4. Normal right ventricular systolic function (RVEF: 62%). 5. No abnormal late gadolinium enhancement. 6. Mild mitral regurgitation. Cardiac MRI Technologist: Trina Corbitt As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report. There are a few typographical errors in the body of the report, which should read as follows: A - LEFT VENTRICLE: Morphology and function: Normal left ventricular (LV) volumes and wall thickness. LV Regional Wall Motion and Late Gadolinium Enhancement (LGE): Basal Anterior: Normokinetic / No LGE Anteroseptal: Hypokinesis / No LGE Inferoseptal: Normokinetic / No LGE Inferior: Normokinetic / No LGE Inferolateral: Normokinetic / No LGE Anterolateral: Normokinetic / No LGE Mid-ventricle Anterior: Normokinetic / No LGE Anteroseptal: Hypokinesis / No LGE Inferoseptal: Normokinetic / No LGE Inferior: Normokinetic / No LGE Inferolateral: Normokinetic / No LGE Anterolateral: Normokinetic / No LGE Apical Anterior: Normokinetic / No LGE Septal: Hypokinesis / No LGE Inferior: Normokinetic / No LGE Lateral: Normokinetic / No LGE Apex: Normokinetic / No LGE B - RIGHT VENTRICLE: Morphology and function: Normal right ventricular (RV) volumes and wall thickness. Normal right ventricular systolic function. CONCLUSIONS: 1. Mildly hypokinetic anteroseptal segment diffusely. 2. Normal chamber sizes. 3. Mildly reduced left ventricular systolic function (LVEF: 47%). 4. Normal right ventricular systolic function (RVEF: 62%). 5. No abnormal late gadolinium enhancement. 6. Mild mitral regurgitation.
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FINDINGS: CARDIAC MORPHOLOGY AND VENTRICULAR FUNCTION The right and left ventricular volumes and functions were compared to the reference values from "Kawel-Boehm et al. Journal of Cardiovascular Magnetic Resonance (2015) 17:29, DOI 10.1186/s12968-015-0111-7". A - LEFT VENTRICLE: Morphology and function: Normal left ventricular (LV) volumes and wall thickness. Normal left ventricular systolic function, with LV ejection fraction (EF) of %, no evidence of regional wall motion abnormalities. No LV myocardial signal abnormality on edema sequences (T2 and triple IR). No evidence of LV myocardial persistent perfusion defect on first pass rest perfusion images or enhancement on late gadolinium enhancement (LGE) images. Left Ventricle measurements: LV End Diastolic Dimension: 57 mm LV End Systolic Dimension: 45 mm LV Posterior Wall: 7 mm Interventricular Septum: 8 mm Left Ventricle Volumes (short axis): End Diastolic Volume: 161 mL - EDV Index = 83 mL/m2 End Systolic Volume: 85 mL - ESV Index = 44 mL/m2 Stroke Volume: 76 mL - SV Index = 39 mL/m2 Ejection Fraction: 47.2% LV Regional Wall Motion and Late Gadolinium Enhancement (LGE): Basal Anterior: Normokinetic / No LGE Anteroseptal: Normokinetic / No LGE Inferoseptal: Normokinetic / No LGE Inferior: Normokinetic / No LGE Inferolateral: Normokinetic / No LGE Anterolateral: Normokinetic / No LGE Mid-ventricle Anterior: Normokinetic / No LGE Anteroseptal: Normokinetic / No LGE Inferoseptal: Normokinetic / No LGE Inferior: Normokinetic / No LGE Inferolateral: Normokinetic / No LGE Anterolateral: Normokinetic / No LGE Apical Anterior: Normokinetic / No LGE Septal: Normokinetic / No LGE Inferior: Normokinetic / No LGE Lateral: Normokinetic / No LGE Apex: Normokinetic / No LGE B - RIGHT VENTRICLE: Morphology and function: Normal right ventricular (RV) volumes and wall thickness. Normal right ventricular systolic function, with RV ejection fraction (EF) of %, no evidence of regional wall motion abnormalities. No LV myocardial signal abnormality on edema sequences (T2 and triple IR). No evidence of RV myocardial abnormal signal intensity on all pulse sequences. Right Ventricle measurements: RV End Diastolic Dimension: 37 mm Right Ventricle Volumes (short axis): End Diastolic Volume: 112 mL - EDV Index = 58 mL/m2 End Systolic Volume: 43 mL - ESV Index = 22 mL/m2 Stroke Volume: 69 mL - SV Index = 35 mL/m2 Ejection Fraction: 61.6% C - ATRIA: Normal in size. Left Atrium: 25 mm Right Atrium: 37 mm D - VALVES: Aortic: Normal AV Regurgitation: None Mitral: Normal MV Regurgitation: Mild Tricuspid: Normal TV Regurgitation: None Pulmonic: Normal PV Regurgitation: None E - GREAT ARTERIES: Left-sided aortic arch with normal branching pattern. The thoracic aorta and the main pulmonary arteries are normal in caliber. Vessel dimensions: Main Pulmonary Artery: 20 mm Right Pulmonary Artery: 13 mm Left Pulmonary Artery: 12 mm Aortic Root: 30 mm Aortic Arch: 22 [18-37] mm Ascending Aorta: 27 [19-37] mm Descending Aorta: 19 [16-29] mm Inferior Vena Cava: 29 mm F - PERICARDIUM: The pericardium is normal in thickness and SI. No evidence of pericardial effusion. G - LUNG, PLEURA AND OTHER NONCARDIOVASCULAR STRUCTURES: There is no pleural effusion. The visualized lungs are grossly unremarkable.