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EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: Renal mass, concern for liver metastases, indeterminate hypoattenuating lesions on prior CT. COMPARISON: CT abdomen pelvis dated 12/29/2021 TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 179 lbs. IV contrast: ProHance, 16 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: The exam is markedly degraded by motion artifact. LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: Postsurgical changes from prior midline sternotomy. ABDOMEN: LIVER: Previously described hypoattenuating lesions in the liver are difficult to evaluate given extensive motion artifact. They appear to correspond to intermediate T2 signal lesions in the medial right hepatic lobe and hepatic dome (series 801, image 39 and 43). The more medial lesion appears to demonstrate peripheral arterial enhancement as seen on series 1003, image 366. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Possible subcentimeter cystic foci may represent a side branch IPMNs. No main pancreatic ductal dilatation. ADRENALS: Normal. KIDNEYS: Redemonstration of large predominantly exophytic mass with restricted diffusion arising from the inferior pole the left kidney. There is questionable invasion/abutment of the left psoas muscle as seen on series 1003, image 82. Additional bilateral T2 hyperintense lesions, possibly representing cysts. No hydronephrosis. Partially duplicated right renal collecting system. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Exam is markedly degraded by motion artifact, limiting evaluation of the hepatic lesions. The postcontrast sequences are essentially nondiagnostic. Cannot exclude metastatic disease. 2. Redemonstration of left renal mass, most consistent with renal cell carcinoma. 3. Other incidental and noncontributory findings as described above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: The exam is markedly degraded by motion artifact. LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: Postsurgical changes from prior midline sternotomy. ABDOMEN: LIVER: Previously described hypoattenuating lesions in the liver are difficult to evaluate given extensive motion artifact. They appear to correspond to intermediate T2 signal lesions in the medial right hepatic lobe and hepatic dome (series 801, image 39 and 43). The more medial lesion appears to demonstrate peripheral arterial enhancement as seen on series 1003, image 366. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Possible subcentimeter cystic foci may represent a side branch IPMNs. No main pancreatic ductal dilatation. ADRENALS: Normal. KIDNEYS: Redemonstration of large predominantly exophytic mass with restricted diffusion arising from the inferior pole the left kidney. There is questionable invasion/abutment of the left psoas muscle as seen on series 1003, image 82. Additional bilateral T2 hyperintense lesions, possibly representing cysts. No hydronephrosis. Partially duplicated right renal collecting system. 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: 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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15,401 |
EXAM: CV MR Cardiac w contrast DATE OF STUDY: 1/25/2022 1:03 PM - REFERRING MD: Provider Universal PATIENT DATA Height: 162 cm. Patient weight: 61 kg. BSA: 1.65 Blood Pressure: 136/85 Heart Rate: 54 bpm. EGFR 60. The patient's creatinine was 0.9 on 01/22/2022. The patient received 12 cc's of Gadavist at a rate of 2 ml per second without immediate complication. INDICATION: Patient studied for evaluation of: pericarditis, I30.9 Acute pericarditis, unspecified Spec Inst: Cox, David A MD refering physician Cardiovascular associates HISTORY: 45 year old man with past medical history of pericarditis presenting for cardiac MRI. COMPARISON TO: No prior cardiac MRI IMAGING DATA Imaging System: GE 1.5T Overall Image Quality: Excellent CARDIOVASCULAR MRI TECHNIQUE: Views: Axial Coronal T2 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, Tagging 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: The left ventricular size is normal. The left ventricular systolic function is normal. The LVEF is 61%. There are no regional wall motion abnormalities. There is no evidence of myocardial edema on the T2 weighted images. There is no perfusion defect at rest with first pass imaging. There is no late gadolinium enhancement (LGE) to suggest underlying inflammation/infiltration/fibrosis/scarring/infarction. Left Ventricle measurements: LV End Diastolic Dimension: 51.4 mm LV End Systolic Dimension: 33.7 mm LV Posterior Wall: 8.7 mm Interventricular Septum: 10.0 mm Left Ventricle Volumes (short axis): End Diastolic Volume: 144.66 mL - EDV Index = 87.76 mL/m2 End Systolic Volume: 56.27 mL - ESV Index = 34.14 mL/m2 Stroke Volume: 88.39 mL - SV Index = 70.29 mL/m2 Ejection Fraction: 61.1% B - RIGHT VENTRICLE: Morphology and function: The right ventricular size is normal. The right ventricular systolic function is normal. Right Ventricle measurements: RV End Diastolic Dimension: 45.3 mm Right Ventricle Volumes (short axis): End Diastolic Volume: 141.83 mL - EDV Index = 86.05 mL/m2 End Systolic Volume: 71.54 mL - ESV Index = 43.4 mL/m2 Stroke Volume: 70.29 mL - SV Index = 42.6 mL/m2 Ejection Fraction: 49.56% C - ATRIA: Normal sized left and right atrium. No thrombus in the visualized segments of the left atrial appendage. Left Atrium: 33.1 mm Right Atrium: 48.9 mm D - VALVES: Mitral: Normal Regurgitation: None Stenosis: None Aortic: tricuspid Regurgitation: None Stenosis: None Tricuspid: Normal Regurgitation: None Stenosis: None Pulmonary: Not well visualized 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: 26.2 mm Aortic Root: 32.1 mm Ascending Aorta: 29.9 [19-37] mm Descending Aorta: 17.5 [16-29] mm F - PERICARDIUM: The pericardium is normal in thickness (2.2 mm) and signal intensity in T1 and T2 weighted images. There is no CMR signs of pericardial constriction on tagging sequences.There is no pericardial late gadolinium enhancement to indicate pericardial fibrosis/scarring/inflammation. No pericardial effusion is noted. G - LUNG, PLEURA AND OTHER NONCARDIOVASCULAR STRUCTURES: There is no pleural effusion. The visualized lungs are grossly unremarkable. CONCLUSIONS: 1. The pericardium is normal in thickness (2.2 mm) and signal intensity in T1 and T2 weighted images. There is no CMR signs of pericardial constriction on tagging sequences.There is no pericardial late gadolinium enhancement to indicate pericardial fibrosis/scarring/inflammation. No pericardial effusion is noted. 2. The left ventricular size is normal. The left ventricular systolic function is normal. The LVEF is 61%. There are no regional wall motion abnormalities. 3. There is no evidence of myocardial edema on the T2 weighted images. There is no perfusion defect at rest with first pass imaging. There is no late gadolinium enhancement (LGE) to suggest underlying inflammation/infiltration/fibrosis/scarring/infarction. 4. The right ventricular size is normal. The right ventricular systolic function is normal. 5. Normal sized left and right atrium. No thrombus in the visualized segments of the left atrial appendage. Overall, no CMR findings of pericarditis. 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: The left ventricular size is normal. The left ventricular systolic function is normal. The LVEF is 61%. There are no regional wall motion abnormalities. There is no evidence of myocardial edema on the T2 weighted images. There is no perfusion defect at rest with first pass imaging. There is no late gadolinium enhancement (LGE) to suggest underlying inflammation/infiltration/fibrosis/scarring/infarction. Left Ventricle measurements: LV End Diastolic Dimension: 51.4 mm LV End Systolic Dimension: 33.7 mm LV Posterior Wall: 8.7 mm Interventricular Septum: 10.0 mm Left Ventricle Volumes (short axis): End Diastolic Volume: 144.66 mL - EDV Index = 87.76 mL/m2 End Systolic Volume: 56.27 mL - ESV Index = 34.14 mL/m2 Stroke Volume: 88.39 mL - SV Index = 70.29 mL/m2 Ejection Fraction: 61.1% B - RIGHT VENTRICLE: Morphology and function: The right ventricular size is normal. The right ventricular systolic function is normal. Right Ventricle measurements: RV End Diastolic Dimension: 45.3 mm Right Ventricle Volumes (short axis): End Diastolic Volume: 141.83 mL - EDV Index = 86.05 mL/m2 End Systolic Volume: 71.54 mL - ESV Index = 43.4 mL/m2 Stroke Volume: 70.29 mL - SV Index = 42.6 mL/m2 Ejection Fraction: 49.56% C - ATRIA: Normal sized left and right atrium. No thrombus in the visualized segments of the left atrial appendage. Left Atrium: 33.1 mm Right Atrium: 48.9 mm D - VALVES: Mitral: Normal Regurgitation: None Stenosis: None Aortic: tricuspid Regurgitation: None Stenosis: None Tricuspid: Normal Regurgitation: None Stenosis: None Pulmonary: Not well visualized 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: 26.2 mm Aortic Root: 32.1 mm Ascending Aorta: 29.9 [19-37] mm Descending Aorta: 17.5 [16-29] mm F - PERICARDIUM: The pericardium is normal in thickness (2.2 mm) and signal intensity in T1 and T2 weighted images. There is no CMR signs of pericardial constriction on tagging sequences.There is no pericardial late gadolinium enhancement to indicate pericardial fibrosis/scarring/inflammation. No pericardial effusion is noted. G - LUNG, PLEURA AND OTHER NONCARDIOVASCULAR STRUCTURES: There is no pleural effusion. The visualized lungs are grossly unremarkable.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Normal cerebral cortical volume for patient's age. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. Nonunion of the posterior arch of C1. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Paranasal sinuses are clear. VESSELS: Normal noncontrast appearance of the vessels.
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15,402 |
EXAM: CV MR Cardiac w contrast, CV MR for Velocity Flow DATE OF STUDY: 1/25/2022 2:40 PM - REFERRING MD: Zubair Khan PATIENT DATA Height: 172 cm. Patient weight: 68 kg. BSA: 1.80247 Blood Pressure: 132/65 Heart Rate: 95 bpm. EGFR 49. The patient's creatinine was 1.4 on 01/25/22. 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: cardiomyopathy, I42.9 Cardiomyopathy, unspecified HISTORY: 82 year old man with past medical history of CAD and systolic heart failure, which he subsequently had PCI to TCA and LAD/diagonal branch 7/23/21. COMPARISON TO: No prior 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 perfusion Additional views: delayed contrast enhancement 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: The left ventricular size is severely dilated (LVEDVi: 130.02 mL/m\S\2). The left ventricular systolic function is severely reduced. The LVEF is 27%. There is severe global left ventriclar hypokinesis. There is thinning and akinesis of the mid and apical anterior, mid anterolateral and the apical lateral segments. There is dyssynchrony of the septum. There is no perfusion defect at rest with first pass imaging. Overall, there is a large amount of late gadolinium enhancement (LGE) as follows: there is subendocardial LGE involving the entire anterolateral wall (50% at the mid and transmural at the apex), there is subendocardial LGE involving the entire anterior wall ((50% at the mid and apex), there is subendocardial LGE involving the basal and mid inferior wall (50% transmurality), there is subendocardial LGE involving the basal and mid inferolateral (50% at the mid), there is subendocardial LGE at the basal inferoseptum (50%). Left Ventricle measurements: LV End Diastolic Dimension: 57.3 mm LV End Systolic Dimension: 48.5 mm LV Posterior Wall: 8.7 mm Interventricular Septum: 10.0 mm Left Ventricle Volumes (short axis): End Diastolic Volume: 245.64 mL - EDV Index = 130.02 mL/m2 End Systolic Volume: 179.94 mL - ESV Index = 95.25 mL/m2 Stroke Volume: 65.7 mL - SV Index = 34.77 mL/m2 Ejection Fraction: 26.74% B - RIGHT VENTRICLE: Morphology and function: The right ventricular size is normal. The right ventricular systolic function is normal. Right Ventricle measurements: RV End Diastolic Dimension: 43.0 mm Right Ventricle Volumes (short axis): End Diastolic Volume: 113.11 mL - EDV Index = 59.63 mL/m2 End Systolic Volume: 54.16 mL - ESV Index = 28.55 mL/m2 Stroke Volume: 58.95 mL - SV Index = 31.08 mL/m2 Ejection Fraction: 52.12% C - ATRIA: Mildly dilated left and right atrium. No thrombus in the visualized segments of the left atrial appendage. Left Atrium: 41.8 mm Right Atrium: 50.2 mm D - VALVES: Mitral: Mildly thickened anterior leaflet Regurgitation: mild-moderate, functional mitral regurgitation. Based on 2D phase contrast imaging, the regurgitant volume is 15.54 mL and the regurgitant fraction is 24%. Stenosis: None Aortic: tricuspid Regurgitation: trivial Stenosis: None Tricuspid: Normal Regurgitation: None Stenosis: None Pulmonary: Not well visualized E - GREAT ARTERIES: Left-sided aortic arch with normal branching pattern. The main pulmonary artery is mildly dilated. The thoracic aorta is normal in caliber. Vessel dimensions: Main Pulmonary Artery: 33.5 mm Aortic Root: 33.5 mm Ascending Aorta: 33.8 [19-37] mm Descending Aorta: 23.1 [16-29] 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. Degenerative changes of the spine. CONCLUSIONS: 1. The left ventricular size is severely dilated (LVEDVi: 130.02 mL/m\S\2). The left ventricular systolic function is severely reduced. The LVEF is 27%. There is severe global left ventriclar hypokinesis. There is thinning and akinesis of the mid and apical anterior, mid anterolateral and the apical lateral segments. There is dyssynchrony of the septum. 2. There is no perfusion defect at rest with first pass imaging. Overall, there is a large amount of late gadolinium enhancement (LGE) as follows: there is subendocardial LGE involving the entire anterolateral wall (50% at the mid and transmural at the apex), there is subendocardial LGE involving the entire anterior wall ((50% at the mid and apex), there is subendocardial LGE involving the basal and mid inferior wall (50% transmurality), there is subendocardial LGE involving the basal and mid inferolateral (50% at the mid), there is subendocardial LGE at the basal inferoseptum (50%). 3. The right ventricular size is normal. The right ventricular systolic function is normal. 4. Mildly dilated left and right atrium. No thrombus in the visualized segments of the left atrial appendage. 5. Mildly thickened anterior leaflet of the mitral valve. There is mild-moderate, functional mitral regurgitation. Based on 2D phase contrast imaging, the regurgitant volume is 15.54 mL and the regurgitant fraction is 24%. 6. The main pulmonary artery is mildly dilated. 7. Degenerative changes of the spine. Overall, viability assessment as follows: Left Anterior Descending territory: non viable at the mid and apical segments Left Circumflex territory: non viable at the mid and apical segments Right Coronary Artery territory: viable Cardiac MRI Technologist: Cathy Gunn As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: 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: The left ventricular size is severely dilated (LVEDVi: 130.02 mL/m\S\2). The left ventricular systolic function is severely reduced. The LVEF is 27%. There is severe global left ventriclar hypokinesis. There is thinning and akinesis of the mid and apical anterior, mid anterolateral and the apical lateral segments. There is dyssynchrony of the septum. There is no perfusion defect at rest with first pass imaging. Overall, there is a large amount of late gadolinium enhancement (LGE) as follows: there is subendocardial LGE involving the entire anterolateral wall (50% at the mid and transmural at the apex), there is subendocardial LGE involving the entire anterior wall ((50% at the mid and apex), there is subendocardial LGE involving the basal and mid inferior wall (50% transmurality), there is subendocardial LGE involving the basal and mid inferolateral (50% at the mid), there is subendocardial LGE at the basal inferoseptum (50%). Left Ventricle measurements: LV End Diastolic Dimension: 57.3 mm LV End Systolic Dimension: 48.5 mm LV Posterior Wall: 8.7 mm Interventricular Septum: 10.0 mm Left Ventricle Volumes (short axis): End Diastolic Volume: 245.64 mL - EDV Index = 130.02 mL/m2 End Systolic Volume: 179.94 mL - ESV Index = 95.25 mL/m2 Stroke Volume: 65.7 mL - SV Index = 34.77 mL/m2 Ejection Fraction: 26.74% B - RIGHT VENTRICLE: Morphology and function: The right ventricular size is normal. The right ventricular systolic function is normal. Right Ventricle measurements: RV End Diastolic Dimension: 43.0 mm Right Ventricle Volumes (short axis): End Diastolic Volume: 113.11 mL - EDV Index = 59.63 mL/m2 End Systolic Volume: 54.16 mL - ESV Index = 28.55 mL/m2 Stroke Volume: 58.95 mL - SV Index = 31.08 mL/m2 Ejection Fraction: 52.12% C - ATRIA: Mildly dilated left and right atrium. No thrombus in the visualized segments of the left atrial appendage. Left Atrium: 41.8 mm Right Atrium: 50.2 mm D - VALVES: Mitral: Mildly thickened anterior leaflet Regurgitation: mild-moderate, functional mitral regurgitation. Based on 2D phase contrast imaging, the regurgitant volume is 15.54 mL and the regurgitant fraction is 24%. Stenosis: None Aortic: tricuspid Regurgitation: trivial Stenosis: None Tricuspid: Normal Regurgitation: None Stenosis: None Pulmonary: Not well visualized E - GREAT ARTERIES: Left-sided aortic arch with normal branching pattern. The main pulmonary artery is mildly dilated. The thoracic aorta is normal in caliber. Vessel dimensions: Main Pulmonary Artery: 33.5 mm Aortic Root: 33.5 mm Ascending Aorta: 33.8 [19-37] mm Descending Aorta: 23.1 [16-29] 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. Degenerative changes of the spine.
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FINDINGS: BRAIN PARENCHYMA: No evidence of intraparenchymal hemorrhage, mass effect, or edema. Focal hyperattenuation in the left cerebellum adjacent to the skull base likely represents artifact. Gray-white matter differentiation is maintained. No evidence of acute infarction. Normal cerebral cortical volume for patient's age. EXTRA-AXIAL SPACES: Subtle gyriform hyperattenuation in the high left frontal lobe (image 52, series #201) which may represent tiny subarachnoid hemorrhage versus artifact. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Tiny mucus retention cyst in the right maxillary sinus. VESSELS: Normal noncontrast appearance of the vessels.
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15,403 |
Clinical history:Assess for cause of headache and dizziness Comparison:None available at the time of interpretation Technique: Multiplanar multisequence pre and postcontrast MRI images of the brain and IACs were obtained. Images include dedicated heavily T2-weighted and postcontrast images through the internal auditory structures. Patient weight: 178 lbs. IV contrast: ProHance, 17 ml, per protocol. IV contrast injection rate: 1 ml per sec. . Findings: There is no enhancing mass in either internal auditory canal, or rest of the brain. There is preservation of the signal in bilateral cochlea and semicircular canals. There is no restricted diffusion to suggest an acute infarct. The ventricles are within normal limits for caliber and configuration. Minor scattered paranasal mucosal thickening. Mastoid air cells are clear. The orbits are within normal limits. No suspicious calvarial lesion is noted. Impression: No acute infarct, or abnormal intracranial enhancement.
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Findings: There is no enhancing mass in either internal auditory canal, or rest of the brain. There is preservation of the signal in bilateral cochlea and semicircular canals. There is no restricted diffusion to suggest an acute infarct. The ventricles are within normal limits for caliber and configuration. 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: 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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15,404 |
EXAM: MR Cervical Spine wo contrast CLINICAL INFORMATION: Cervical radiculopathy. COMPARISON: Cervical spine radiograph dated 1/19/2022 and cervical spine CT dated 12/10/2021. Of note there is also a cervical spine MR dated 11/7/2016. TECHNIQUE: MR Cervical Spine wo contrast. FINDINGS: Redemonstrated anterior cervical fusion hardware spanning C4-C7. No acute compression fracture or compression deformity. No abnormal cord signal. Mild anterolisthesis of C7 on T1 without associated spinal canal narrowing. C2-C3: Mild broad-based disc bulge without significant spinal canal narrowing. Mild right predominant uncovertebral hypertrophy without significant neural foraminal narrowing. C3-C4: Broad-based disc bulge which is eccentric to left side resulting in mild left foraminal narrowing. Mild associated bilateral uncovertebral hypertrophy. Mild spinal canal stenosis. C4-C5: No significant disc bulge. Mild bilateral right worse than left uncovertebral hypertrophy resulting in mild right foraminal narrowing. C5-C6: No significant disc bulge. No significant foraminal narrowing. C6-C7: Mild right greater than left uncovertebral hypertrophy resulting in mild right foraminal narrowing. C7-T1: At the level of C7 there is asymmetric right ligamentum flavum hypertrophy and facet arthropathy with severe right neural foraminal narrowing and compression over exiting right C8 nerve root best appreciated on axial series 8 image 19. No significant disc bulge or osseous foraminal narrowing. The visualized intracranial structures are unremarkable. The visualized soft tissues are unremarkable. Lung apices are clear. CONCLUSION: Postsurgical changes status post anterior fusion from C4 to C7 without residual spinal canal stenosis at the surgical levels. Severe right neural foraminal narrowing at C7-T1 level. 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: Redemonstrated anterior cervical fusion hardware spanning C4-C7. No acute compression fracture or compression deformity. No abnormal cord signal. Mild anterolisthesis of C7 on T1 without associated spinal canal narrowing. C2-C3: Mild broad-based disc bulge without significant spinal canal narrowing. Mild right predominant uncovertebral hypertrophy without significant neural foraminal narrowing. C3-C4: Broad-based disc bulge which is eccentric to left side resulting in mild left foraminal narrowing. Mild associated bilateral uncovertebral hypertrophy. Mild spinal canal stenosis. C4-C5: No significant disc bulge. Mild bilateral right worse than left uncovertebral hypertrophy resulting in mild right foraminal narrowing. C5-C6: No significant disc bulge. No significant foraminal narrowing. C6-C7: Mild right greater than left uncovertebral hypertrophy resulting in mild right foraminal narrowing. C7-T1: At the level of C7 there is asymmetric right ligamentum flavum hypertrophy and facet arthropathy with severe right neural foraminal narrowing and compression over exiting right C8 nerve root best appreciated on axial series 8 image 19. No significant disc bulge or osseous foraminal narrowing. The visualized intracranial structures are unremarkable. The visualized soft tissues are unremarkable. Lung apices are clear.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Periventricular white matter hypoattenuation consistent with mild chronic microangiopathic changes. Mild age-appropriate diffuse parenchymal volume loss. No sulcal effacement. EXTRA-AXIAL SPACES: No extra-axial collections. Basal cisterns are patent. SKULL AND SKULL BASE: No fracture. Trace bilateral mastoid air cell effusions. VENTRICULAR SYSTEM: Normal. ORBITS: Bilateral pseudophakia. SINUSES: Mild mucosal thickening of the left maxillary sinus. VESSELS: Scattered atherosclerosis of the bilateral carotid siphons.
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15,405 |
EXAM: MR TMJ CLINICAL INFORMATION: Male patient 26 years with TMJ pain or limited movement, M26.629 Arthralgia of temporomandibular joint, unspecified side, M26.69 Other specified disorders of temporomandibular joint, M26.69 Other specified disorders of temporomandibular joint, M26.609 Unspecified temporomandibular joint disorder, unspecified side Spec Inst: MRI B TMJ s with open and closed coronal views wout contrast. PainDysfunction TECHNIQUE: Sagittal proton-density, sagittal T2 and coronal proton-density closed mouth views as well as sagittal proton-density, coronal proton-density open-mouth views and cine images of the TMJs were obtained without intravenous gadolinium. COMPARISON: None available. FINDINGS: The left mandibular condyle is normally seated within the glenoid fossa. The disc appears normally positioned. There is no significant joint effusion. On the open-mouth views there is capture of the disc and also normal anterior translation On the right the mandibular condyle is normally seated within the glenoid fossa. The disc is appropriately positioned. However the central portion of the disc is not well seen. There is a small osteophyte arising from the lateral aspect of the mandibular condyle. On the open-mouth view there is capture of the disc and mildly decreased anterior translation. CONCLUSION: LEFT TMJ: Disc is normally positioned in the closed mouth view. There is normal capture of the disc and anterior translation during open-mouth maneuvers. RIGHT TMJ: Disc is normally positioned in close mouth position. However there is persistent abnormal signal involving the central portion of the disc suggesting degenerative fraying/tearing. There is also mild degenerative osteoarthrosis. There is normal capture and only mildly decreased anterior translation during open mouth maneuvers.
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FINDINGS: The left mandibular condyle is normally seated within the glenoid fossa. The disc appears normally positioned. There is no significant joint effusion. On the open-mouth views there is capture of the disc and also normal anterior translation On the right the mandibular condyle is normally seated within the glenoid fossa. The disc is appropriately positioned. However the central portion of the disc is not well seen. There is a small osteophyte arising from the lateral aspect of the mandibular condyle. On the open-mouth view there is capture of the disc and mildly decreased anterior translation.
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Findings: There is no evidence of acute intracranial hemorrhage, infarction, brain edema, mass effect or hydrocephalus. Mild diffuse brain volume loss with ex vacuo ventricular prominence. The visualized paranasal sinuses, right mastoid air cells and middle ear cavities are clear. Persistent opacification of left mastoid air cells. Both orbits appear normal.
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15,406 |
EXAM: MR Brain wo+w contrast CLINICAL INFORMATION: Intractable epilepsy. COMPARISON: Brain MR dated 8/13/2021. CTA head with and without contrast dated 1/24/2022 at 14:11 hours. TECHNIQUE: Limited Axial T1 3D pre and postcontrast sequences of the brain were obtained.. Patient weight: 155 lbs. IV contrast: ProHance, 14 ml, per protocol. FINDINGS: Asymmetric abnormal hyperintense T2-weighted signal of the left hippocampus is better characterized in prior routine MRI of the brain, without associated abnormal enhancement in the current study. Unchanged left frontal temporoparietal cortical atrophy with associated left subdural hygroma. No new parenchymal abnormality in these limited sequences. No abnormal leptomeningeal or pachymeningeal enhancement. The ventricles are within normal size limits and there is no midline shift. No abnormal bone marrow signal. The middle ears, mastoid air cells, and paranasal sinuses are clear. The orbits and globes are unremarkable. The visualized soft tissues are unremarkable. IMPRESSION: 1. Limited T1-weighted pre and post contrast images of the brain demonstrate unchanged left frontal temporoparietal cortical atrophy with associated left subdural hygroma. 2. Asymmetric abnormal hyperintense T2-weighted signal of the left hippocampus is better characterized in prior routine MRI of the brain, without associated abnormal enhancement in the current study. 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: Asymmetric abnormal hyperintense T2-weighted signal of the left hippocampus is better characterized in prior routine MRI of the brain, without associated abnormal enhancement in the current study. Unchanged left frontal temporoparietal cortical atrophy with associated left subdural hygroma. No new parenchymal abnormality in these limited sequences. No abnormal leptomeningeal or pachymeningeal enhancement. The ventricles are within normal size limits and there is no midline shift. No abnormal bone marrow signal. The middle ears, mastoid air cells, and paranasal sinuses are clear. The orbits and globes are unremarkable. The visualized soft tissues are unremarkable.
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: There is bibasilar subsegmental atelectasis. No pulmonary nodule or mass is identified. There is no pleural effusion. There are few scattered calcified granulomas seen bilaterally. The central airways are patent. HEART / VESSELS: There is mild coronary and thoracic aortic atherosclerotic calcification. No large pericardial effusion is seen. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Left hepatic lobe mass is again noted. Additional small subcentimeter lesions in the liver are better visualized on prior CT. Bilateral adrenal nodularity as well as gastrohepatic/periportal adenopathy is again noted. MUSCULOSKELETAL: Mild degenerative changes are seen within the spine. No focal destructive osseous lesion is identified.
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15,407 |
MR Lumbar Spine wo contrast 1/24/2022 5:23 PM Clinical information: 79 years Male patient with left leg pain, M79.605 Pain in left leg Spec Inst: eval for Level 3 Disc on Left side Comparison: Plain films of the lumbar spine dated 1/19/2022. Technique: Sagittal and axial T1, T2 and STIR images were obtained of the lumbar spine, without intravenous contrast administration. Findings: The sagittal images demonstrate unchanged dextrocurvature centered at L3-L4, with preservation of the lumbar lordosis, and grade 1 anterolisthesis of L4 on L5. The vertebral bodies maintain normal height and marrow signal. The intervertebral discs appear desiccated from decreased T2-weighted signal, with associated mild L3-4 and moderate L5-S1 disc height loss. The distal spinal cord is normal in size and signal intensity, without expansile lesions. The tip of the conus medullaris terminates normally at L1. L1-L2: Left subarticular protrusion, resulting in mild left neuroforaminal narrowing, without significant spinal canal stenosis. L2-L3: Circumferential disc bulge and left subarticular protrusion, with bilateral facet hypertrophy, resulting in severe left and moderate right neuroforaminal narrowing, with mild spinal canal stenosis. L3-4: Circumferential disc bulge with bilateral facet hypertrophy, resulting in severe left and moderate right neuroforaminal narrowing, with moderate to severe spinal canal stenosis and effacement of the left lateral recess. L4-5: Asymmetric left pseudodisc bulge with right paracentral annular fissure and bilateral facet hypertrophy, resulting in severe left neuroforaminal narrowing, with mild spinal canal stenosis. L5-S1: Circumferential disc bulge and epidural lipomatosis, resulting in mild right neuroforaminal narrowing, without significant spinal canal stenosis. The paraspinal soft tissues appear unremarkable, without organized fluid collections. Partially visualized right extrarenal pelvis and left simple renal cyst, measuring up to 10 mm. IMPRESSION: 1. No evidence of acute findings in the lumbar spine. 2. Unchanged dextrocurvature centered at L3-L4, with preservation of the lumbar lordosis, and grade 1 anterolisthesis of L4 on L5. 3. Chronic multilevel degenerative changes as described, resulting in severe left L2-L3/L3-L4/L4-L5 neuroforaminal narrowing, impinging upon the left L2, left L3 and left L4 nerve roots, with associated moderate to severe L3-4 spinal canal stenosis.
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Findings: The sagittal images demonstrate unchanged dextrocurvature centered at L3-L4, with preservation of the lumbar lordosis, and grade 1 anterolisthesis of L4 on L5. The vertebral bodies maintain normal height and marrow signal. The intervertebral discs appear desiccated from decreased T2-weighted signal, with associated mild L3-4 and moderate L5-S1 disc height loss. The distal spinal cord is normal in size and signal intensity, without expansile lesions. The tip of the conus medullaris terminates normally at L1. L1-L2: Left subarticular protrusion, resulting in mild left neuroforaminal narrowing, without significant spinal canal stenosis. L2-L3: Circumferential disc bulge and left subarticular protrusion, with bilateral facet hypertrophy, resulting in severe left and moderate right neuroforaminal narrowing, with mild spinal canal stenosis. L3-4: Circumferential disc bulge with bilateral facet hypertrophy, resulting in severe left and moderate right neuroforaminal narrowing, with moderate to severe spinal canal stenosis and effacement of the left lateral recess. L4-5: Asymmetric left pseudodisc bulge with right paracentral annular fissure and bilateral facet hypertrophy, resulting in severe left neuroforaminal narrowing, with mild spinal canal stenosis. L5-S1: Circumferential disc bulge and epidural lipomatosis, resulting in mild right neuroforaminal narrowing, without significant spinal canal stenosis. The paraspinal soft tissues appear unremarkable, without organized fluid collections. Partially visualized right extrarenal pelvis and left simple renal cyst, measuring up to 10 mm.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Normal cerebral cortical volume for patient's age. Empty sella. Cerebellar tonsillar ectopia with crowding at the foramen magnum. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Suboccipital craniectomy and C1 laminectomy. Bilateral mastoid air cells are clear. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Paranasal sinuses are clear. VESSELS: Normal noncontrast appearance of the vessels.
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15,408 |
MR Breast Bilateral wo Contrast Implant CLINICAL INFORMATION: 55-year-old woman with history of breast cancer status post bilateral mastectomies with silicone implant reconstructions. Examination is performed to evaluate integrity of the silicone implants. hx silicone implant recon, Z79.811 Long term (current) use of aromatase inhibitors, Z98.890 Other specified postprocedural states, Z90.13 Acquired absence of bilateral breasts and nipples, C50.919 Malignant neoplasm of unspecified site of unspecified female breast. TECHNIQUE: Axial T2 STIR and sagittal T2 water sat sequences were performed to evaluate the silicone implants. COMPARISON: MR breast 1/15/2020 FINDINGS: The silicone implants are intact bilaterally without evidence of intracapsular or extracapsular rupture. There is no suspicious periimplant fluid. IMPRESSION: Intact bilateral silicone implants. Please note that malignancy is not excluded on the basis of this examination. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: The silicone implants are intact bilaterally without evidence of intracapsular or extracapsular rupture. There is no suspicious periimplant fluid.
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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. Suboccipital craniectomy. ATLANTODENTAL INTERVAL: Normal (
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15,409 |
MR Brain wo+w contrast 1/24/2022 4:57 PM Clinical information: 49 years Female patient with Seizure, nontraumatic, R56.9 Unspecified convulsions Spec Inst: Epilepsy Protocol - patient with various, fluctuating neurological symptoms and treatment refractory seizures Comparison: None available. Technique: Multiplanar, multisequence MRI of the brain was performed before and after the administration of intravenous contrast. Patient weight: 215 lbs. IV contrast: ProHance, 10 ml, per protocol. FINDINGS: Cerebral parenchyma: The brain parenchyma volume is appropriate for patient's age. No evidence of neuronal migrational disorders, abnormal enhancement, intracranial mass lesion, hemorrhage, or infarction. The bilateral hippocampi and parahippocampal gyri are normal in size and signal intensity. 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, bilateral frontal and maxillary sinus mucosal thickening. Visualized orbits: No ocular or retrobulbar pathology. Calvarium and skull base: No osseous destruction. Pituitary and Pineal Glands: Incidental empty sella. No mass lesion. Soft tissues: No significant abnormality. IMPRESSION: No acute intracranial process or abnormal enhancement identified. In particular no structural abnormality to explain patient's seizures.
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FINDINGS: Cerebral parenchyma: The brain parenchyma volume is appropriate for patient's age. No evidence of neuronal migrational disorders, abnormal enhancement, intracranial mass lesion, hemorrhage, or infarction. The bilateral hippocampi and parahippocampal gyri are normal in size and signal intensity. 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, bilateral frontal and maxillary sinus mucosal thickening. Visualized orbits: No ocular or retrobulbar pathology. Calvarium and skull base: No osseous destruction. Pituitary and Pineal Glands: Incidental empty sella. No mass lesion. Soft tissues: No significant abnormality.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Mild mixed-type centrilobular and paraseptal emphysema. Right basilar tree-in-bud opacities. Right medial lung base suture material, possible prior wedge resection or lobectomy. Trace bibasilar dependent atelectasis. No pleural effusion, pneumothorax, or suspicious pulmonary nodule. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Normal cardiac size. No pericardial effusion. Mild coronary artery atherosclerotic calcifications. Mild mixed descending thoracic aortic atherosclerotic plaque. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Mild intrahepatic and extrahepatic biliary ductal dilation. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Bilateral adrenal gland thickening without discrete nodularity. KIDNEYS: Nonobstructive 2 mm right lower pole renal calculus. Partially exophytic, subcentimeter hypoattenuating right lateral interpolar lesion, probable cyst. Additional subcentimeter hypoattenuating lesions in the right upper pole, technically indeterminate. Bilateral extrarenal pelvis. No left-sided nephrolithiasis. Multiple subcentimeter left upper pole probable cysts and additional subcentimeter hypoattenuating lesions scattered throughout the left kidney, technically indeterminate. No focal enhancing mass bilaterally. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Noninflamed diverticulosis. The appendix is surgically absent. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate mixed aortoiliac atherosclerotic plaque without aneurysmal dilatation. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is surgically absent. Left ovarian cyst. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Healed remote fracture deformity of the lateral right seventh rib. Multiple age-indeterminate vertebral body compression deformities with sclerotic endplate changes and associated moderate height loss at T9, severe at T10, and mild at T12. Trace retropulsion of the T12 superior endplate up to 5 mm without significant spinal canal stenosis. Chronic-appearing mild to moderate compression deformities at L3-L4 with vertebroplasty changes. Trace retropulsion of the L3 inferior endplate up to 6 mm with mild spinal canal stenosis. Multilevel moderate to severe thoracolumbar spine degenerative changes with severe intervertebral disc space height loss at L3-L4 and L5-S1. Mild degenerative retrolisthesis of L5 on S1 with associated mild spinal canal stenosis. No aggressive osseous lesion. Cystic lesions in the right T9-T10 and T10-11 neural foramen, possible perineural cysts or pseudomeningocele
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15,410 |
EXAM: MR Abdomen Partial Study CLINICAL INFORMATION: Hepatic adenoma COMPARISON: MRI dated 1/25/2022 TECHNIQUE: MR Abdomen Partial Study FINDINGS: The patient was rescheduled at a different MRI scanner on UAB campus due to artifact identified on the limited T2 images obtained. CONCLUSION: Exam terminated early due to artifact. Please see separately dictated complete MRI dated 1/25/2022 As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: The patient was rescheduled at a different MRI scanner on UAB campus due to artifact identified on the limited T2 images obtained.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. Technically limited evaluation due to significant metallic streak artifact from bilateral hip arthroplasty hardware. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Bibasilar subsegmental atelectasis. DISTAL ESOPHAGUS: Small hiatal hernia. HEART / VESSELS: Normal cardiac size. No pericardial effusion. Partially imaged right ventricular pacemaker lead. Trace thoracic aortic atherosclerotic ossifications. Mitral valvular calcification. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Collapsed. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: No nephrolithiasis or hydroureteronephrosis bilaterally. Left lower pole probable cyst. LYMPH NODES: Moderately enlarged 1.4 cm right lower quadrant mesenteric node (series 2, image 211). STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Noninflamed diverticulosis. The appendix is nondilated. No hyperdense fecalith. PERITONEUM / MESENTERY: Regional right lower quadrant inflammatory mesenteric stranding adjacent to enlarged right lower quadrant lymph node. No free fluid or free intraperitoneal air. RETROPERITONEUM: Normal. VESSELS: Trace abdominal aortic atherosclerotic calcifications. URINARY BLADDER: Limited evaluation due to bilateral hip arthroplasty hardware metallic streak artifact. Suboptimally evaluated due to underdistention. REPRODUCTIVE ORGANS: Limited evaluation of the uterus and bilateral adnexa due to hardware artifact. BODY WALL: Tiny fat-containing periumbilical hernia. Small area of right lateral chest wall subcutaneous fat stranding. MUSCULOSKELETAL: S-shaped thoracolumbar scoliosis. Bilateral hip arthroplasties without evidence of hardware failure or loosening. No acute osseous abnormality or focal aggressive osseous lesion.