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Linear atelectasis in the left lower lobe. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Nonobstructive renal calculus of the left lower pole measuring 10 mm (series 301 image 129), unchanged. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No acute abnormality. Particulate material in the distal related to slow transit time. COLON / APPENDIX: There is a large rectal fecal ball with asymmetric thickening of the right rectum and surrounding perirectal fat. No discrete rectal wall defect is identified. Perirectal stranding and fluid. No organized fluid collections PERITONEUM / MESENTERY: No intraperitoneal fluid or free air.. RETROPERITONEUM: Presacral fluid VESSELS: Unchanged moderate to advanced atherosclerotic calcification of the suprarenal abdominal aorta with mild narrowing at the origin of the celiac axis and SMA. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is surgically absent. There is air in the vaginal cuff. BODY WALL: Small fat-containing periumbilical hernia. MUSCULOSKELETAL: No evidence of aggressive osseous lesion or acute fracture. Severe intervertebral disc space narrowing with vacuum phenomena at L4-L5.
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15,294 |
CV MR Brain wo+w contrast Clinical Information: tumor This examination was performed in the Boshell Building MRI Facility. To access the report, please look in the Documentation section of IMPACT/Cerner, Choose to list All, and the report will be found titled Radiology Reports-- Neurology Procedure Note on the date it was performed. ?Please call 934-9906 if you have any questions about this.
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This examination was performed in the Boshell Building MRI Facility. To access the report, please look in the Documentation section of IMPACT/Cerner, Choose to list All, and the report will be found titled Radiology Reports-- Neurology Procedure Note on the date it was performed. ?Please call 934-9906 if you have any questions about this.
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: New cavitary nodule of the left lung apex measuring 9 x 8 mm (series 201 image 27). Trace groundglass opacity within the posterior right lower lobe. Lungs are otherwise clear throughout. No pleural effusions. HEART / VESSELS: Cardiac chambers and great vessels are normal in size. No central PE. Advanced coronary artery calcifications. Prosthetic aortic valve is noted. MEDIASTINUM / ESOPHAGUS: Similar appearance of the bulky, heterogenous enhancing distal one third esophageal mass with severe circumferential esophageal luminal narrowing. Mass measures approximately 4.3 x 3.7 cm in greatest axial dimensions (series 201 image 100). Previously placed esophageal stent has dislodged from the esophagus, and is now located in the mid gastric body. LYMPH NODES: Prominent left paraesophageal lymph node measures 1.6 x 1.6 cm. No additional areas of thoracic lymphadenopathy are identified. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Imaged portions of superior abdomen demonstrate intragastric esophageal stent as above. Otherwise unremarkable for exam technique. MUSCULOSKELETAL: No evidence of aggressive osseous lesion or acute fracture. Postsurgical changes of median sternotomy without evidence of sternal wire fracture.
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15,295 |
CV MR Brain wo+w contrast Clinical Information: tumor perfusion This examination was performed in the Boshell Building MRI Facility. To access the report, please look in the Documentation section of IMPACT/Cerner, Choose to list All, and the report will be found titled Radiology Reports-- Neurology Procedure Note on the date it was performed. ?Please call 934-9906 if you have any questions about this.