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15,411 |
EXAM:MR Shoulder Right wo contrast CLINICAL INFORMATION:Right shoulder pain and weakness COMPARISON:11/30/2021 TECHNIQUE: Multiplanar and multisequence MRI of the right shoulder was obtained without intravenous contrast. FINDINGS: BONES:No fracture, marrow replacement or suspicious focal lesion. ROTATOR CUFF: Supraspinatus:Complete tear with retraction to the glenohumeral joint. Infraspinatus:Full-thickness tear of the anterior fibers. Partial thickness bursal surface tear of the posterior fibers. Subscapularis:Thickening and intermediate signal. Teres minor: Intact tendon. LONG HEAD BICEPS TENDON:The intra-articular portion of the long head biceps tendon is not well-visualized possibly representing at least a high-grade partial thickness tear. Fluid is seen within the biceps tendon sheath. GLENOHUMERAL JOINT: Position:Normal. Articular cartilage:Widespread high-grade cartilage loss of the superior aspect of the humeral head. Ligaments/Capsule:Normal. Labrum: Degenerative signal within the superior and anterior portions. BURSAE:Fluid is seen within the subacromial and subdeltoid spaces. ACROMIAL CLAVICULAR JOINT:Moderate degenerative changes of the acromioclavicular joint with capsular hypertrophy. No os acromiale. SUBACROMIAL ENCROACHMENT:None. MUSCLES:Fatty atrophy of the infraspinatus and teres minor muscles. CONCLUSION: 1. Complete tear of the supraspinatus tendon with retraction to the glenohumeral joint. 2. Full-thickness tear of the anterior fibers of the infraspinatus tendon. Intermediate grade partial-thickness bursal surface tear of the posterior fibers. 3. Subscapularis tendinosis. 4. Poor visualization of the intra-articular portion of the long head biceps tendon likely reflects at least high-grade partial-thickness tear at the level of rotator interval. 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:Complete tear with retraction to the glenohumeral joint. Infraspinatus:Full-thickness tear of the anterior fibers. Partial thickness bursal surface tear of the posterior fibers. Subscapularis:Thickening and intermediate signal. Teres minor: Intact tendon. LONG HEAD BICEPS TENDON:The intra-articular portion of the long head biceps tendon is not well-visualized possibly representing at least a high-grade partial thickness tear. Fluid is seen within the biceps tendon sheath. GLENOHUMERAL JOINT: Position:Normal. Articular cartilage:Widespread high-grade cartilage loss of the superior aspect of the humeral head. Ligaments/Capsule:Normal. Labrum: Degenerative signal within the superior and anterior portions. BURSAE:Fluid is seen within the subacromial and subdeltoid spaces. ACROMIAL CLAVICULAR JOINT:Moderate degenerative changes of the acromioclavicular joint with capsular hypertrophy. No os acromiale. SUBACROMIAL ENCROACHMENT:None. MUSCLES:Fatty atrophy of the infraspinatus and teres minor muscles.
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FINDINGS: BRAIN PARENCHYMA: Multifocal small volume intraparenchymal hemorrhage in the left frontal lobe and anterior bilateral temporal lobes. The largest focus of intraparenchymal hemorrhages in the right anterior temporal lobe measuring 2.5 x 1.5 cm (image 27, series #201). Mild associated edema. No significant mass effect or midline shift. Gray-white matter differentiation is maintained. No evidence of acute infarction. Periventricular white matter hypoattenuation consistent with chronic microangiopathic changes. Moderate diffuse parenchymal volume loss. EXTRA-AXIAL SPACES: Small subarachnoid hemorrhage in the suprasellar cisterns, left anterior temporal cortical gyri and posterior sylvian fissures. Small subdural hemorrhage along the left parafalcine region and left frontal convexity. No mass effect or midline shift. VENTRICULAR SYSTEM: Trace intraventricular hemorrhage in the occipital horns of the bilateral lateral ventricles. Ex vacuo dilatation without overt hydrocephalus. ORBITS: Bilateral pseudophakia. No fracture. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. Small midline occipital scalp contusion. Cerumen in the bilateral EACs. FACIAL BONES: No fracture. Bilateral pterygoid plates are intact. MANDIBLE: No fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Paranasal sinuses are clear.
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15,412 |
MR Facial Bones wo+w contrast 1/24/2022 5:22 PM CLINICAL INFORMATION: History of IFS, B49 Unspecified mycosis COMPARISON: Multiple priors. CT face from same day and MR facial bones 10/18/2021. TECHNIQUE: Multiplanar, multisequence MR images of the facial bones were obtained before and after the administration of intravenous contrast. Patient weight: 225 lbs. IV contrast: ProHance, 10 ml, per protocol. FINDINGS: Redemonstrated is extensive postsurgical changes of sinus surgery including left maxillectomy and uncinectomy, left middle and inferior turbinectomy, left ethmoidectomy, partial resection of the left hard palate, in addition postsurgical changes to the left orbital floor. Status post bone grafting of the left maxillary bone. There is a persistent nonenhancing fluid collection in the left prepontine cistern which demonstrates restricted diffusion, with residual enhancement in the left middle cranial fossa (series 13 image 24). Left masticator space, pterygoid space and left infratemporal space T2/STIR hyperintense signal with associated enhancement appears slightly improved. There is persistent mucosal thickening in the region of the left sphenoid sinus. There are small, left greater than right mastoid air cell effusions. The previously noted subcutaneous loculated fluid collection of the left zygomatic region is not seen anymore. CONCLUSION: 1. Persistent enhancing fluid collection in the left pterygopalatine fossa extending to the prepontine cistern hand left middle cranial fossa with associated diffusion restriction consistent with treated abscess versus proteinaceous fluid collection. 2. Extensive postsurgical changes as described with improvement in left masticator space edema and enhancement. 3 interval resolution of a small subcutaneous loculated fluid collection in the left zygomatic region. 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: Redemonstrated is extensive postsurgical changes of sinus surgery including left maxillectomy and uncinectomy, left middle and inferior turbinectomy, left ethmoidectomy, partial resection of the left hard palate, in addition postsurgical changes to the left orbital floor. Status post bone grafting of the left maxillary bone. There is a persistent nonenhancing fluid collection in the left prepontine cistern which demonstrates restricted diffusion, with residual enhancement in the left middle cranial fossa (series 13 image 24). Left masticator space, pterygoid space and left infratemporal space T2/STIR hyperintense signal with associated enhancement appears slightly improved. There is persistent mucosal thickening in the region of the left sphenoid sinus. There are small, left greater than right mastoid air cell effusions. The previously noted subcutaneous loculated fluid collection of the left zygomatic region is not seen anymore.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Bilateral dependent atelectasis. Platelike atelectasis in the right middle lobe. No pleural effusion or pneumothorax. HEART / VESSELS: Coronary and thoracic aortic vascular calcifications. The heart is mildly enlarged. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Indeterminant left adrenal nodule. Right adrenal thickening KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is not identified. Scattered descending colon and sigmoid diverticulosis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered vascular calcifications. URINARY BLADDER: Mildly distended. REPRODUCTIVE ORGANS: The uterus is absent. No adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Minimally displaced fracture of the anterior right seventh rib. Chronic left anterolateral 5th through 7th ribs. Chronic deformity of the left inferior pubic ramus. THORACIC: VERTEBRA: Age indeterminate compression deformity of the superior T3 endplate with less than 20% vertebral body height loss. No other displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative change with mild facet arthropathy. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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15,413 |
EXAM: MR Thoracic Spine wo+w contrast CLINICAL INFORMATION: Female patient 73 years with LE weakness and unsteady gait TECHNIQUE: Sagittal T1, sagittal T2, sagittal STIR, axial T1, axial T2 images of the thoracic spine were obtained without intravenous gadolinium. In addition sagittal T1 and axial T1-weighted images were obtained after the intravenous administration of gadolinium. Technique: Patient weight: 128 lbs. IV contrast: ProHance, 6 ml, per protocol. COMPARISON: None available. FINDINGS: There is mild leftward curvature of the thoracic spine., Possibly positional. There is no loss of height of the thoracic vertebrae and no subluxation. There is no focal abnormal marrow signal other than mild reactive endplate changes at T5-T6.. There is no prevertebral soft tissue swelling and also no abnormal paraspinal soft tissue swelling. There is no abnormal signal within the thoracic spinal cord and caliber appears within normal limits. There is no abnormal fluid collection within the thoracic spinal canal. There is multilevel disc desiccation. There is a mild disc bulges at T6-T7, T7-T8, T8-T9, T10-T11 and also T11-T12 without significant central canal narrowing. There is multilevel mild facet arthropathy within the upper thoracic spine and also on the right at C7-T1.There is also moderate right facet arthropathy and mild left facet arthropathy at at T11-T12. There is mild neural foraminal narrowing on the right at T11-T12. There is no other significant neural foraminal narrowing. There There is enhancement on the right at C7-T1 and also on the right at T11-T12 involving the facet joints There is a small incidental left perineural cyst at T7-T8 and also T11-T12. CONCLUSION: 01. Mild multilevel degenerative disc disease. There is however no significant spinal canal narrowing, specifically no evidence of cord compression. 02. Upper thoracic spine and inferior thoracic spine facet arthropathy, greatest at C7-T1 and T11-T12 on the right where there is mild enhancement reflecting synovitis on degenerative basis. There is also mild neural foraminal narrowing on the right at T11-T12. No exiting nerve root impingement is noted however.
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FINDINGS: There is mild leftward curvature of the thoracic spine., Possibly positional. There is no loss of height of the thoracic vertebrae and no subluxation. There is no focal abnormal marrow signal other than mild reactive endplate changes at T5-T6.. There is no prevertebral soft tissue swelling and also no abnormal paraspinal soft tissue swelling. There is no abnormal signal within the thoracic spinal cord and caliber appears within normal limits. There is no abnormal fluid collection within the thoracic spinal canal. There is multilevel disc desiccation. There is a mild disc bulges at T6-T7, T7-T8, T8-T9, T10-T11 and also T11-T12 without significant central canal narrowing. There is multilevel mild facet arthropathy within the upper thoracic spine and also on the right at C7-T1.There is also moderate right facet arthropathy and mild left facet arthropathy at at T11-T12. There is mild neural foraminal narrowing on the right at T11-T12. There is no other significant neural foraminal narrowing. There There is enhancement on the right at C7-T1 and also on the right at T11-T12 involving the facet joints There is a small incidental left perineural cyst at T7-T8 and also T11-T12.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Bilateral dependent atelectasis. Platelike atelectasis in the right middle lobe. No pleural effusion or pneumothorax. HEART / VESSELS: Coronary and thoracic aortic vascular calcifications. The heart is mildly enlarged. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Indeterminant left adrenal nodule. Right adrenal thickening KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is not identified. Scattered descending colon and sigmoid diverticulosis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered vascular calcifications. URINARY BLADDER: Mildly distended. REPRODUCTIVE ORGANS: The uterus is absent. No adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Minimally displaced fracture of the anterior right seventh rib. Chronic left anterolateral 5th through 7th ribs. Chronic deformity of the left inferior pubic ramus. THORACIC: VERTEBRA: Age indeterminate compression deformity of the superior T3 endplate with less than 20% vertebral body height loss. No other displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative change with mild facet arthropathy. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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15,414 |
MR scans of the cervical, thoracic and lumbar spine. Clinical: Technical: CT C-spine, T-spine and L-spine protocols before and after contrast. IV contrast: ProHance, 20 ml, per protocol. Findings: C-spine: The craniovertebral junction appears normal. The cervical cord has normal morphology and signal intensity with no syrinx, tumor or atrophy. There is no right paramedian disc protrusion at C6-7 which contacts but does not compress the cord. Marrow spaces and paraspinal soft tissues are unremarkable. Postcontrast scans show no abnormal enhancement. T-spine: There is minimal bulging disc at T5-6 and T10-11 on the right but there is no cord impingement or compression. The cord has normal morphology and signal intensity. The spinal canal is adequate with no significant stenosis. Postcontrast scans show no abnormal enhancement. L-spine: There is a phlegmon and possible fluid in the posterior subcutaneous soft tissues at L4 and L5 measuring 1.7 x 3.6 x 4.8 cm with enhancement on postcontrast scans (axial series 15 #33 and sagittal series 20 6 #9). Postcontrast scans show enhancing phlegmon surrounding the collection and extending into the L1-S3 paraspinal soft tissues and also in phlegmon in the posterior epidural space from T11 to S2-3, the site of previous epidural abscess shown on 12/26/2021. There is also enhancement of phlegmon in the paraspinal muscles from L1 to S3 in the region of prior abscesses. There is slight enhancement in facet joints at L1-2 through L5-1 and in the spinous processes of L3-L5. There is residual enhancement in the L4 vertebral body. There is resolution of prior epidural abscess which extended from T11 through S1 on the scan on 12/26/2021. The conus ends at L1 with normal appearance. --------------- Conclusion: Resolution of prior posterior epidural abscess extending from T11 to S2-3 and prior posterior paraspinous abscesses and L3-S2. Enhancing phlegmon in the prior epidural abscess and in the posterior paraspinal abscesses at L3-S2. Essentially negative pre and postcontrast MR scans of the cervical and thoracic spine.
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Findings: C-spine: The craniovertebral junction appears normal. The cervical cord has normal morphology and signal intensity with no syrinx, tumor or atrophy. There is no right paramedian disc protrusion at C6-7 which contacts but does not compress the cord. Marrow spaces and paraspinal soft tissues are unremarkable. Postcontrast scans show no abnormal enhancement. T-spine: There is minimal bulging disc at T5-6 and T10-11 on the right but there is no cord impingement or compression. The cord has normal morphology and signal intensity. The spinal canal is adequate with no significant stenosis. Postcontrast scans show no abnormal enhancement. L-spine: There is a phlegmon and possible fluid in the posterior subcutaneous soft tissues at L4 and L5 measuring 1.7 x 3.6 x 4.8 cm with enhancement on postcontrast scans (axial series 15 #33 and sagittal series 20 6 #9). Postcontrast scans show enhancing phlegmon surrounding the collection and extending into the L1-S3 paraspinal soft tissues and also in phlegmon in the posterior epidural space from T11 to S2-3, the site of previous epidural abscess shown on 12/26/2021. There is also enhancement of phlegmon in the paraspinal muscles from L1 to S3 in the region of prior abscesses. There is slight enhancement in facet joints at L1-2 through L5-1 and in the spinous processes of L3-L5. There is residual enhancement in the L4 vertebral body. There is resolution of prior epidural abscess which extended from T11 through S1 on the scan on 12/26/2021. The conus ends at L1 with normal appearance. ---------------
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FINDINGS: Exam is severely limited due to motion artifact. CT of the head with and without contrast: Please see separately reported same day noncontrast CT head for intracranial findings including multicompartmental hemorrhage. No abnormal intracranial enhancement. CT angiogram of the brain: RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. Minimal atherosclerosis of the carotid siphon. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. Minimal atherosclerosis of the carotid siphon. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Unremarkable. Hypoplastic right A1 segment. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. Linear hyperattenuation in the superior aspect of the left anterior temporal intracranial hemorrhage appears to represent a small vessel (image 533, series #402). No definite evidence of extravasation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Moderate calcified atherosclerosis of the aortic arch. RIGHT CAROTID: Focal mild irregular narrowing of the distal ICA, likely grade I injury versus fibromuscular dysplasia. No evidence of occlusion or flap. LEFT CAROTID: Mild irregular narrowing of the distal ICA, likely grade I injury versus fibromuscular dysplasia. No evidence of occlusion or flap. RIGHT VERTEBRAL ARTERY: Nondiagnostic exam due to motion. LEFT VERTEBRAL ARTERY: Nondiagnostic exam due to motion. SOFT TISSUES: The neck soft tissues are unremarkable. Please see separately reported same day CT chest. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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15,415 |
MR scans of the cervical, thoracic and lumbar spine. Clinical: Technical: CT C-spine, T-spine and L-spine protocols before and after contrast. IV contrast: ProHance, 20 ml, per protocol. Findings: C-spine: The craniovertebral junction appears normal. The cervical cord has normal morphology and signal intensity with no syrinx, tumor or atrophy. There is no right paramedian disc protrusion at C6-7 which contacts but does not compress the cord. Marrow spaces and paraspinal soft tissues are unremarkable. Postcontrast scans show no abnormal enhancement. T-spine: There is minimal bulging disc at T5-6 and T10-11 on the right but there is no cord impingement or compression. The cord has normal morphology and signal intensity. The spinal canal is adequate with no significant stenosis. Postcontrast scans show no abnormal enhancement. L-spine: There is a phlegmon and possible fluid in the posterior subcutaneous soft tissues at L4 and L5 measuring 1.7 x 3.6 x 4.8 cm with enhancement on postcontrast scans (axial series 15 #33 and sagittal series 20 6 #9). Postcontrast scans show enhancing phlegmon surrounding the collection and extending into the L1-S3 paraspinal soft tissues and also in phlegmon in the posterior epidural space from T11 to S2-3, the site of previous epidural abscess shown on 12/26/2021. There is also enhancement of phlegmon in the paraspinal muscles from L1 to S3 in the region of prior abscesses. There is slight enhancement in facet joints at L1-2 through L5-1 and in the spinous processes of L3-L5. There is residual enhancement in the L4 vertebral body. There is resolution of prior epidural abscess which extended from T11 through S1 on the scan on 12/26/2021. The conus ends at L1 with normal appearance. --------------- Conclusion: Resolution of prior posterior epidural abscess extending from T11 to S2-3 and prior posterior paraspinous abscesses and L3-S2. Enhancing phlegmon in the prior epidural abscess and in the posterior paraspinal abscesses at L3-S2. Essentially negative pre and postcontrast MR scans of the cervical and thoracic spine.
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Findings: C-spine: The craniovertebral junction appears normal. The cervical cord has normal morphology and signal intensity with no syrinx, tumor or atrophy. There is no right paramedian disc protrusion at C6-7 which contacts but does not compress the cord. Marrow spaces and paraspinal soft tissues are unremarkable. Postcontrast scans show no abnormal enhancement. T-spine: There is minimal bulging disc at T5-6 and T10-11 on the right but there is no cord impingement or compression. The cord has normal morphology and signal intensity. The spinal canal is adequate with no significant stenosis. Postcontrast scans show no abnormal enhancement. L-spine: There is a phlegmon and possible fluid in the posterior subcutaneous soft tissues at L4 and L5 measuring 1.7 x 3.6 x 4.8 cm with enhancement on postcontrast scans (axial series 15 #33 and sagittal series 20 6 #9). Postcontrast scans show enhancing phlegmon surrounding the collection and extending into the L1-S3 paraspinal soft tissues and also in phlegmon in the posterior epidural space from T11 to S2-3, the site of previous epidural abscess shown on 12/26/2021. There is also enhancement of phlegmon in the paraspinal muscles from L1 to S3 in the region of prior abscesses. There is slight enhancement in facet joints at L1-2 through L5-1 and in the spinous processes of L3-L5. There is residual enhancement in the L4 vertebral body. There is resolution of prior epidural abscess which extended from T11 through S1 on the scan on 12/26/2021. The conus ends at L1 with normal appearance. ---------------
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Bilateral dependent atelectasis. Platelike atelectasis in the right middle lobe. No pleural effusion or pneumothorax. HEART / VESSELS: Coronary and thoracic aortic vascular calcifications. The heart is mildly enlarged. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Indeterminant left adrenal nodule. Right adrenal thickening KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is not identified. Scattered descending colon and sigmoid diverticulosis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered vascular calcifications. URINARY BLADDER: Mildly distended. REPRODUCTIVE ORGANS: The uterus is absent. No adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Minimally displaced fracture of the anterior right seventh rib. Chronic left anterolateral 5th through 7th ribs. Chronic deformity of the left inferior pubic ramus. THORACIC: VERTEBRA: Age indeterminate compression deformity of the superior T3 endplate with less than 20% vertebral body height loss. No other displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative change with mild facet arthropathy. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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15,416 |
MR scans of the cervical, thoracic and lumbar spine. Clinical: Technical: CT C-spine, T-spine and L-spine protocols before and after contrast. IV contrast: ProHance, 20 ml, per protocol. Findings: C-spine: The craniovertebral junction appears normal. The cervical cord has normal morphology and signal intensity with no syrinx, tumor or atrophy. There is no right paramedian disc protrusion at C6-7 which contacts but does not compress the cord. Marrow spaces and paraspinal soft tissues are unremarkable. Postcontrast scans show no abnormal enhancement. T-spine: There is minimal bulging disc at T5-6 and T10-11 on the right but there is no cord impingement or compression. The cord has normal morphology and signal intensity. The spinal canal is adequate with no significant stenosis. Postcontrast scans show no abnormal enhancement. L-spine: There is a phlegmon and possible fluid in the posterior subcutaneous soft tissues at L4 and L5 measuring 1.7 x 3.6 x 4.8 cm with enhancement on postcontrast scans (axial series 15 #33 and sagittal series 20 6 #9). Postcontrast scans show enhancing phlegmon surrounding the collection and extending into the L1-S3 paraspinal soft tissues and also in phlegmon in the posterior epidural space from T11 to S2-3, the site of previous epidural abscess shown on 12/26/2021. There is also enhancement of phlegmon in the paraspinal muscles from L1 to S3 in the region of prior abscesses. There is slight enhancement in facet joints at L1-2 through L5-1 and in the spinous processes of L3-L5. There is residual enhancement in the L4 vertebral body. There is resolution of prior epidural abscess which extended from T11 through S1 on the scan on 12/26/2021. The conus ends at L1 with normal appearance. --------------- Conclusion: Resolution of prior posterior epidural abscess extending from T11 to S2-3 and prior posterior paraspinous abscesses and L3-S2. Enhancing phlegmon in the prior epidural abscess and in the posterior paraspinal abscesses at L3-S2. Essentially negative pre and postcontrast MR scans of the cervical and thoracic spine.
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Findings: C-spine: The craniovertebral junction appears normal. The cervical cord has normal morphology and signal intensity with no syrinx, tumor or atrophy. There is no right paramedian disc protrusion at C6-7 which contacts but does not compress the cord. Marrow spaces and paraspinal soft tissues are unremarkable. Postcontrast scans show no abnormal enhancement. T-spine: There is minimal bulging disc at T5-6 and T10-11 on the right but there is no cord impingement or compression. The cord has normal morphology and signal intensity. The spinal canal is adequate with no significant stenosis. Postcontrast scans show no abnormal enhancement. L-spine: There is a phlegmon and possible fluid in the posterior subcutaneous soft tissues at L4 and L5 measuring 1.7 x 3.6 x 4.8 cm with enhancement on postcontrast scans (axial series 15 #33 and sagittal series 20 6 #9). Postcontrast scans show enhancing phlegmon surrounding the collection and extending into the L1-S3 paraspinal soft tissues and also in phlegmon in the posterior epidural space from T11 to S2-3, the site of previous epidural abscess shown on 12/26/2021. There is also enhancement of phlegmon in the paraspinal muscles from L1 to S3 in the region of prior abscesses. There is slight enhancement in facet joints at L1-2 through L5-1 and in the spinous processes of L3-L5. There is residual enhancement in the L4 vertebral body. There is resolution of prior epidural abscess which extended from T11 through S1 on the scan on 12/26/2021. The conus ends at L1 with normal appearance. ---------------
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Bilateral dependent atelectasis. Platelike atelectasis in the right middle lobe. No pleural effusion or pneumothorax. HEART / VESSELS: Coronary and thoracic aortic vascular calcifications. The heart is mildly enlarged. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Indeterminant left adrenal nodule. Right adrenal thickening KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is not identified. Scattered descending colon and sigmoid diverticulosis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered vascular calcifications. URINARY BLADDER: Mildly distended. REPRODUCTIVE ORGANS: The uterus is absent. No adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Minimally displaced fracture of the anterior right seventh rib. Chronic left anterolateral 5th through 7th ribs. Chronic deformity of the left inferior pubic ramus. THORACIC: VERTEBRA: Age indeterminate compression deformity of the superior T3 endplate with less than 20% vertebral body height loss. No other displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative change with mild facet arthropathy. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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15,417 |
EXAM: MR Thoracic Spine wo+w contrast, MR Lumbar Spine wo+w contrast CLINICAL INFORMATION: New onset lower extremity weakness, bilaterally. Of note, the patient has a history of infective endocarditis and IV drug use. COMPARISON: None. TECHNIQUE: MR Thoracic Spine wo+w contrast, MR Lumbar Spine wo+w contrast. Patient weight: 175 lbs. IV contrast: ProHance, 8 ml, per protocol. FINDINGS: THORACIC SPINE: Expansile invasive mass lesion is noted appearing to arise from the posterior elements of the T6 vertebral body and shows isointensity on T1, heterogeneously mild increased signal on T2, increased signal on the STIR images as well as heterogeneous contrast enhancement. There is erosion and destruction of the entirety of the posterior elements of the T6 vertebral body with complete destruction of both the superior and inferior facets as well as the majority of the spinous process. There is also extension into both the T6 pedicles and into the posterior most aspect of the T6 vertebral body. There is suspected invasion of the proximal aspect of the left T6 rib (axial series 501 image 10). There is also associated likely involvement of the inferior aspect of the T5 spinous process as well as the inferior aspects of the T5 inferior facets, bilaterally. There is definitive extradural extension into the spinal canal with severe compression of the spinal cord at this level. There is no definite abnormal cord signal. There is extensive adjacent soft tissue swelling extending both superiorly and inferiorly within the paraspinal musculature. No associated overlying dermal sinus is noted. This mass measures approximately 4.7 x 2.6 x 5.8 cm on axial series 901 image 40 and sagittal series 801 image 23.. There is a component of invasive spread tracking along the course of the exiting T5 nerve roots. Similar-appearing smaller expansile lesion involving the spinous process of the T1 vertebral body also shows mild contrast enhancement and osseous destruction and measures 1.2 x 1.0 x 1.1 cm on axial series 901 image 58 and sagittal series 801 image 23. Large heterogeneously enhancing aggressive appearing left apical lung mass is partially within the field-of-view. There is significant osseous destruction of multiple posterior ribs as well as extensive chest wall invasion. This lesion is incompletely characterized on the basis of this exam but there is the appearance of extension to involve the left hilum. LUMBAR SPINE: No abnormal vertebral body marrow replacement or compression deformity. No spondylolisthesis. The disc heights appear maintained. The conus terminates at L2-L3. There is multilevel facet arthropathy within the lumbar spine No significant spinal canal or neuroforaminal narrowing. Large centrally necrotic-appearing enhancing mass is noted in the expected region of the right adrenal gland and measures 8.7 x 4.5 cm on axial series 401 image 22. There is also enlargement and heterogeneous enhancement of the left adrenal gland CONCLUSION: 1. Redemonstrated expansile/invasive mass lesion involving the posterior elements of the T6 vertebral body with severe cord compression and spinal canal narrowing at this level extending from the inferior aspect of T5 to the superior aspect of T7. No associated abnormal cord signal. Given the concurrent findings of a large left apical lung mass this spinal lesion is most likely related to metastatic disease. 2. A second focus of osseous metastasis is noted involving the spinous process of T1. 3. Partially visualized large heterogeneously enhancing left apical lung mass with extensive posterior rib involvement and chest wall invasion. Please see separately dictated CT chest abdomen and pelvis for further characterization. 4. Bilateral intrarenal gland metastatic lesions As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: THORACIC SPINE: Expansile invasive mass lesion is noted appearing to arise from the posterior elements of the T6 vertebral body and shows isointensity on T1, heterogeneously mild increased signal on T2, increased signal on the STIR images as well as heterogeneous contrast enhancement. There is erosion and destruction of the entirety of the posterior elements of the T6 vertebral body with complete destruction of both the superior and inferior facets as well as the majority of the spinous process. There is also extension into both the T6 pedicles and into the posterior most aspect of the T6 vertebral body. There is suspected invasion of the proximal aspect of the left T6 rib (axial series 501 image 10). There is also associated likely involvement of the inferior aspect of the T5 spinous process as well as the inferior aspects of the T5 inferior facets, bilaterally. There is definitive extradural extension into the spinal canal with severe compression of the spinal cord at this level. There is no definite abnormal cord signal. There is extensive adjacent soft tissue swelling extending both superiorly and inferiorly within the paraspinal musculature. No associated overlying dermal sinus is noted. This mass measures approximately 4.7 x 2.6 x 5.8 cm on axial series 901 image 40 and sagittal series 801 image 23.. There is a component of invasive spread tracking along the course of the exiting T5 nerve roots. Similar-appearing smaller expansile lesion involving the spinous process of the T1 vertebral body also shows mild contrast enhancement and osseous destruction and measures 1.2 x 1.0 x 1.1 cm on axial series 901 image 58 and sagittal series 801 image 23. Large heterogeneously enhancing aggressive appearing left apical lung mass is partially within the field-of-view. There is significant osseous destruction of multiple posterior ribs as well as extensive chest wall invasion. This lesion is incompletely characterized on the basis of this exam but there is the appearance of extension to involve the left hilum. LUMBAR SPINE: No abnormal vertebral body marrow replacement or compression deformity. No spondylolisthesis. The disc heights appear maintained. The conus terminates at L2-L3. There is multilevel facet arthropathy within the lumbar spine No significant spinal canal or neuroforaminal narrowing. Large centrally necrotic-appearing enhancing mass is noted in the expected region of the right adrenal gland and measures 8.7 x 4.5 cm on axial series 401 image 22. There is also enlargement and heterogeneous enhancement of the left adrenal gland
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FINDINGS: BRAIN PARENCHYMA: Multifocal small volume intraparenchymal hemorrhage in the left frontal lobe and anterior bilateral temporal lobes. The largest focus of intraparenchymal hemorrhages in the right anterior temporal lobe measuring 2.5 x 1.5 cm (image 27, series #201). Mild associated edema. No significant mass effect or midline shift. Gray-white matter differentiation is maintained. No evidence of acute infarction. Periventricular white matter hypoattenuation consistent with chronic microangiopathic changes. Moderate diffuse parenchymal volume loss. EXTRA-AXIAL SPACES: Small subarachnoid hemorrhage in the suprasellar cisterns, left anterior temporal cortical gyri and posterior sylvian fissures. Small subdural hemorrhage along the left parafalcine region and left frontal convexity. No mass effect or midline shift. VENTRICULAR SYSTEM: Trace intraventricular hemorrhage in the occipital horns of the bilateral lateral ventricles. Ex vacuo dilatation without overt hydrocephalus. ORBITS: Bilateral pseudophakia. No fracture. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. Small midline occipital scalp contusion. Cerumen in the bilateral EACs. FACIAL BONES: No fracture. Bilateral pterygoid plates are intact. MANDIBLE: No fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Paranasal sinuses are clear.
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15,418 |
EXAM: MR Thoracic Spine wo+w contrast, MR Lumbar Spine wo+w contrast CLINICAL INFORMATION: New onset lower extremity weakness, bilaterally. Of note, the patient has a history of infective endocarditis and IV drug use. COMPARISON: None. TECHNIQUE: MR Thoracic Spine wo+w contrast, MR Lumbar Spine wo+w contrast. Patient weight: 175 lbs. IV contrast: ProHance, 8 ml, per protocol. FINDINGS: THORACIC SPINE: Expansile invasive mass lesion is noted appearing to arise from the posterior elements of the T6 vertebral body and shows isointensity on T1, heterogeneously mild increased signal on T2, increased signal on the STIR images as well as heterogeneous contrast enhancement. There is erosion and destruction of the entirety of the posterior elements of the T6 vertebral body with complete destruction of both the superior and inferior facets as well as the majority of the spinous process. There is also extension into both the T6 pedicles and into the posterior most aspect of the T6 vertebral body. There is suspected invasion of the proximal aspect of the left T6 rib (axial series 501 image 10). There is also associated likely involvement of the inferior aspect of the T5 spinous process as well as the inferior aspects of the T5 inferior facets, bilaterally. There is definitive extradural extension into the spinal canal with severe compression of the spinal cord at this level. There is no definite abnormal cord signal. There is extensive adjacent soft tissue swelling extending both superiorly and inferiorly within the paraspinal musculature. No associated overlying dermal sinus is noted. This mass measures approximately 4.7 x 2.6 x 5.8 cm on axial series 901 image 40 and sagittal series 801 image 23.. There is a component of invasive spread tracking along the course of the exiting T5 nerve roots. Similar-appearing smaller expansile lesion involving the spinous process of the T1 vertebral body also shows mild contrast enhancement and osseous destruction and measures 1.2 x 1.0 x 1.1 cm on axial series 901 image 58 and sagittal series 801 image 23. Large heterogeneously enhancing aggressive appearing left apical lung mass is partially within the field-of-view. There is significant osseous destruction of multiple posterior ribs as well as extensive chest wall invasion. This lesion is incompletely characterized on the basis of this exam but there is the appearance of extension to involve the left hilum. LUMBAR SPINE: No abnormal vertebral body marrow replacement or compression deformity. No spondylolisthesis. The disc heights appear maintained. The conus terminates at L2-L3. There is multilevel facet arthropathy within the lumbar spine No significant spinal canal or neuroforaminal narrowing. Large centrally necrotic-appearing enhancing mass is noted in the expected region of the right adrenal gland and measures 8.7 x 4.5 cm on axial series 401 image 22. There is also enlargement and heterogeneous enhancement of the left adrenal gland CONCLUSION: 1. Redemonstrated expansile/invasive mass lesion involving the posterior elements of the T6 vertebral body with severe cord compression and spinal canal narrowing at this level extending from the inferior aspect of T5 to the superior aspect of T7. No associated abnormal cord signal. Given the concurrent findings of a large left apical lung mass this spinal lesion is most likely related to metastatic disease. 2. A second focus of osseous metastasis is noted involving the spinous process of T1. 3. Partially visualized large heterogeneously enhancing left apical lung mass with extensive posterior rib involvement and chest wall invasion. Please see separately dictated CT chest abdomen and pelvis for further characterization. 4. Bilateral intrarenal gland metastatic lesions As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: THORACIC SPINE: Expansile invasive mass lesion is noted appearing to arise from the posterior elements of the T6 vertebral body and shows isointensity on T1, heterogeneously mild increased signal on T2, increased signal on the STIR images as well as heterogeneous contrast enhancement. There is erosion and destruction of the entirety of the posterior elements of the T6 vertebral body with complete destruction of both the superior and inferior facets as well as the majority of the spinous process. There is also extension into both the T6 pedicles and into the posterior most aspect of the T6 vertebral body. There is suspected invasion of the proximal aspect of the left T6 rib (axial series 501 image 10). There is also associated likely involvement of the inferior aspect of the T5 spinous process as well as the inferior aspects of the T5 inferior facets, bilaterally. There is definitive extradural extension into the spinal canal with severe compression of the spinal cord at this level. There is no definite abnormal cord signal. There is extensive adjacent soft tissue swelling extending both superiorly and inferiorly within the paraspinal musculature. No associated overlying dermal sinus is noted. This mass measures approximately 4.7 x 2.6 x 5.8 cm on axial series 901 image 40 and sagittal series 801 image 23.. There is a component of invasive spread tracking along the course of the exiting T5 nerve roots. Similar-appearing smaller expansile lesion involving the spinous process of the T1 vertebral body also shows mild contrast enhancement and osseous destruction and measures 1.2 x 1.0 x 1.1 cm on axial series 901 image 58 and sagittal series 801 image 23. Large heterogeneously enhancing aggressive appearing left apical lung mass is partially within the field-of-view. There is significant osseous destruction of multiple posterior ribs as well as extensive chest wall invasion. This lesion is incompletely characterized on the basis of this exam but there is the appearance of extension to involve the left hilum. LUMBAR SPINE: No abnormal vertebral body marrow replacement or compression deformity. No spondylolisthesis. The disc heights appear maintained. The conus terminates at L2-L3. There is multilevel facet arthropathy within the lumbar spine No significant spinal canal or neuroforaminal narrowing. Large centrally necrotic-appearing enhancing mass is noted in the expected region of the right adrenal gland and measures 8.7 x 4.5 cm on axial series 401 image 22. There is also enlargement and heterogeneous enhancement of the left adrenal gland
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FINDINGS: Exam is severely limited due to motion artifact. CT of the head with and without contrast: Please see separately reported same day noncontrast CT head for intracranial findings including multicompartmental hemorrhage. No abnormal intracranial enhancement. CT angiogram of the brain: RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. Minimal atherosclerosis of the carotid siphon. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. Minimal atherosclerosis of the carotid siphon. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Unremarkable. Hypoplastic right A1 segment. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. Linear hyperattenuation in the superior aspect of the left anterior temporal intracranial hemorrhage appears to represent a small vessel (image 533, series #402). No definite evidence of extravasation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Moderate calcified atherosclerosis of the aortic arch. RIGHT CAROTID: Focal mild irregular narrowing of the distal ICA, likely grade I injury versus fibromuscular dysplasia. No evidence of occlusion or flap. LEFT CAROTID: Mild irregular narrowing of the distal ICA, likely grade I injury versus fibromuscular dysplasia. No evidence of occlusion or flap. RIGHT VERTEBRAL ARTERY: Nondiagnostic exam due to motion. LEFT VERTEBRAL ARTERY: Nondiagnostic exam due to motion. SOFT TISSUES: The neck soft tissues are unremarkable. Please see separately reported same day CT chest. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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15,419 |
EXAM: MR Knee Right wo contrast CLINICAL INFORMATION: Right knee pain COMPARISON: 1/24/2022 TECHNIQUE: Multiplanar and multisequence MRI of the right knee was obtained without intravenous contrast. FINDINGS: BONES:No fracture, marrow replacement, or aggressive osseous lesion. ARTICULATIONS: Effusion:None. Patellofemoral compartment:No cartilage defect. Medial compartment:No cartilage defect. Lateral compartment:No cartilage defect. MENISCI: Medial meniscus:Linear intermediate signal seen within the posterior horn, not extending through the articular surface. No discrete tear. Lateral meniscus:Intact. LIGAMENTS: Cruciate ligaments:Intact. Medial collateral ligament:There is thickening of the proximal MCL edema along the superficial fibers. Edema is noted deep to the MCL representing injury of the medial meniscal femoral ligament with small focus of hyperintense signal on PD and T2 signal possibly representing an avulsed fragment. Lateral collateral ligament:Intact. Posterolateral corner structures:Intact. EXTENSOR MECHANISM:The distal quadriceps and patellar tendons are intact. CONCLUSION: Grade 2 sprain of the MCL with complete tear of the deep medial meniscal femoral ligament with small avulsed fracture fragment. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: BONES:No fracture, marrow replacement, or aggressive osseous lesion. ARTICULATIONS: Effusion:None. Patellofemoral compartment:No cartilage defect. Medial compartment:No cartilage defect. Lateral compartment:No cartilage defect. MENISCI: Medial meniscus:Linear intermediate signal seen within the posterior horn, not extending through the articular surface. No discrete tear. Lateral meniscus:Intact. LIGAMENTS: Cruciate ligaments:Intact. Medial collateral ligament:There is thickening of the proximal MCL edema along the superficial fibers. Edema is noted deep to the MCL representing injury of the medial meniscal femoral ligament with small focus of hyperintense signal on PD and T2 signal possibly representing an avulsed fragment. Lateral collateral ligament:Intact. Posterolateral corner structures:Intact. EXTENSOR MECHANISM:The distal quadriceps and patellar tendons are intact.