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This examination was performed in the Boshell Building MRI Facility. To access the report, please look in the Documentation section of IMPACT/Cerner, Choose to list All, and the report will be found titled Radiology Reports-- Neurology Procedure Note on the date it was performed. ?Please call 934-9906 if you have any questions about this.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Diffuse cerebral volume loss and chronic white matter microangiopathic changes. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Ex vacuo dilatation. ORBITS: Bilateral lens replacements. The orbits are otherwise unremarkable. SINUSES: Normal. MASTOIDS: Clear. SOFT TISSUE: Unremarkable.
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15,296 |
MRI brain with and without Indication: Recurrent Squamous cell lung cancer staging, C34.90 Malignant neoplasm of unspecified part of unspecified bronchus or lung, D05.11 Intraductal carcinoma in situ of right breast 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: 187 lbs. IV contrast: ProHance, 18 ml, per protocol. Findings: There is mild diffuse cerebral volume loss with ventricular prominence, Vacuo basis. There is a chronic left cerebellar small infarct. 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 space-occupying lesion. There are mild white matter FLAIR hyperintensities, compatible with mild chronic microangiopathic changes. 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 abnormal enhancement. The remaining visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Impression: 1. No acute intracranial process. No pathologic enhancement is appreciated to indicate intracranial metastasis. 2. Small chronic left cerebellar infarct.
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Findings: There is mild diffuse cerebral volume loss with ventricular prominence, Vacuo basis. There is a chronic left cerebellar small infarct. 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 space-occupying lesion. There are mild white matter FLAIR hyperintensities, compatible with mild chronic microangiopathic changes. 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 abnormal enhancement. The remaining visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics.
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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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15,297 |
Lumbar MRI without contrast Clinical information: 45-year-old female. Low back pain, SI joint pain, Comparison: Radiograph 9/20/2021 and MR 7/30/2015 Technique: Multiplanar multisequence MRI of the lumbar spine were obtained in the axial and sagittal plane without the use of intravenous contrast per protocol. Findings: Five nonrib-bearing lumbovertebral bodies. Alignment is normal. The vertebral body and disc space heights are normal. The marrow signal is normal. The conus terminates at the pedicle level of L1. No abnormal signal at the sacroiliac joints. T12-L1: No significant disc bulge. No significant spinal canal or foraminal narrowing. L1-2: No significant disc bulge. No significant spinal canal or foraminal narrowing. L2-3: No significant disc bulge. No significant spinal canal narrowing. L3-4: No significant disc bulge. No significant spinal canal narrowing. Minimal facet DJD. No significant foraminal narrowing. T2 hyperintensity in the right inferior articular process, likely tiny subarticular degenerative change. L4-5: Mild disc desiccation and height loss, progressed since the prior. Mild right subarticular/foraminal disc protrusion with tiny annular fissure and minimal foraminal narrowing. No significant spinal canal narrowing. Moderate right facet DJD, slightly progressed since the prior exam. Minimal left facet DJD. L5-S1: Mild disc desiccation overall unchanged. A tiny right subarticular annular fissure. No significant disc bulge. No significant spinal canal or foraminal narrowing. The paraspinal structures are normal. The remaining osseous and soft tissue structures are normal. Anterior and posterior ligamentous complexes are intact. CONCLUSION: Mild degenerative changes, mainly at L4-5 and L5-S1. Mild progression of disc desiccation and height loss at L4-5. Moderate right L4-5 facet DJD, also progressed since 2015. Overall no significant spinal canal or foraminal narrowing with nerve root impingement. 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: Five nonrib-bearing lumbovertebral bodies. Alignment is normal. The vertebral body and disc space heights are normal. The marrow signal is normal. The conus terminates at the pedicle level of L1. No abnormal signal at the sacroiliac joints. T12-L1: No significant disc bulge. No significant spinal canal or foraminal narrowing. L1-2: No significant disc bulge. No significant spinal canal or foraminal narrowing. L2-3: No significant disc bulge. No significant spinal canal narrowing. L3-4: No significant disc bulge. No significant spinal canal narrowing. Minimal facet DJD. No significant foraminal narrowing. T2 hyperintensity in the right inferior articular process, likely tiny subarticular degenerative change. L4-5: Mild disc desiccation and height loss, progressed since the prior. Mild right subarticular/foraminal disc protrusion with tiny annular fissure and minimal foraminal narrowing. No significant spinal canal narrowing. Moderate right facet DJD, slightly progressed since the prior exam. Minimal left facet DJD. L5-S1: Mild disc desiccation overall unchanged. A tiny right subarticular annular fissure. No significant disc bulge. No significant spinal canal or foraminal narrowing. The paraspinal structures are normal. The remaining osseous and soft tissue structures are normal. Anterior and posterior ligamentous complexes are intact.
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Findings: Since the prior head CT there is unchanged postsurgical changes from left craniectomy with protrusion of brain parenchyma through the craniectomy defect. Stable areas of encephalomalacia in the left temporal, frontoparietal and occipital lobes with ex vacuo dilatation of the left lateral ventricle and leftward midline shift by 8 mm. Previously seen foci of hyperattenuation along the superior aspect of the herniating brain parenchyma appears less dense on the present exam and may represent resolving hemorrhagic foci (coronal image #54, series 5, previously coronal image #54, series 7). There is no new hemorrhage. The visualized paranasal sinuses, right mastoid air cells and middle ear cavities are clear. Small left mastoid effusion. Both orbits appear normal.
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15,298 |
MR Brain wo+w contrast 1/24/2022 8:00 AM Clinical Information: Craniopharyngioma, D44.4 Neoplasm of uncertain behavior of craniopharyngeal duct Spec Inst: Craniopharyngioma - evaluate sella Comparison: Brain MRI 3/30/2021 Technique: T1 sagittal and coronal images were obtained through the sella turcica both before and after contrast administration. A dynamic T1 weighted coronal series was also obtained during the first pass of contrast. Please note the whole brain is not evaluated on this dedicated pituitary protocol. Patient weight: 235 lbs. IV contrast: ProHance, 10 ml, per protocol. IV contrast injection rate: 2 ml per sec. Findings: Lobulated heterogeneous mixed signal intensity sellar/suprasellar lesion with T2 hypointensity and mixed T1 hyperintensity is again noted. This measures approximately 2.3 x 1.5 cm in the coronal plane and 21 mm in the AP dimension, which is similar to the prior study. The superior aspect of the infundibulum appears enlarged, also similar to the prior exam. The infundibulum is otherwise slightly to the right of the midline. The pituitary gland enhances homogeneously. Contact with the optic chiasm and mass effect is unchanged. There is no involvement of the cavernous sinus or the ICAs. In the limited remaining visualized brain parenchyma, no obvious abnormality seen. There is a small mucous retention cyst in the right maxillary sinus. Impression: 1. Stable heterogeneous lobulated suprasellar lesion with mixed signal intensity including T2 hypointensity and mild enhancement compatible with a craniopharyngioma. No significant change in size or associated mass effect.
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Findings: Lobulated heterogeneous mixed signal intensity sellar/suprasellar lesion with T2 hypointensity and mixed T1 hyperintensity is again noted. This measures approximately 2.3 x 1.5 cm in the coronal plane and 21 mm in the AP dimension, which is similar to the prior study. The superior aspect of the infundibulum appears enlarged, also similar to the prior exam. The infundibulum is otherwise slightly to the right of the midline. The pituitary gland enhances homogeneously. Contact with the optic chiasm and mass effect is unchanged. There is no involvement of the cavernous sinus or the ICAs. In the limited remaining visualized brain parenchyma, no obvious abnormality seen. There is a small mucous retention cyst in the right maxillary sinus.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Unchanged appearance of hiatal hernia repair stable residual/recurrent hiatal hernia and herniated omental fat. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. Otherwise unremarkable. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Mild fatty atrophy, most prominent at the pancreatic head and neck. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal aside from stable left upper pole renal cortical scarring. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Normal. COLON / APPENDIX: Noninflamed colonic diverticula. Appendix is normal. PERITONEUM / MESENTERY: No free intraperitoneal air or fluid. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Fibroid uterus. Bilateral adnexa appear unremarkable. BODY WALL: Unchanged prior ventral abdominal wall hernia mesh repair. Stable small uncomplicated fat-containing left lateral abdominal wall hernia. MUSCULOSKELETAL: No acute fracture or aggressive osseous lesion.