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FINDINGS: Exam is severely limited due to motion artifact. CT of the head with and without contrast: Please see separately reported same day noncontrast CT head for intracranial findings including multicompartmental hemorrhage. No abnormal intracranial enhancement. CT angiogram of the brain: RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. Minimal atherosclerosis of the carotid siphon. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. Minimal atherosclerosis of the carotid siphon. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Unremarkable. Hypoplastic right A1 segment. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. Linear hyperattenuation in the superior aspect of the left anterior temporal intracranial hemorrhage appears to represent a small vessel (image 533, series #402). No definite evidence of extravasation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Moderate calcified atherosclerosis of the aortic arch. RIGHT CAROTID: Focal mild irregular narrowing of the distal ICA, likely grade I injury versus fibromuscular dysplasia. No evidence of occlusion or flap. LEFT CAROTID: Mild irregular narrowing of the distal ICA, likely grade I injury versus fibromuscular dysplasia. No evidence of occlusion or flap. RIGHT VERTEBRAL ARTERY: Nondiagnostic exam due to motion. LEFT VERTEBRAL ARTERY: Nondiagnostic exam due to motion. SOFT TISSUES: The neck soft tissues are unremarkable. Please see separately reported same day CT chest. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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EXAM: MR Knee Right wo contrast CLINICAL INFORMATION: 15-year-old male with right knee pain, evaluate for ACL tear, prior right knee ACL reconstruction with patellar tendon graft. COMPARISON: Right knee radiograph 10/29/2021 and outside MRI 9/16/2021. TECHNIQUE: MR Knee Right wo contrast STRUCTURED REPORT: MRI Knee 1/2/2020 FINDINGS: BONES:No fracture, marrow replacement, or aggressive osseous lesion. Mild bone marrow edema and contour deformity noted in the lateral femoral condyle. There are postsurgical changes from a prior ACL reconstruction. There is mild bone marrow edema surrounding the femoral tunnel. ARTICULATIONS: Effusion:Trace suprapatellar effusion. Patellofemoral compartment:Mild chondromalacia of the medial patellar facet. Medial compartment:No cartilage defect. Lateral compartment:No cartilage defect. MENISCI: Medial meniscus:Intact. Lateral meniscus:Small tear of the posterior horn (501:17-18). LIGAMENTS: Cruciate ligaments:The PCL is intact. Marked susceptibility artifact significantly limits evaluation of ACL. Medial collateral ligament:Intact. Lateral collateral ligament:Intact. Posterolateral corner structures:Intact. EXTENSOR MECHANISM: The distal quadriceps tendon is intact. There is abnormal signal in the patellar tendon, consistent with graft harvest. There is scarring in the Hoffa fat pad, consistent with prior arthroscopy. CONCLUSION: 1. Chronic deformity of lateral femoral condyle of indeterminate chronicity, since only mild bone marrow edema is present 2. Evaluation of ACL graft integrity is markedly limited by susceptibility artifact. If evaluation of ACL graft is still needed, consider CT arthrogram. 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. Mild bone marrow edema and contour deformity noted in the lateral femoral condyle. There are postsurgical changes from a prior ACL reconstruction. There is mild bone marrow edema surrounding the femoral tunnel. ARTICULATIONS: Effusion:Trace suprapatellar effusion. Patellofemoral compartment:Mild chondromalacia of the medial patellar facet. Medial compartment:No cartilage defect. Lateral compartment:No cartilage defect. MENISCI: Medial meniscus:Intact. Lateral meniscus:Small tear of the posterior horn (501:17-18). LIGAMENTS: Cruciate ligaments:The PCL is intact. Marked susceptibility artifact significantly limits evaluation of ACL. Medial collateral ligament:Intact. Lateral collateral ligament:Intact. Posterolateral corner structures:Intact. EXTENSOR MECHANISM: The distal quadriceps tendon is intact. There is abnormal signal in the patellar tendon, consistent with graft harvest. There is scarring in the Hoffa fat pad, consistent with prior arthroscopy.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Advanced diffuse parenchymal volume loss with unchanged significant atrophy of the brainstem and cerebellum compared to the adjacent parenchyma. Atrophic corpus callosum. Periventricular white matter hypoattenuation consistent with chronic microangiopathic changes. EXTRA-AXIAL SPACES: No extra-axial collections. Prominent extra-axial spaces due to parenchymal volume loss. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. VENTRICULAR SYSTEM: Stable size of the ventricles which are severely diffusely enlarged. There is unchanged communication of the fourth ventricle with the cisterna magna, consistent with Dandy-Walker variant. ORBITS: Bilateral pseudophakia. SINUSES: Paranasal sinuses are clear. VESSELS: Scattered vascular calculations of the carotid siphons.
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EXAM: MR Foot Left wo contrast CLINICAL INFORMATION: Navicular fracture COMPARISON: 1/24/2022 TECHNIQUE: Multiplanar and multisequence MRI of the left foot was obtained without contrast. FINDINGS: BONES: Marrow edema is noted within the medial navicular with subtle T1 hypointensity on the dorsal aspect (image eight, series 7) us representing a nondisplaced fracture. No aggressive osseous lesion. Type I on navicularis. JOINTS: Alignment: Normal, including Lisfranc alignment. Effusion: None. Cartilage: Normal. Degenerative changes:None. MUSCLES/TENDON: Normal. OTHER: Soft tissue edema of the midfoot. CONCLUSION: 1. Nondisplaced fracture and marrow contusion medial navicular. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: BONES: Marrow edema is noted within the medial navicular with subtle T1 hypointensity on the dorsal aspect (image eight, series 7) us representing a nondisplaced fracture. No aggressive osseous lesion. Type I on navicularis. JOINTS: Alignment: Normal, including Lisfranc alignment. Effusion: None. Cartilage: Normal. Degenerative changes:None. MUSCLES/TENDON: Normal. OTHER: Soft tissue edema of the midfoot.
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Findings: Head CT: There is trace pneumocephalus in the right middle cranial fossa. There is no acute intracranial hemorrhage or brain edema. There is no evidence of acute infarction, intracranial mass or hydrocephalus. There is moderate size arachnoid cyst in the left anterior middle cranial fossa. There is no acute calvarial fracture. Maxillofacial CT: There is a fracture of the squamous portion of the temporal bone involving the glenoid fossa and extending through the right mastoid air cells. No involvement of the capsule. There are blood products middle ear and right mastoid air cells. There is a left mastoid effusion without definite fracture. There is anterior facial soft tissue swelling involving the right cheek and extending to the upper lip. Numerous dental caries and periapical lucencies are noted. There are no acute maxillofacial or mandibular fractures or traumatic TMJ dislocation . There is no evidence of orbital soft tissue injury. The paranasal sinuses are clear.
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EXAM: MR Hip Left wo contrast CLINICAL INFORMATION: Left hip pain COMPARISON: 11/17/2021 TECHNIQUE: Multiplanar and multisequence MRI of the left hip was obtained without intravenous contrast. FINDINGS: BONES: No fracture, marrow replacement or aggressive osseous lesion. Diffuse red marrow reconversion. HIP JOINTS: Alignment: Normal. Effusion: None. Labrum: Normal allowing for non-arthrographic technique. Cartilage: Normal. Capsule and ligaments:Normal. MUSCLES/TENDON: Edema and fluid are noted adjacent to the gluteal insertions of the left greater trochanter. The remaining muscles and tendons are unremarkable. VESSELS:No significant disease. NERVES: Normal. INTRAPELVIC: Status post hysterectomy. Sigmoid diverticulosis. There are two well-circumscribed T2 hyperintense lesions within the right adnexa, each measuring approximately 2 cm in greatest diameter (image 25, series 401). No lymphadenopathy. No free fluid in the pelvis. CONCLUSION: 1. Left greater trochanteric bursitis. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: BONES: No fracture, marrow replacement or aggressive osseous lesion. Diffuse red marrow reconversion. HIP JOINTS: Alignment: Normal. Effusion: None. Labrum: Normal allowing for non-arthrographic technique. Cartilage: Normal. Capsule and ligaments:Normal. MUSCLES/TENDON: Edema and fluid are noted adjacent to the gluteal insertions of the left greater trochanter. The remaining muscles and tendons are unremarkable. VESSELS:No significant disease. NERVES: Normal. INTRAPELVIC: Status post hysterectomy. Sigmoid diverticulosis. There are two well-circumscribed T2 hyperintense lesions within the right adnexa, each measuring approximately 2 cm in greatest diameter (image 25, series 401). No lymphadenopathy. No free fluid in the pelvis.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: No focal consolidation, pleural effusion, 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. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is not identified. The colon is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Replaced common hepatic artery arising from the SMA. Two right renal arteries. URINARY BLADDER: Mild distention. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: The patient is skeletally immature. Small irregularity at the inferior aspect of the left sacrum/SI joint best appreciated on axial series 501 image 422 and coronal series 503 image 77. This appearance is atypical for acute fracture and may represent an apophysis. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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Clinical Information: Evaluation for bilateral lower extremity weakness Comparison: Not available Technique: Axial and sagittal T1, axial and sagittal T2, sagittal STIR, and axial and sagittal T1 FS postcontrast sequences were acquired of the cervical spine. Patient weight: 175 lbs. IV contrast: ProHance, 8 ml, per protocol. Findings: There is reversal of normal cervical lordosis. There is also partial fusion of C5-C6 vertebral bodies with partial obliteration of disc space which can be sequela of previous vertebral osteomyelitis, based on patient's history. There is mild segmental kyphosis at this level secondary to chronic loss of height of the anterior aspect of the C6 vertebral body. Mild Retrolisthesis of C6 on C7 vertebral body is noted. There are reactive endplate changes at C6-C7. Remainder of the marrow signal within the cervical spine appears within normal limits. There is no prevertebral soft tissue swelling and also no abnormal paraspinal soft tissue swelling. The visualized portions of the posterior fossa and craniocervical junction appear normal. The cervical spinal cord is unremarkable. No abnormal enhancement. Degenerative changes of the cervical spine are described on a level by level basis below: C2-C3: No evidence of neural foraminal or spinal canal stenosis is noted. C3-C4: There is a mild disc bulge. There is no central canal narrowing. There is moderate left facet arthropathy causing mild left neural foraminal narrowing. C4-C5: There is diffuse disc bulge causing. There is a small superimposed right foraminal disc protrusion. There is moderate right neural foraminal narrowing. C5-C6:. No central canal narrowing or neural foraminal narrowing. C6-C7: There is small disc- osteophyte complex and also thickening of the ligamentum flavum resulting in moderate central canal narrowing. There are uncovertebral degenerative changes bilaterally resulting in severe left and moderate right neural foraminal narrowing. C7-T1: There is mild bilateral facet arthropathy with no evidence of spinal canal or neural foramina narrowing. T1-T2: No evidence of the spinal canal or neural foraminal stenosis is noted. T2-T3: There is mild diffuse disc bulge without significant spinal canal or neural foraminal stenosis. There is a partially visualized large left lung mass. There are destructive changes of the partially visualized left posterior third rib. There is extension through the pleura into the left thoracic paraspinal musculature There is also left greater than right upper thoracic paraspinal muscle enhancement. There is also mild enhancement within the left posterior lateral paraspinal musculature within the cervical spine Impression: 1.Partially visualized large left thoracic cavity mass with extension through the pleura, partial destruction of the posterior left third rib and into the left thoracic paraspinal musculature.. There is no definite extension into the upper thoracic spinal canal or involvement of the cervical spinal canal. 2.Partial chronic fusion of C5-C6 vertebral bodies with partial obliteration of disc space which can be sequela of previous vertebral osteomyelitis or possibly remote trauma. There is chronic anterior wedging of the C6 vertebral body resulting in mild segmental kyphosis 3. Multilevel degenerative disc disease without significant spinal canal narrowing. There is however severe left neural foraminal narrowing and moderate right neural foraminal narrowing at C6-C7 secondary to significant uncovertebral degenerative 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. There is also small enhancing lesion involving the T1 spinous process
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Findings: There is reversal of normal cervical lordosis. There is also partial fusion of C5-C6 vertebral bodies with partial obliteration of disc space which can be sequela of previous vertebral osteomyelitis, based on patient's history. There is mild segmental kyphosis at this level secondary to chronic loss of height of the anterior aspect of the C6 vertebral body. Mild Retrolisthesis of C6 on C7 vertebral body is noted. There are reactive endplate changes at C6-C7. Remainder of the marrow signal within the cervical spine appears within normal limits. There is no prevertebral soft tissue swelling and also no abnormal paraspinal soft tissue swelling. The visualized portions of the posterior fossa and craniocervical junction appear normal. The cervical spinal cord is unremarkable. No abnormal enhancement. Degenerative changes of the cervical spine are described on a level by level basis below: C2-C3: No evidence of neural foraminal or spinal canal stenosis is noted. C3-C4: There is a mild disc bulge. There is no central canal narrowing. There is moderate left facet arthropathy causing mild left neural foraminal narrowing. C4-C5: There is diffuse disc bulge causing. There is a small superimposed right foraminal disc protrusion. There is moderate right neural foraminal narrowing. C5-C6:. No central canal narrowing or neural foraminal narrowing. C6-C7: There is small disc- osteophyte complex and also thickening of the ligamentum flavum resulting in moderate central canal narrowing. There are uncovertebral degenerative changes bilaterally resulting in severe left and moderate right neural foraminal narrowing. C7-T1: There is mild bilateral facet arthropathy with no evidence of spinal canal or neural foramina narrowing. T1-T2: No evidence of the spinal canal or neural foraminal stenosis is noted. T2-T3: There is mild diffuse disc bulge without significant spinal canal or neural foraminal stenosis. There is a partially visualized large left lung mass. There are destructive changes of the partially visualized left posterior third rib. There is extension through the pleura into the left thoracic paraspinal musculature There is also left greater than right upper thoracic paraspinal muscle enhancement. There is also mild enhancement within the left posterior lateral paraspinal musculature within the cervical spine
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: No focal consolidation, pleural effusion, 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. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is not identified. The colon is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Replaced common hepatic artery arising from the SMA. Two right renal arteries. URINARY BLADDER: Mild distention. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: The patient is skeletally immature. Small irregularity at the inferior aspect of the left sacrum/SI joint best appreciated on axial series 501 image 422 and coronal series 503 image 77. This appearance is atypical for acute fracture and may represent an apophysis. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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EXAM: MR Bone Pelvis wo+w contrast CLINICAL INFORMATION: Patient with history of bladder cancer status post resection. COMPARISON: 10/19/2021 TECHNIQUE: Multiplanar and multisequence MRI of the pelvis was obtained without and with intravenous contrast. Patient weight: 140 lbs. IV contrast: ProHance, 7 ml, per protocol. FINDINGS: BONES: No acute fracture is seen. Within the posterior right ilium, there is an enhancing marrow replacing lesion measuring 2.3 x 1.7 x 1.9 cm (image 22, series 16; image 29, series 18). There are similar-appearing lesions within the right iliac wing (image 20, series 16), left ilium (image 10, series 16), as well as in the L5 and S1 vertebral bodies. Perineural cysts are seen involving the right S2 and left S3 nerve roots. HIP JOINTS: Alignment: Normal. Effusion: None. Labrum: Degenerative signal of the anterior and superior labrum bilaterally. Cartilage: Normal. Capsule and ligaments:Normal. MUSCLES/TENDON: Small amount of edema seen at the origins of the bilateral adductor musculature, possibly reflecting low-grade strains. Fluid is also noted adjacent to the bilateral iliopsoas tendons, left greater than right. Edema is also seen within the left bilateral iliac is muscles, left greater than right. VESSELS:No significant disease. NERVES: Normal. INTRAPELVIC: Status post cystectomy. Sigmoid diverticulosis. No lymphadenopathy. No free fluid in the pelvis. CONCLUSION: 1. Osseous metastatic disease involving the bilateral ilii, sacrum, and L5 vertebral body. 2. Findings which can be seen with iliopsoas bursitis. 3. Low-grade strains of the bilateral adductor musculature. 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 acute fracture is seen. Within the posterior right ilium, there is an enhancing marrow replacing lesion measuring 2.3 x 1.7 x 1.9 cm (image 22, series 16; image 29, series 18). There are similar-appearing lesions within the right iliac wing (image 20, series 16), left ilium (image 10, series 16), as well as in the L5 and S1 vertebral bodies. Perineural cysts are seen involving the right S2 and left S3 nerve roots. HIP JOINTS: Alignment: Normal. Effusion: None. Labrum: Degenerative signal of the anterior and superior labrum bilaterally. Cartilage: Normal. Capsule and ligaments:Normal. MUSCLES/TENDON: Small amount of edema seen at the origins of the bilateral adductor musculature, possibly reflecting low-grade strains. Fluid is also noted adjacent to the bilateral iliopsoas tendons, left greater than right. Edema is also seen within the left bilateral iliac is muscles, left greater than right. VESSELS:No significant disease. NERVES: Normal. INTRAPELVIC: Status post cystectomy. Sigmoid diverticulosis. No lymphadenopathy. No free fluid in the pelvis.