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15,299 |
MRI brain with and without Indication: Multiple sclerosis, G35 Multiple sclerosis, Z79.899 Other long term (current) drug therapy, R26.9 Unspecified abnormalities of gait and mobility, N31.9 Neuromuscular dysfunction of bladder, unspecified Spec Inst: MS Protocol Comparison: No previous similar studies are available for comparison at this time. Technique: Multiple T1 and T2-weighted MR sequence images of the brain were obtained in the sagittal axial and coronal planes pre-and post administration of intravenous contrast per departmental protocol. Patient weight: 110 lbs. IV contrast: ProHance, 10 ml, per protocol. IV contrast injection rate: 1 ml per sec. Findings: There are multifocal confluent and discrete FLAIR hyperintensities in the periventricular, pericallosal, deep and subcortical white matter. There are multiple areas of extensive associated T1 hypointensity with several black holes. The FLAIR hyperintensity extends into the corpus callosum which appears thin. There is a T2 FLAIR hyperintense focus in the left dorsal medulla. A prominent T2 hyperintense focus is seen in the right lateral cord at the C2 level. There is a small linear FLAIR hyperintensity in the right cerebellar hemisphere, which could be a chronic infarct. Postcontrast images demonstrate no abnormal parenchymal or meningeal enhancement. There is a small developmental venous anomaly in the left inferior medial cerebellar hemisphere. There is no acute infarction, hemorrhage or hydrocephalus. The visualized paranasal sinuses and mastoid air cells are clear. Impression: 1. Multifocal T2/flair white matter hyperintensities in the supratentorial white matter and brainstem compatible with demyelination/multiple sclerosis, as detailed above with associated T1 hypointensity/black holes. No abnormal enhancement to suggest active demyelination. 2. Prominent T2 hyperintense focus in the right lateral cord at the C2 level. Correlation with cervical spine MRI would be helpful to evaluate the full extent, as indicated. 3. Small T2 hyperintense focus in the right cerebellum, in configuration suggestive of chronic infarct.
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Findings: There are multifocal confluent and discrete FLAIR hyperintensities in the periventricular, pericallosal, deep and subcortical white matter. There are multiple areas of extensive associated T1 hypointensity with several black holes. The FLAIR hyperintensity extends into the corpus callosum which appears thin. There is a T2 FLAIR hyperintense focus in the left dorsal medulla. A prominent T2 hyperintense focus is seen in the right lateral cord at the C2 level. There is a small linear FLAIR hyperintensity in the right cerebellar hemisphere, which could be a chronic infarct. Postcontrast images demonstrate no abnormal parenchymal or meningeal enhancement. There is a small developmental venous anomaly in the left inferior medial cerebellar hemisphere. There is no acute infarction, hemorrhage or hydrocephalus. The visualized paranasal sinuses and mastoid air cells are clear.
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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: Small bilateral pleural effusions, improved from prior, with adjacent dependent consolidation. Calcified granuloma in the posterior right middle lobe. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: The heart is mildly enlarged without pericardial effusion. Multivessel coronary artery and aortic annular calcifications are present. Dense calcifications versus stent in the RCA, unchanged. ABDOMEN and PELVIS: LIVER: Diffusely hyperattenuating, unchanged. Punctate calcified granuloma near the falciform ligament. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Stable indeterminate bilateral adrenal nodules. KIDNEYS: There is been interval retraction of the right percutaneous nephrostomy catheter, with the pigtail formed in an interpolar calyx. There are 2-3 nonobstructing calculi in the right renal pelvis, similar to prior. Unchanged right perinephric fat stranding. There is mild pelviectasis without frank hydronephrosis. Subcentimeter left renal hyperdensities have a similar appearance. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: The stomach is unremarkable. Multiple endoscopic clips within the duodenum are again noted. The loops of small bowel are normal in caliber. COLON / APPENDIX: Scattered noninflamed colonic diverticula. Normal appendix. PERITONEUM / MESENTERY: No intraperitoneal free fluid or free air. RETROPERITONEUM: As above. VESSELS: Moderate aortobiiliac calcific atherosclerosis with stable mild ectasia of bilateral common iliac arteries. Redemonstration of embolic coils within the gastroduodenal artery. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is absent. No suspicious adnexal abnormality. BODY WALL: Rectus diastasis and small fat-containing umbilical hernia. MUSCULOSKELETAL: Stable appearance of lumbar spine fixation hardware spanning L4-S1. No focal destructive osseous lesion.
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