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FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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MR Lumbar Spine wo+w contrast 1/24/2022 6:03 PM CLINICAL INFORMATION: Bladder Cancer, C67.9 Malignant neoplasm of bladder, unspecified Spec Inst: LumbarSacrum COMPARISON: Prior PET/CT 10/19/2021, CT chest 11/17/2021, CT abdomen pelvis 4/1/2021 TECHNIQUE: Multiplanar, multisequence MR images of the lumbar spine were obtained before and after the administration of intravenous contrast. Patient weight: 140 lbs. IV contrast: ProHance, 7 ml, per protocol. FINDINGS: Alignment of the lumbar spine demonstrates mild retrolisthesis of L1 over L2, otherwise normal. There is a diffuse marrow replacing process involving the entire vertebral body of L3 and nearly the entire vertebral body of L2 as well as the anterior aspect of the L1 vertebral body. There is also lesion in the anterior S1 vertebral body and inferior L5 vertebral body.Tissue replacement is T2/STIR hyperintense, T1 and T2 heterogenous, and diffusely enhancing on postcontrast images. This only trace ventral epidural enhancement behind the L3 vertebral body. There is vertical T2 hypointense, nonenhancing line in the L2 vertebral body (best seen on series 9 image 12, series 19 image 12 ). There is a prominent Schmorl's node in the superior endplate of L4. There are multilevel degenerative changes of the lumbar spine given on a segmental basis as below: T12-L1: Unremarkable. L1-L2: Mild retrolisthesis of L1 over L2 and addition to bilateral facet arthropathy resulting in mild-moderate bilateral neural foraminal narrowing. No significant spinal canal stenosis. L2-L3: Moderate bilateral facet arthropathy with mild bilateral neural foraminal narrowing. L3-L4: Schmorl's node formation seen along the superior endplate of the L4 vertebral body. There is a broad-based posterior disc bulge with ligamentum flavum hypertrophy and mild spinal canal stenosis. There is advanced bilateral facet arthropathy which results in moderate-severe left and mild-moderate right neural foraminal narrowing. L4-L5: There is severe right L4-L5 facet arthropathy with moderate right neural foraminal narrowing and compression of the exiting right L4 nerve root. There is also mild deviation of the transiting right L5 nerve root due to facet hypertrophy. There is moderate left greater than right subarticular recess stenosis. L5-S1: Advanced facet arthropathy with mild right neural foraminal narrowing. Limited evaluation of the intra-abdominal structures shows conglomerate of multiple para-aortic lymph nodes with one measured lymph node measuring 1.6 cm in greatest short axis dimension (series 14 image 29). There is mild atrophy of the paraspinal musculature. CONCLUSION: 1. Marrow replacing process of the L3, L2 and to lesser extent L1 vertebral bodies with associated enhancement highly concerning for osseous metastatic involvement of the lumbar spine. Also small lesions in the L5 and S1 vertebral bodies. This only trace ventral epidural enhancement behind the L3 vertebral body. -- Vertical T2 hypointense, nonenhancing line in the L2 vertebral body, is worrisome for a fracture line. Recommend correlation with acute pain symptoms. 2. Enlarged, suspected necrotic conglomerate periaortic lymph nodes also concerning for metastatic disease. These can be further assessed with dedicated abdominal imaging. 3. Multilevel degenerative changes with multiple areas of neural foraminal narrowing as described. There is advanced neuroforaminal stenosis at right L4-5 and left L3-L4. Preliminary report findings discussed with Dr. Arnab Base on 1/24/2022 7:14 PM by Dr. Bready by telephone. 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 of the lumbar spine demonstrates mild retrolisthesis of L1 over L2, otherwise normal. There is a diffuse marrow replacing process involving the entire vertebral body of L3 and nearly the entire vertebral body of L2 as well as the anterior aspect of the L1 vertebral body. There is also lesion in the anterior S1 vertebral body and inferior L5 vertebral body.Tissue replacement is T2/STIR hyperintense, T1 and T2 heterogenous, and diffusely enhancing on postcontrast images. This only trace ventral epidural enhancement behind the L3 vertebral body. There is vertical T2 hypointense, nonenhancing line in the L2 vertebral body (best seen on series 9 image 12, series 19 image 12 ). There is a prominent Schmorl's node in the superior endplate of L4. There are multilevel degenerative changes of the lumbar spine given on a segmental basis as below: T12-L1: Unremarkable. L1-L2: Mild retrolisthesis of L1 over L2 and addition to bilateral facet arthropathy resulting in mild-moderate bilateral neural foraminal narrowing. No significant spinal canal stenosis. L2-L3: Moderate bilateral facet arthropathy with mild bilateral neural foraminal narrowing. L3-L4: Schmorl's node formation seen along the superior endplate of the L4 vertebral body. There is a broad-based posterior disc bulge with ligamentum flavum hypertrophy and mild spinal canal stenosis. There is advanced bilateral facet arthropathy which results in moderate-severe left and mild-moderate right neural foraminal narrowing. L4-L5: There is severe right L4-L5 facet arthropathy with moderate right neural foraminal narrowing and compression of the exiting right L4 nerve root. There is also mild deviation of the transiting right L5 nerve root due to facet hypertrophy. There is moderate left greater than right subarticular recess stenosis. L5-S1: Advanced facet arthropathy with mild right neural foraminal narrowing. Limited evaluation of the intra-abdominal structures shows conglomerate of multiple para-aortic lymph nodes with one measured lymph node measuring 1.6 cm in greatest short axis dimension (series 14 image 29). There is mild atrophy of the paraspinal musculature.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: No focal consolidation, pleural effusion, 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. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is not identified. The colon is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Replaced common hepatic artery arising from the SMA. Two right renal arteries. URINARY BLADDER: Mild distention. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: The patient is skeletally immature. Small irregularity at the inferior aspect of the left sacrum/SI joint best appreciated on axial series 501 image 422 and coronal series 503 image 77. This appearance is atypical for acute fracture and may represent an apophysis. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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EXAM:MR Shoulder Left wo contrast CLINICAL INFORMATION:Left shoulder pain COMPARISON:12/29/2021 TECHNIQUE: Multiplanar and multisequence MRI of the left shoulder was obtained without intravenous contrast. FINDINGS: BONES:No fracture, marrow replacement or suspicious focal lesion. T2 hyperintense lesion is noted within the greater tuberosity, likely representing an intraosseous ganglion. ROTATOR CUFF: Supraspinatus:Complete full-thickness tear of the supraspinatus tendon with retraction to the glenoid. Infraspinatus:Complete full-thickness tear of the supraspinatus tendon with retraction to the glenoid. Subscapularis: Intermediate grade, partial-thickness articular surface tear of the distal tendon. Teres minor: Intact. LONG HEAD BICEPS TENDON: The long head biceps tendon is not visualized and likely completely torn with retraction. GLENOHUMERAL JOINT: Position:There is superior subluxation of the humeral head relation to the glenoid. Articular cartilage:Mild degenerative changes of the glenohumeral joint. Ligaments/Capsule:Normal. Labrum:Tears of the anterior and superior labrum. BURSAE:Large amount of fluid within the subacromial and subdeltoid spaces reflecting complete rotator cuff tears. ACROMIAL CLAVICULAR JOINT:Osteophytes are present with capsular hypertrophy. No os acromiale. MUSCLES:Edema is noted within the visualized portions of the supraspinatus, infraspinatus, and teres minor muscles. No significant atrophy is seen. CONCLUSION: 1. Complete tears of the supraspinatus and infraspinatus tendons with retraction to the glenoid. Muscle edema is noted within the muscle bellies. 2. Complete tear of the long head biceps tendon with retraction. 3. Intermediate grade partial-thickness articular surface tear of the subscapularis tendon. 4. Tear of the anterior and superior glenoid labrum. 5. Mild edema is noted within the teres minor muscle. 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. T2 hyperintense lesion is noted within the greater tuberosity, likely representing an intraosseous ganglion. ROTATOR CUFF: Supraspinatus:Complete full-thickness tear of the supraspinatus tendon with retraction to the glenoid. Infraspinatus:Complete full-thickness tear of the supraspinatus tendon with retraction to the glenoid. Subscapularis: Intermediate grade, partial-thickness articular surface tear of the distal tendon. Teres minor: Intact. LONG HEAD BICEPS TENDON: The long head biceps tendon is not visualized and likely completely torn with retraction. GLENOHUMERAL JOINT: Position:There is superior subluxation of the humeral head relation to the glenoid. Articular cartilage:Mild degenerative changes of the glenohumeral joint. Ligaments/Capsule:Normal. Labrum:Tears of the anterior and superior labrum. BURSAE:Large amount of fluid within the subacromial and subdeltoid spaces reflecting complete rotator cuff tears. ACROMIAL CLAVICULAR JOINT:Osteophytes are present with capsular hypertrophy. No os acromiale. MUSCLES:Edema is noted within the visualized portions of the supraspinatus, infraspinatus, and teres minor muscles. No significant atrophy is seen.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: No focal consolidation, pleural effusion, 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. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is not identified. The colon is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Replaced common hepatic artery arising from the SMA. Two right renal arteries. URINARY BLADDER: Mild distention. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: The patient is skeletally immature. Small irregularity at the inferior aspect of the left sacrum/SI joint best appreciated on axial series 501 image 422 and coronal series 503 image 77. This appearance is atypical for acute fracture and may represent an apophysis. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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MR Lumbar Spine wo contrast 1/24/2022 5:47 PM CLINICAL INFORMATION: Low back pain, left leg sciatica, M54.32 Sciatica, left side, M54.50 Low back pain, unspecified Spec Inst: MRI LSpine without contrast .br low back pain, sciatica COMPARISON: MR lumbar spine performed 4/9/2018, lumbar spine radiograph 6/14/2021. TECHNIQUE: Multiplanar, multisequence MR images of the lumbar spine were obtained without the administration of intravenous contrast. FINDINGS: The lumbar spine demonstrate normal alignment. Vertebral body heights are relatively well-maintained. Intervertebral disc spaces show mild disc height loss in the mid lumbar spine at L2-L3 and L3-4, with mild disc desiccation. There are mild Modic type I degenerative endplate changes anteriorly at L2-L3, otherwise there is no abnormal marrow signal change. The conus appears normal, terminating at the level of L1-L2. Additional findings given on a level by level basis as below: T12-L1: No spinal canal stenosis or neural foraminal narrowing bilaterally. L1-L2: Mild facet arthropathy without spinal canal stenosis or neural foraminal narrowing bilaterally. L2-L3: There is a broad-based disc bulge with narrowing of the right extraforaminal space and likely mild compression of the exiting right L2 nerve root. No appreciable left neural foraminal narrowing. There is mild ligamentum flavum hypertrophy without significant spinal canal stenosis. L3-L4: There is a broad-based posterior disc bulge with small annular fissure, in addition to ligamentum flavum hypertrophy, epidural lipomatosis and bilateral facet arthropathy results in mild spinal canal stenosis at this level which appears similar to the prior examination. There is mild bilateral neural foraminal narrowing. L4-L5: There is a broad-based posterior disc bulge with ligamentum flavum hypertrophy and mild epidural lipomatosis resulting in moderate spinal canal stenosis at this level which is not significantly changed. There is advanced facet arthropathy bilaterally with bilateral mild neural foraminal stenosis. L5-S1: Epidural lipomatosis is seen at this resulting in moderate to severe thecal sac stenosis. There is advanced facet arthropathy with mild neural foraminal narrowing bilaterally. Limited evaluation of the intra-abdominal structures shows no significant abnormality. The paraspinal musculature is within normal limits. CONCLUSION: Multilevel degenerative changes of the lumbar spine as described, which are not significantly changed from the prior examination, including epidural lipomatosis which causes moderate-severe thecal sac stenosis at L5-S1. Possible mild right L2 nerve root impingement. Please refer to the report for detailed level by level assessment. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: The lumbar spine demonstrate normal alignment. Vertebral body heights are relatively well-maintained. Intervertebral disc spaces show mild disc height loss in the mid lumbar spine at L2-L3 and L3-4, with mild disc desiccation. There are mild Modic type I degenerative endplate changes anteriorly at L2-L3, otherwise there is no abnormal marrow signal change. The conus appears normal, terminating at the level of L1-L2. Additional findings given on a level by level basis as below: T12-L1: No spinal canal stenosis or neural foraminal narrowing bilaterally. L1-L2: Mild facet arthropathy without spinal canal stenosis or neural foraminal narrowing bilaterally. L2-L3: There is a broad-based disc bulge with narrowing of the right extraforaminal space and likely mild compression of the exiting right L2 nerve root. No appreciable left neural foraminal narrowing. There is mild ligamentum flavum hypertrophy without significant spinal canal stenosis. L3-L4: There is a broad-based posterior disc bulge with small annular fissure, in addition to ligamentum flavum hypertrophy, epidural lipomatosis and bilateral facet arthropathy results in mild spinal canal stenosis at this level which appears similar to the prior examination. There is mild bilateral neural foraminal narrowing. L4-L5: There is a broad-based posterior disc bulge with ligamentum flavum hypertrophy and mild epidural lipomatosis resulting in moderate spinal canal stenosis at this level which is not significantly changed. There is advanced facet arthropathy bilaterally with bilateral mild neural foraminal stenosis. L5-S1: Epidural lipomatosis is seen at this resulting in moderate to severe thecal sac stenosis. There is advanced facet arthropathy with mild neural foraminal narrowing bilaterally. Limited evaluation of the intra-abdominal structures shows no significant abnormality. The paraspinal musculature is within normal limits.
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Findings: Head CT: There is trace pneumocephalus in the right middle cranial fossa. There is no acute intracranial hemorrhage or brain edema. There is no evidence of acute infarction, intracranial mass or hydrocephalus. There is moderate size arachnoid cyst in the left anterior middle cranial fossa. There is no acute calvarial fracture. Maxillofacial CT: There is a fracture of the squamous portion of the temporal bone involving the glenoid fossa and extending through the right mastoid air cells. No involvement of the capsule. There are blood products middle ear and right mastoid air cells. There is a left mastoid effusion without definite fracture. There is anterior facial soft tissue swelling involving the right cheek and extending to the upper lip. Numerous dental caries and periapical lucencies are noted. There are no acute maxillofacial or mandibular fractures or traumatic TMJ dislocation . There is no evidence of orbital soft tissue injury. The paranasal sinuses are clear.
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EXAM: MR Knee Left wo contrast CLINICAL INFORMATION: Ruptured Baker's cyst COMPARISON: 1/12/2022 TECHNIQUE: Multiplanar and multisequence MRI of the left knee was obtained without intravenous contrast. FINDINGS: BONES:No acute fracture. There is a low-grade cartilaginous lesion within the distal medial femoral metaphysis measuring 1.4 x 0.9 x 1.5 cm (image 18, series 701; image 21, series 601). No aggressive osseous lesion. ARTICULATIONS: Effusion:Moderate Patellofemoral compartment:Articular cartilage thinning and fissuring of the lateral patellar facet and mid sagittal ridge. Osteochondral lesion of the lateral trochlear articular surface as well as full-thickness articular cartilage loss and subchondral marrow edema. Medial compartment:No full-thickness articular cartilage defect. Marginal osteophytes are noted. Lateral compartment:No full-thickness articular cartilage defect. Marginal osteophytes are noted. MENISCI: Medial meniscus:Intact. Lateral meniscus:Degenerative free edge tear of the body. LIGAMENTS: Cruciate ligaments: ACL is intact. The PCL is intact. Medial collateral ligament:Intact. Lateral collateral ligament:Intact. Posterolateral corner structures:Intact. EXTENSOR MECHANISM:The distal quadriceps and patellar tendons are intact. Edema is seen within the superolateral aspect of Hoffa's fat. The tibial tuberosity to trochlear groove distance measures 2.1 cm. CONCLUSION: 1. Degenerative free edge tear of the body of the lateral meniscus. 2. Tricompartmental osteoarthritis, most severe within the patellofemoral compartment with lateral trochlear osteochondral lesion. 3. Patellar maltracking with findings of patellar tendon-lateral femoral condyle friction syndrome. 4. Enchondroma of the distal medial femoral metaphysis. 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 acute fracture. There is a low-grade cartilaginous lesion within the distal medial femoral metaphysis measuring 1.4 x 0.9 x 1.5 cm (image 18, series 701; image 21, series 601). No aggressive osseous lesion. ARTICULATIONS: Effusion:Moderate Patellofemoral compartment:Articular cartilage thinning and fissuring of the lateral patellar facet and mid sagittal ridge. Osteochondral lesion of the lateral trochlear articular surface as well as full-thickness articular cartilage loss and subchondral marrow edema. Medial compartment:No full-thickness articular cartilage defect. Marginal osteophytes are noted. Lateral compartment:No full-thickness articular cartilage defect. Marginal osteophytes are noted. MENISCI: Medial meniscus:Intact. Lateral meniscus:Degenerative free edge tear of the body. LIGAMENTS: Cruciate ligaments: ACL is intact. The PCL is intact. Medial collateral ligament:Intact. Lateral collateral ligament:Intact. Posterolateral corner structures:Intact. EXTENSOR MECHANISM:The distal quadriceps and patellar tendons are intact. Edema is seen within the superolateral aspect of Hoffa's fat. The tibial tuberosity to trochlear groove distance measures 2.1 cm.
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FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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EXAM: MR Knee Right wo contrast CLINICAL INFORMATION: 55-year-old female with right knee pain, rule out meniscal versus ligamentous pathology. COMPARISON: Right knee radiograph 12/29/2021. TECHNIQUE: MR Knee Right wo contrast STRUCTURED REPORT: MRI Knee 1/2/2020 FINDINGS: BONES:No fracture, marrow replacement, or aggressive osseous lesion. Heterogeneous signal throughout the visualized femoral diaphysis, likely representing bone marrow reconversion. ARTICULATIONS: Effusion:None. Patellofemoral compartment: Moderate chondromalacia of the medial patellar facet. Medial compartment:No cartilage defect. Lateral compartment:No cartilage defect. MENISCI: Medial meniscus:Intact. Lateral meniscus:There is increased signal intensity within the anterior horn of the lateral meniscus without extension to an articular surface (series 900 image 14). 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. Mild subcutaneous edema overlying the lateral patella and patellar tendon. CONCLUSION: 1. No evidence of ligamentous or meniscal pathology. 2. Subcutaneous edema overlying the lateral patella and patellar tendon. 3. High-grade chondromalacia in the medial patellar facet. 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. Heterogeneous signal throughout the visualized femoral diaphysis, likely representing bone marrow reconversion. ARTICULATIONS: Effusion:None. Patellofemoral compartment: Moderate chondromalacia of the medial patellar facet. Medial compartment:No cartilage defect. Lateral compartment:No cartilage defect. MENISCI: Medial meniscus:Intact. Lateral meniscus:There is increased signal intensity within the anterior horn of the lateral meniscus without extension to an articular surface (series 900 image 14). 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. Mild subcutaneous edema overlying the lateral patella and patellar tendon.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Mild diffuse parenchymal volume loss. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Globes are intact. No fracture. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. Diffuse cortical hyperostosis of the calvarium. FACIAL BONES: No fracture. Pterygoid plates are intact. MANDIBLE: No fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Minimal mucosal thickening of the left maxillary sinus. OTHER: Small round radiopaque densities in the superficial soft tissues of the left cheek.
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MR Lumbar Spine wo contrast 1/24/2022 6:19 PM CLINICAL INFORMATION: LUMBAR RADICULOPATHY, M54.16 Radiculopathy, lumbar region COMPARISON: None. TECHNIQUE: Multiplanar, multisequence MR images of the lumbar spine were obtained without the administration of intravenous contrast. FINDINGS: The lumbar spine is normal in alignment. Vertebral body heights are well-maintained and intervertebral disc spaces are preserved. There is disc desiccation most notable at L3-L4, from decreased T2-weighted signal, without significant disc height loss. There is no abnormal marrow signal change. The conus appears normal, terminating at the level of L1. Additional findings are given on a segmental basis as below: T12-L1: Unremarkable. L1-L2: Unremarkable. L2-L3: Unremarkable. L3-L4: Tiny bilateral facet joint effusions, without significant neural foraminal narrowing, or spinal canal stenosis. L4-L5: Mild bilateral facet hypertrophy, resulting in mild left neuroforaminal narrowing, without significant spinal canal stenosis. L5-S1: Mild epidural lipomatosis extending into the sacral canal, without significant spinal canal stenosis or neuroforaminal narrowing Limited evaluation of the intra-abdominal structures shows no significant abnormality. The paraspinal musculature is mildly atrophied, without discrete fluid collections identified. IMPRESSION: 1. No evidence of acute findings in the upper spine. 2. Mild chronic degenerative changes of the lower lumbar spine as described, resulting in mild left L4-L5 neuroforaminal narrowing, without significant spinal canal stenosis. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: The lumbar spine is normal in alignment. Vertebral body heights are well-maintained and intervertebral disc spaces are preserved. There is disc desiccation most notable at L3-L4, from decreased T2-weighted signal, without significant disc height loss. There is no abnormal marrow signal change. The conus appears normal, terminating at the level of L1. Additional findings are given on a segmental basis as below: T12-L1: Unremarkable. L1-L2: Unremarkable. L2-L3: Unremarkable. L3-L4: Tiny bilateral facet joint effusions, without significant neural foraminal narrowing, or spinal canal stenosis. L4-L5: Mild bilateral facet hypertrophy, resulting in mild left neuroforaminal narrowing, without significant spinal canal stenosis. L5-S1: Mild epidural lipomatosis extending into the sacral canal, without significant spinal canal stenosis or neuroforaminal narrowing Limited evaluation of the intra-abdominal structures shows no significant abnormality. The paraspinal musculature is mildly atrophied, without discrete fluid collections identified.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The trachea and central airways are patent. No pleural effusion or pneumothorax. No focal consolidation. Small noncalcified pulmonary nodule in the right lung apex measuring 5 mm on axial series 501 image 90. Basilar dependent atelectasis. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Anterior chest wall contusion overlying the right hemithorax. ABDOMEN and PELVIS: LIVER: There is trace free fluid adjacent to the inferior tip of the liver. No hepatic laceration is identified. Liver is normal in size and morphology. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Subtle stranding adjacent to the bilateral adrenal glands without sizable adrenal hematoma or other significant abnormality. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Postsurgical changes of gastric bypass. Small bowel is normal in caliber. COLON / APPENDIX: The appendix is normal. The colon is unremarkable. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is absent. Left Bartholin's cyst. BODY WALL: Multifocal contusion overlying the anterior abdominal wall. Fat-containing ventral hernia is noted. MUSCULOSKELETAL: Mild sclerosis and irregularity involving the pubic symphysis suggesting osteitis pubis. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative change. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative change of lower lumbar spine facet arthropathy. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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MR Cervical Spine wo contrast 1/24/2022 6:30 PM CLINICAL INFORMATION: Cervical radiculopathy, no red flags, M54.12 Radiculopathy, cervical region, M54.2 Cervicalgia COMPARISON: Prior cervical spine radiographs 10/25/2021. TECHNIQUE: Multiplanar, multisequence MR images of the cervical spine were obtained without the administration of intravenous contrast. FINDINGS: There is slight straightening of the lordotic curvature of cervical spine. The vertebral body heights are maintained. There is no abnormal marrow signal change. The visualized posterior fossa structures are within normal limits. There is artifact on the axial T2-weighted images at the level of C5, C6. There is no definite cord signal abnormality. Additional findings are given on a segmental basis as below: C2-C3: No spinal canal stenosis or neural foraminal narrowing bilaterally. C3-C4: Combination of disc bulge, mild bilateral uncovertebral, facet and ligamentum flavum hypertrophy results in mild spinal canal narrowing. There is mild facet arthropathy but no appreciable neural foraminal narrowing. C4-C5: There is a small posterior disc/osteophyte complex which does not result in significant spinal canal stenosis. Left greater than right uncovertebral and facet hypertrophy results in left greater than right mild neuroforaminal narrowing. C5-C6: There is a posterior disc/osteophyte complex, asymmetric to right, with right paracentral disc protrusion, moderate right uncovertebral and facet hypertrophy narrows the right lateral recess. Overall there is moderate spinal canal stenosis with flattening of the ventral aspect of the cervical spinal cord. Right moderate to severe right neural foraminal narrowing. C6-C7: Combination of disc bulge and uncovertebral hypertrophic resulting in mild spinal canal narrowing. No appreciable neural foraminal stenosis. C7-T1: Unremarkable. The prevertebral soft tissues are unremarkable. The paraspinal musculature is within normal limits. CONCLUSION: 1. Multilevel degenerative changes most pronounced at C5-C6 where there is asymmetric right moderate spinal canal stenosis and flattening of the ventral aspect of the cervical spinal cord. Also moderate to severe right neuroforaminal stenosis. Please see report for detailed level by level assessment As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: There is slight straightening of the lordotic curvature of cervical spine. The vertebral body heights are maintained. There is no abnormal marrow signal change. The visualized posterior fossa structures are within normal limits. There is artifact on the axial T2-weighted images at the level of C5, C6. There is no definite cord signal abnormality. Additional findings are given on a segmental basis as below: C2-C3: No spinal canal stenosis or neural foraminal narrowing bilaterally. C3-C4: Combination of disc bulge, mild bilateral uncovertebral, facet and ligamentum flavum hypertrophy results in mild spinal canal narrowing. There is mild facet arthropathy but no appreciable neural foraminal narrowing. C4-C5: There is a small posterior disc/osteophyte complex which does not result in significant spinal canal stenosis. Left greater than right uncovertebral and facet hypertrophy results in left greater than right mild neuroforaminal narrowing. C5-C6: There is a posterior disc/osteophyte complex, asymmetric to right, with right paracentral disc protrusion, moderate right uncovertebral and facet hypertrophy narrows the right lateral recess. Overall there is moderate spinal canal stenosis with flattening of the ventral aspect of the cervical spinal cord. Right moderate to severe right neural foraminal narrowing. C6-C7: Combination of disc bulge and uncovertebral hypertrophic resulting in mild spinal canal narrowing. No appreciable neural foraminal stenosis. C7-T1: Unremarkable. The prevertebral soft tissues are unremarkable. The paraspinal musculature is within normal limits.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The trachea and central airways are patent. No pleural effusion or pneumothorax. No focal consolidation. Small noncalcified pulmonary nodule in the right lung apex measuring 5 mm on axial series 501 image 90. Basilar dependent atelectasis. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Anterior chest wall contusion overlying the right hemithorax. ABDOMEN and PELVIS: LIVER: There is trace free fluid adjacent to the inferior tip of the liver. No hepatic laceration is identified. Liver is normal in size and morphology. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Subtle stranding adjacent to the bilateral adrenal glands without sizable adrenal hematoma or other significant abnormality. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Postsurgical changes of gastric bypass. Small bowel is normal in caliber. COLON / APPENDIX: The appendix is normal. The colon is unremarkable. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is absent. Left Bartholin's cyst. BODY WALL: Multifocal contusion overlying the anterior abdominal wall. Fat-containing ventral hernia is noted. MUSCULOSKELETAL: Mild sclerosis and irregularity involving the pubic symphysis suggesting osteitis pubis. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative change. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative change of lower lumbar spine facet arthropathy. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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HISTORY: Frontal lobe glioblastoma status post surgery and radiation Clinical Information: Worsening of the weakness Comparison: CT dated 1/24/2022 MRI dated 11/16/2021 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, 19 ml, per protocol. IV contrast injection rate: 4 ml per sec. Findings: Right frontal craniotomy changes are again noted.. There is interval increase in size of the heterogeneously enhancing part of the lesion, now measures 4.6 x 5.9 cm, previously measured 3.4 x 4.0 cm on MRI dated 11/16/2021 when remeasured by me. There is no significant change in size of the cystic portion of the lesion which now measures 2.8 x 2.4 cm, previously measured 3.0 x 2.1 cm, on axial T2 images. Scattered areas of diffusion restriction is seen in the enhancing part of the lesion associated with susceptibility artifact, on the SWI image, suggesting microhemorrhages There is also interval significant increase in associated vasogenic edema involving the right frontal, temporal and right parietal lobes with mass effect on the right lateral ventricle and about 14 mm right-to-left midline shift. Evidence of early stages of right uncal herniation with mass effect on the right cerebral peduncle is also noted. There is mild interval enlargement of the left lateral ventricle suggesting early entrapment Perfusion images demonstrate patchy areas of increased perfusion primarily along the posterior and superior aspect of the lesion. There is also small area of increased perfusion along the inferior most aspect of the lesion. Significant portions of decreased perfusion within the center of the lesion suggestive of necrosis . The visualized paranasal sinuses and mastoid air cells are clear. Postsurgical changes status post right frontal craniotomy is noted. Impression: 1..Interval interval increase in size of the heterogeneously enhancing part of the right frontal lobe lesion. Cystic portion of the lesion is not significantly changed in size. There is increased perfusion of the lesion superiorly and posteriorly and also inferiorly but there are also large areas of nonincreased perfusion centrally. Constellation of findings suggest residual/recurrent tumor at the periphery with significant central necrosis. 02. Significantly increased vasogenic edema within the right cerebral hemisphere resulting in new moderate right to left midline shift. 03. Mild enlargement of left lateral ventricle suggesting partial entrapment. 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 frontal craniotomy changes are again noted.. There is interval increase in size of the heterogeneously enhancing part of the lesion, now measures 4.6 x 5.9 cm, previously measured 3.4 x 4.0 cm on MRI dated 11/16/2021 when remeasured by me. There is no significant change in size of the cystic portion of the lesion which now measures 2.8 x 2.4 cm, previously measured 3.0 x 2.1 cm, on axial T2 images. Scattered areas of diffusion restriction is seen in the enhancing part of the lesion associated with susceptibility artifact, on the SWI image, suggesting microhemorrhages There is also interval significant increase in associated vasogenic edema involving the right frontal, temporal and right parietal lobes with mass effect on the right lateral ventricle and about 14 mm right-to-left midline shift. Evidence of early stages of right uncal herniation with mass effect on the right cerebral peduncle is also noted. There is mild interval enlargement of the left lateral ventricle suggesting early entrapment Perfusion images demonstrate patchy areas of increased perfusion primarily along the posterior and superior aspect of the lesion. There is also small area of increased perfusion along the inferior most aspect of the lesion. Significant portions of decreased perfusion within the center of the lesion suggestive of necrosis . The visualized paranasal sinuses and mastoid air cells are clear. Postsurgical changes status post right frontal craniotomy is noted.
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FINDINGS: Limited evaluation of the lower cervical spine and proximal arteries due to photon starvation artifact. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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15,433 |
MR Lumbar Spine wo contrast 1/24/2022 6:46 PM CLINICAL INFORMATION: Lumbar radiculopathy, M54.16 Radiculopathy, lumbar region COMPARISON: Prior CT lumbar spine without contrast dated 10/28/2006. TECHNIQUE: Multiplanar, multisequence MR images of the lumbar spine were obtained without the administration of intravenous contrast. FINDINGS: The lumbar spine is normal in alignment. Vertebral body heights are maintained and intervertebral disc spaces are preserved. A rounded focus of T1 and T2 hyperintense signal in the right L5 vertebral body is consistent with a and intraosseous hemangioma. Otherwise, there is no abnormal marrow signal change. The conus terminates at the inferior aspect of L2. Additional findings given on a segmental basis as below: T12-L1/L1-L2: Unremarkable. L2-L3/L3-L4: Mild bilateral facet arthropathy without spinal canal stenosis or significant neural foraminal narrowing. L4-L5: Mild bilateral facet arthropathy with superimposed small facet effusions, and ligamentum flavum hypertrophy, resulting in mild left neuroforaminal narrowing, without significant spinal canal stenosis. L5-S1: Mild bilateral facet arthropathy and ligamentum flavum hypertrophy is seen, without significant spinal canal stenosis or neural foraminal narrowing. Limited evaluation of the intra-abdominal structures shows no relevant abnormality. The paraspinal musculature is within normal limits, without organized fluid collections. IMPRESSION: 1. No evidence of acute findings in the lumbar spine. 2. Early degenerative changes as described, most significant at L4-L5, resulting in mild left neuroforaminal narrowing, without significant spinal canal stenosis. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: The lumbar spine is normal in alignment. Vertebral body heights are maintained and intervertebral disc spaces are preserved. A rounded focus of T1 and T2 hyperintense signal in the right L5 vertebral body is consistent with a and intraosseous hemangioma. Otherwise, there is no abnormal marrow signal change. The conus terminates at the inferior aspect of L2. Additional findings given on a segmental basis as below: T12-L1/L1-L2: Unremarkable. L2-L3/L3-L4: Mild bilateral facet arthropathy without spinal canal stenosis or significant neural foraminal narrowing. L4-L5: Mild bilateral facet arthropathy with superimposed small facet effusions, and ligamentum flavum hypertrophy, resulting in mild left neuroforaminal narrowing, without significant spinal canal stenosis. L5-S1: Mild bilateral facet arthropathy and ligamentum flavum hypertrophy is seen, without significant spinal canal stenosis or neural foraminal narrowing. Limited evaluation of the intra-abdominal structures shows no relevant abnormality. The paraspinal musculature is within normal limits, without organized fluid collections.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The trachea and central airways are patent. No pleural effusion or pneumothorax. No focal consolidation. Small noncalcified pulmonary nodule in the right lung apex measuring 5 mm on axial series 501 image 90. Basilar dependent atelectasis. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Anterior chest wall contusion overlying the right hemithorax. ABDOMEN and PELVIS: LIVER: There is trace free fluid adjacent to the inferior tip of the liver. No hepatic laceration is identified. Liver is normal in size and morphology. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Subtle stranding adjacent to the bilateral adrenal glands without sizable adrenal hematoma or other significant abnormality. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Postsurgical changes of gastric bypass. Small bowel is normal in caliber. COLON / APPENDIX: The appendix is normal. The colon is unremarkable. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is absent. Left Bartholin's cyst. BODY WALL: Multifocal contusion overlying the anterior abdominal wall. Fat-containing ventral hernia is noted. MUSCULOSKELETAL: Mild sclerosis and irregularity involving the pubic symphysis suggesting osteitis pubis. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative change. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative change of lower lumbar spine facet arthropathy. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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MR Lumbar Spine wo contrast 1/24/2022 6:45 PM CLINICAL INFORMATION: LOW BACK PAIN, M54.50 Low back pain, unspecified COMPARISON: MR lumbar spine 10/19/2020 TECHNIQUE: Multiplanar, multisequence MR images of the lumbar spine were obtained without the administration of intravenous contrast. FINDINGS: The lumbar spine is normal in alignment. Vertebral body heights are well-maintained and intervertebral disc spaces are preserved. There is no abnormal marrow signal change. There are mild disc desiccation changes and L4-L5 and L5-S1. The conus appears normal terminating at the level of L1. Additional findings are given on a segmental basis as below: T12-L1: No spinal canal stenosis or neuroforaminal narrowing. L1-L2: No spinal canal stenosis or neural foraminal narrowing appreciated. L2-L3: There is mild, right greater than left facet arthropathy and mild ligament hypertrophy but no spinal canal stenosis is seen. No appreciable neural foraminal narrowing. L3-L4: Facet arthropathy and ligamentum flavum hypertrophy are noted. These changes result in mild bilateral neural foraminal narrowing. Findings are difficult to compare to the prior examination given motion limitation on the prior exam. L4-L5: There is a broad-based posterior disc bulge in addition to ligamentum flavum hypertrophy and epidural lipomatosis resulting in mild spinal canal stenosis. Additionally, there is bilateral facet arthropathy and bilateral mild-moderate neural foraminal narrowing which appears slightly worsened compared to the prior examination. L5-S1: There is a posterior disc bulge which does not result in significant spinal canal stenosis. There is mild bilateral facet arthropathy resulting in mild bilateral neural foraminal narrowing. Limited evaluation of the intra-abdominal structures shows no significant abnormality. The paraspinal musculature is within normal limits. CONCLUSION: 1. Broad-based disc bulge and ligamentum flavum hypertrophy resulting in mild spinal canal stenosis at L4-L5. 2. Multilevel degenerative changes with multiple areas of facet arthropathy, most pronounced at L4-L5 where there is bilateral mild-moderate neural foraminal narrowing, slightly worsened compared to the prior examination. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: The lumbar spine is normal in alignment. Vertebral body heights are well-maintained and intervertebral disc spaces are preserved. There is no abnormal marrow signal change. There are mild disc desiccation changes and L4-L5 and L5-S1. The conus appears normal terminating at the level of L1. Additional findings are given on a segmental basis as below: T12-L1: No spinal canal stenosis or neuroforaminal narrowing. L1-L2: No spinal canal stenosis or neural foraminal narrowing appreciated. L2-L3: There is mild, right greater than left facet arthropathy and mild ligament hypertrophy but no spinal canal stenosis is seen. No appreciable neural foraminal narrowing. L3-L4: Facet arthropathy and ligamentum flavum hypertrophy are noted. These changes result in mild bilateral neural foraminal narrowing. Findings are difficult to compare to the prior examination given motion limitation on the prior exam. L4-L5: There is a broad-based posterior disc bulge in addition to ligamentum flavum hypertrophy and epidural lipomatosis resulting in mild spinal canal stenosis. Additionally, there is bilateral facet arthropathy and bilateral mild-moderate neural foraminal narrowing which appears slightly worsened compared to the prior examination. L5-S1: There is a posterior disc bulge which does not result in significant spinal canal stenosis. There is mild bilateral facet arthropathy resulting in mild bilateral neural foraminal narrowing. Limited evaluation of the intra-abdominal structures shows no significant abnormality. The paraspinal musculature is within normal limits.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The trachea and central airways are patent. No pleural effusion or pneumothorax. No focal consolidation. Small noncalcified pulmonary nodule in the right lung apex measuring 5 mm on axial series 501 image 90. Basilar dependent atelectasis. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Anterior chest wall contusion overlying the right hemithorax. ABDOMEN and PELVIS: LIVER: There is trace free fluid adjacent to the inferior tip of the liver. No hepatic laceration is identified. Liver is normal in size and morphology. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Subtle stranding adjacent to the bilateral adrenal glands without sizable adrenal hematoma or other significant abnormality. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Postsurgical changes of gastric bypass. Small bowel is normal in caliber. COLON / APPENDIX: The appendix is normal. The colon is unremarkable. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is absent. Left Bartholin's cyst. BODY WALL: Multifocal contusion overlying the anterior abdominal wall. Fat-containing ventral hernia is noted. MUSCULOSKELETAL: Mild sclerosis and irregularity involving the pubic symphysis suggesting osteitis pubis. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative change. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel discogenic degenerative change of lower lumbar spine facet arthropathy. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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MR Neck Soft Tissue wo+w contrast 1/24/2022 7:43 PM Clinical information: 38 years Female patient with Neck mass, nonpulsatile, R22.1 Localized swelling, mass and lump, neck Spec Inst: ho prior neck swelling in childhood Comparison: None available. Technique: Multiplanar multisequence images of the neck were obtained before and after intravenous contrast administration. Patient weight: 209 lbs. IV contrast: ProHance, 20 ml, per protocol. FINDINGS: Note is made of a circumscribed, lobulated, tubular, predominantly hyperintense T1/T2 lesion in the right lateral neck soft tissues, medial to the right sternocleidomastoid muscle at the level of C1-C2, demonstrating internal fluid-fluid level, measuring approximately 35 x 21 x 19 mm. Incidental sebaceous cyst anterior lateral to the left masseter muscle, measuring approximately up to 12 x 9 mm. Paranasal Sinuses/Skull Base: The paranasal sinuses are well developed and clear. No acute fractures or suspicious osseous lesions are identified of the skull base. The mastoid air cell complexes are clear. Nasal Fossa: The nasal fossa is patent and has a normal appearance. No significant nasal septal deviation appreciated Nasopharynx: Normal appearance. Suprahyoid Neck: Normal appearance. Oropharynx: Normal appearance. Oral cavity: Normal appearance. Parapharyngeal: Normal appearance. Retropharyngeal space: Normal appearance. Infrahyoid Neck: Normal appearance. Larynx: No intrinsic abnormality is seen within the larynx or trachea. The true and false vocal cords are without focal abnormality. Hypopharynx: Normal appearance. Supraglottis: Normal appearance. Parotid and submandibular glands: Normal appearance. Thyroid: Normal appearance. Lymph Nodes: Scattered subcentimeter benign-appearing bilateral cervical lymph nodes. Vascular Structures: The vascular structures have a normal appearance with no hemodynamically significant stenoses or large aneurysmal dilations visualized. Cervical spine: The cervical spine is anatomically aligned. No acute fractures or suspicious osseous lesions are identified. The vertebral bodies have normal height. The intervertebral disc spaces are preserved. No significant degenerative changes are seen. Lung Apices: The visualized lung apices are clear. Visualized Brain: The visualized brain parenchyma is grossly normal in appearance. IMPRESSION: 1. Circumscribed, lobulated, tubular, predominantly hyperintense T1/T2 lesion in the right lateral neck soft tissues, medial to the right sternocleidomastoid muscle at the level of C1-C2, demonstrating internal fluid-fluid level, measuring approximately 35 x 21 x 19 mm. Findings most likely represent a benign veno-lymphatic malformation. 2. Otherwise, no evidence of dominant solid enhancing soft tissue mass, cervical lymphadenopathy, or discrete fluid collections in the neck.
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FINDINGS: Note is made of a circumscribed, lobulated, tubular, predominantly hyperintense T1/T2 lesion in the right lateral neck soft tissues, medial to the right sternocleidomastoid muscle at the level of C1-C2, demonstrating internal fluid-fluid level, measuring approximately 35 x 21 x 19 mm. Incidental sebaceous cyst anterior lateral to the left masseter muscle, measuring approximately up to 12 x 9 mm. Paranasal Sinuses/Skull Base: The paranasal sinuses are well developed and clear. No acute fractures or suspicious osseous lesions are identified of the skull base. The mastoid air cell complexes are clear. Nasal Fossa: The nasal fossa is patent and has a normal appearance. No significant nasal septal deviation appreciated Nasopharynx: Normal appearance. Suprahyoid Neck: Normal appearance. Oropharynx: Normal appearance. Oral cavity: Normal appearance. Parapharyngeal: Normal appearance. Retropharyngeal space: Normal appearance. Infrahyoid Neck: Normal appearance. Larynx: No intrinsic abnormality is seen within the larynx or trachea. The true and false vocal cords are without focal abnormality. Hypopharynx: Normal appearance. Supraglottis: Normal appearance. Parotid and submandibular glands: Normal appearance. Thyroid: Normal appearance. Lymph Nodes: Scattered subcentimeter benign-appearing bilateral cervical lymph nodes. Vascular Structures: The vascular structures have a normal appearance with no hemodynamically significant stenoses or large aneurysmal dilations visualized. Cervical spine: The cervical spine is anatomically aligned. No acute fractures or suspicious osseous lesions are identified. The vertebral bodies have normal height. The intervertebral disc spaces are preserved. No significant degenerative changes are seen. Lung Apices: The visualized lung apices are clear. Visualized Brain: The visualized brain parenchyma is grossly normal in appearance.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Mild diffuse parenchymal volume loss. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Globes are intact. No fracture. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. Diffuse cortical hyperostosis of the calvarium. FACIAL BONES: No fracture. Pterygoid plates are intact. MANDIBLE: No fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Minimal mucosal thickening of the left maxillary sinus. OTHER: Small round radiopaque densities in the superficial soft tissues of the left cheek.
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15,436 |
MR Brain wo+w contrast 1/24/2022 8:48 PM Clinical information: 63 years Female patient with Memory Loss, R41.3 Other amnesia Comparison: CT sinuses without contrast dated 6/26/2017. MRI brain with and without contrast dated 10/2/2008. Technique: Multiplanar, multisequence MRI of the brain was performed before and after the administration of intravenous contrast. Patient weight: 275 lbs. IV contrast: ProHance, 20 ml, per protocol. FINDINGS: Cerebral parenchyma: Mild frontal age-appropriate brain parenchymal volume loss is seen. Slightly progressive scattered periventricular and subcortical white matter long TR hyperintense signal foci are seen, likely sequela of mild chronic microvascular ischemic disease. No abnormal enhancement, intracranial mass lesion, hemorrhage, or infarction. On the MP-RAGE coronal series, on an image oriented perpendicular to the AC-PC line and passing through the mamillary bodies, the patient has grade 0 right hippocampal atrophy and grade 0 left hippocampal atrophy using the visual grading system of Duara et al. 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: Enlarging left maxillary sinus mucous retention cyst. Persistent 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. No acute intracranial process or abnormal enhancement identified. 2. Age-appropriate brain involution and slightly progressive mild chronic microvascular ischemic disease, without evidence of hippocampal atrophy.
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FINDINGS: Cerebral parenchyma: Mild frontal age-appropriate brain parenchymal volume loss is seen. Slightly progressive scattered periventricular and subcortical white matter long TR hyperintense signal foci are seen, likely sequela of mild chronic microvascular ischemic disease. No abnormal enhancement, intracranial mass lesion, hemorrhage, or infarction. On the MP-RAGE coronal series, on an image oriented perpendicular to the AC-PC line and passing through the mamillary bodies, the patient has grade 0 right hippocampal atrophy and grade 0 left hippocampal atrophy using the visual grading system of Duara et al. 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: Enlarging left maxillary sinus mucous retention cyst. Persistent 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: Limited evaluation of the lower cervical spine and proximal arteries due to photon starvation artifact. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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15,437 |
EXAM: MR Enterography CLINICAL INFORMATION: Abdominal pain, Crohns w stricturing disease COMPARISON: MR enterography dated 11/12/2018 TECHNIQUE: MR Enterography Patient weight: 150 lbs. IV contrast: ProHance, 7 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: STRUCTURED REPORT: MRI Enterography LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN AND PELVIS: STOMACH: No abnormality. SMALL BOWEL: Luminal narrowing near the ileocecal valve (coronal image 19, series 401) which remains narrowed on delayed postcontrast sequences. There is mural thickening, mucosal hyperenhancement, and mesenteric vascular engorgement adjacent to the terminal ileum spanning approximately 4-6 cm on coronal image 17, series 401. The remainder of the small bowel appears normal. PERITONEUM / MESENTERY: Normal. COLORECTAL: No abnormal bowel wall thickening or enhancement. The appendix is normal. APPENDIX: Normal. LIVER: Partially imaged portions are normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. SPLEEN: Partially imaged portions are normal. PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Focal narrowing at the level of the ileocecal valve, perhaps indicating an inflammatory stricture although no significant upstream dilation noted. 2. Active inflammation involving approximately 6 cm of terminal ileum, compatible with active Crohn's disease. 3. Ill-defined enhancing soft tissue within the mesentery near the segment of active inflammation the terminal ileum, perhaps sequelae of fistulous disease. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: MRI Enterography LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN AND PELVIS: STOMACH: No abnormality. SMALL BOWEL: Luminal narrowing near the ileocecal valve (coronal image 19, series 401) which remains narrowed on delayed postcontrast sequences. There is mural thickening, mucosal hyperenhancement, and mesenteric vascular engorgement adjacent to the terminal ileum spanning approximately 4-6 cm on coronal image 17, series 401. The remainder of the small bowel appears normal. PERITONEUM / MESENTERY: Normal. COLORECTAL: No abnormal bowel wall thickening or enhancement. The appendix is normal. APPENDIX: Normal. LIVER: Partially imaged portions are normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. SPLEEN: Partially imaged portions are normal. PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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Findings: Included portions of the brain and skull base appear normal. There is left-sided pseudophakia. There is pan sinus opacification with near complete opacification of right middle ear and mastoid air cells there is a trace left mastoid effusion. There is a left IJ approach central venous catheter terminating in the left brachiocephalic vein. There are small locules of gas surrounding the tip of the catheter. Both internal jugular veins, bilateral brachiocephalic veins and the cranial SVC appears somewhat small in caliber. There are a few prominent collaterals in the anterior chest wall Endotracheal tube is in satisfactory position. There is an orogastric catheter in place. There are prominent secretions throughout the nasal cavity and pharynx. No other significant abnormality in the pharynx or larynx. No discrete mass or lymphadenopathy is identified in the neck. The parotid, submandibular, and thyroid glands appear normal. There are prominent groundglass disease in the imaged upper lungs with dependent consolidation. There is no acute osseous abnormality or focal aggressive osseous lesion.
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15,438 |
MR Brain wo+w contrast 1/26/2022 9:06 PM Clinical information: 65 years Female patient with PUI for COVID status epilepticus Spec Inst: Epilepsy protocol Comparison: CT angiogram head and neck with contrast dated 1/25/2022. Technique: Multiplanar, multisequence MRI of the brain was performed before and after the administration of intravenous contrast. Patient weight: 235 lbs. IV contrast: ProHance, 20 ml, per protocol. FINDINGS: Please note evaluation is limited due to motion artifacts. Cerebral parenchyma: Subtle linear foci of restricted diffusion and abnormal hyperintense long TR signal are noted in the right anterior periatrial white matter and the right posterior parietal cortex, which may represent acute/early subacute infarcts, without evidence of confluent hemorrhagic transformation. Mild frontal age-appropriate brain parenchymal volume loss is again seen. Scattered subcortical white matter long TR hyperintense signal foci may represent sequela of early chronic microvascular ischemic disease. No abnormal enhancement, or intracranial mass lesion. 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: Pansinus mucosal thickening, with moderate opacification of the bilateral ethmoid air cells and sphenoid sinuses. Visualized orbits: No ocular or retrobulbar pathology. Calvarium and skull base: No osseous destruction. Partial opacification of the bilateral mastoid air cells. Pituitary and Pineal Glands: No mass lesion. Soft tissues: No significant abnormality. IMPRESSION: 1. Limited evaluation due to motion artifacts. 2. Subtle linear foci of restricted diffusion and abnormal hyperintense long TR signal in the right anterior periatrial white matter and the right posterior parietal cortex, may represent acute/early subacute infarcts, without evidence of confluent hemorrhagic transformation. 3. Persistent age-appropriate brain involution and suggestion of early chronic microvascular ischemic disease.
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FINDINGS: Please note evaluation is limited due to motion artifacts. Cerebral parenchyma: Subtle linear foci of restricted diffusion and abnormal hyperintense long TR signal are noted in the right anterior periatrial white matter and the right posterior parietal cortex, which may represent acute/early subacute infarcts, without evidence of confluent hemorrhagic transformation. Mild frontal age-appropriate brain parenchymal volume loss is again seen. Scattered subcortical white matter long TR hyperintense signal foci may represent sequela of early chronic microvascular ischemic disease. No abnormal enhancement, or intracranial mass lesion. 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: Pansinus mucosal thickening, with moderate opacification of the bilateral ethmoid air cells and sphenoid sinuses. Visualized orbits: No ocular or retrobulbar pathology. Calvarium and skull base: No osseous destruction. Partial opacification of the bilateral mastoid air cells. Pituitary and Pineal Glands: No mass lesion. Soft tissues: No significant abnormality.
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FINDINGS: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. SOFT TISSUES: Patchy groundglass opacities and consolidation in the bilateral lungs. Bovine arch.
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15,439 |
MR Brain wo contrast 1/25/2022 6:17 AM Clinical Information: Evaluation for stroke Comparison: CT angiogram head dated 1/24/2022 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 mild diffuse cerebral volume loss. There are also multiple prominent perivascular spaces within the basal ganglia bilaterally secondary to atrophy. There are confluent areas of FLAIR hyperintensity in centrum semiovale and periventricular deep white matter, suggestive of moderate microangiopathic changes. There is a tiny remote left cerebellar infarction. The brainstem and craniocervical junction are unremarkable No intracranial mass, mass effect, edema, hemorrhage, hydrocephalus, or evidence of acute infarction is seen.. Major intracranial vessels appear within normal limits. Mucous retention cysts are seen in bilateral maxillary sinuses. Partial opacification of bilateral mastoid air cells is noted.. No acute osseous or soft tissue abnormality. Impression: 01. No acute intracranial abnormality. Tiny remote left cerebellar infarction 02. Moderate microangiopathic changes and mild generalized atrophy 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 mild diffuse cerebral volume loss. There are also multiple prominent perivascular spaces within the basal ganglia bilaterally secondary to atrophy. There are confluent areas of FLAIR hyperintensity in centrum semiovale and periventricular deep white matter, suggestive of moderate microangiopathic changes. There is a tiny remote left cerebellar infarction. The brainstem and craniocervical junction are unremarkable No intracranial mass, mass effect, edema, hemorrhage, hydrocephalus, or evidence of acute infarction is seen.. Major intracranial vessels appear within normal limits. Mucous retention cysts are seen in bilateral maxillary sinuses. Partial opacification of bilateral mastoid air cells is noted.. No acute osseous or soft tissue abnormality.
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FINDINGS: STRUCTURED REPORT: CTA Aorta Runoff 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: Patent. RIGHT ILIAC ARTERIES: No significant abnormality. RIGHT FEMORAL \T\ POPLITEAL ARTERIES: No significant abnormality. RIGHT TIBIAL AND PERONEAL ARTERIES: No significant abnormality. RIGHT FOOT ARTERIES: No significant abnormality. LEFT ILIAC ARTERIES: No significant abnormality. LEFT FEMORAL \T\ POPLITEAL ARTERIES: No significant abnormality. LEFT TIBIAL AND PERONEAL ARTERIES: No significant abnormality. LEFT FOOT ARTERIES: No significant abnormality. ------------------------------------------------------------- LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Focal fat deposition about the falciform ligament. Otherwise Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: The stomach is normal. Small bowel is normal in caliber. Mild fecalization of the terminal ileum. COLON / APPENDIX: The appendix is normal. A few colonic diverticula. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Normal. MUSCULOSKELETAL: Acute ballistic injury to the right thigh with severely comminuted fracture of the mid MR diaphysis. One shaft width posterior dislocation of the distal fracture fragments with mild apex posterior angulation. No significant associated shortening. Innumerable tiny ballistic fragments and osseous fragments are noted scattered throughout this region limiting detection of small foci of active extravasation. Extensive surrounding soft tissue emphysema as well as contusion and a soft tissue defect overlying the anterior/medial aspect of the thigh. Small intramuscular hematoma is noted inferiorly tracking towards the knee. The knee joint is maintained and uninvolved. The distal right lower extremity is unremarkable. Bilateral os navicularis. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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15,440 |
MRI brain without Indication: stroke Comparison: Multiple priors, including same day CT head without contrast Technique: Multiple T1 and T2-weighted MR sequence images of the brain were obtained in the sagittal axial and coronal planes without the use of intravenous contrast per departmental protocol. Findings: Acute infarcts in the right inferior cerebellum medially showing evidence of restricted diffusion and hyperintense signal on T2/FLAIR images. Additional foci of diffusion hyperintensity with suppression/pseudonormalization on the ADC maps are seen in the right parietal lobe right posterior insula and right anterior centrum semiovale. Extensive confluent T2/FLAIR hyperintensity bilateral cerebral white matter and pons. Foci of prior ischemia/chronic infarcts in the left centrum semiovale both thalami left basal ganglia, bilaterally in the occipital lobes and both cerebellar hemispheres. There is generalized prominence of the extra-axial spaces appearing disproportionate for age suggesting moderate atrophy. Impression: Acute infarct in the right cerebral hemisphere. A few scattered foci of recent (acute to subacute infarct in the right cerebral hemisphere. Extensive chronic microvascular ischemic disease and chronic lacunar infarcts as detailed. Moderate parenchymal atrophy.
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Findings: Acute infarcts in the right inferior cerebellum medially showing evidence of restricted diffusion and hyperintense signal on T2/FLAIR images. Additional foci of diffusion hyperintensity with suppression/pseudonormalization on the ADC maps are seen in the right parietal lobe right posterior insula and right anterior centrum semiovale. Extensive confluent T2/FLAIR hyperintensity bilateral cerebral white matter and pons. Foci of prior ischemia/chronic infarcts in the left centrum semiovale both thalami left basal ganglia, bilaterally in the occipital lobes and both cerebellar hemispheres. There is generalized prominence of the extra-axial spaces appearing disproportionate for age suggesting moderate atrophy.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube distal tip projects 1.8 cm superior to the carina. Trace secretions surrounding the balloon of the ET tube and within the distal trachea. Ballistic injury to the left lower lobe with laceration and extensive contusion as well as a small residual anterior left pneumothorax. Two left chest tubes are noted one coursing more superiorly and one coursing inferiorly terminating in the anterior costophrenic angle. Numerous ballistic fragments are noted within the left lower lobe. There are faint groundglass densities throughout the right lung. No right pleural effusion or pneumothorax. HEART / VESSELS: Small amount of gas within the pericardial sac. No other significant abnormality. MEDIASTINUM / ESOPHAGUS: A few small foci of gas are noted in the anterior/superior mediastinum. DIAPHRAGM: Suspected diaphragmatic injury on the left posterior/medial aspect. LYMPH NODES: None enlarged. CHEST WALL: Extensive left chest wall emphysema. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Grade 2 superior splenic laceration. No evidence of active extravasation. Ballistic fragments are noted in the region. ADRENALS: Normal. KIDNEYS: Contrast is noted within the collecting systems. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is not visualized. The colon is normal. PERITONEUM / MESENTERY: A few scattered foci of postsurgical free intraperitoneal air. Small volume free fluid surrounding the liver. Hemoperitoneum in the left upper quadrant centered around the spleen. RETROPERITONEUM: Free fluid in the pelvis. VESSELS: Two left renal arteries. URINARY BLADDER: Collapsed around a Foley balloon. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Scattered foci of soft tissue gas overlying the anterior midline abdomen secondary to exploratory laparotomy. MUSCULOSKELETAL: Comminuted left scapular fractures as pronounced at the inferior aspect. There is extensive associated intramuscular and soft tissue gas and contusion. The humeral head continues to articulate appropriately with the glenoid. Associated comminuted fractures of the lateral/posterior aspect of the left sixth and seventh ribs. There is also comminuted fracture of the base of the left 11th rib with associated T11 left transverse process fracture. THORACIC: VERTEBRA: No compression deformity. T11 transverse process fracture extending to involve the lamina and left inferior facet. Ballistic fragment is noted within the posterior spinal canal at the level of T12. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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EXAM: MR Cervical Spine wo contrast 1/25/2022 2:07 AM CLINICAL INFORMATION: Neck pain with negative CT scan. COMPARISON: 1/24/2022 CT C-spine. TECHNIQUE: Sagittal T1, sagittal T2, sagittal STIR, sagittal GRE, axial T2 axial T1 axial T2 3D, coronal PD FINDINGS: The spinal alignment is normal. Vertebral body heights are preserved. There are no suspicious bone marrow signal abnormalities. The craniovertebral junction appears unremarkable. No definite cord signal abnormality is identified. No significant degenerative findings. CONCLUSION: Unremarkable MRI of the cervical 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: The spinal alignment is normal. Vertebral body heights are preserved. There are no suspicious bone marrow signal abnormalities. The craniovertebral junction appears unremarkable. No definite cord signal abnormality is identified. No significant degenerative findings.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube distal tip projects 1.8 cm superior to the carina. Trace secretions surrounding the balloon of the ET tube and within the distal trachea. Ballistic injury to the left lower lobe with laceration and extensive contusion as well as a small residual anterior left pneumothorax. Two left chest tubes are noted one coursing more superiorly and one coursing inferiorly terminating in the anterior costophrenic angle. Numerous ballistic fragments are noted within the left lower lobe. There are faint groundglass densities throughout the right lung. No right pleural effusion or pneumothorax. HEART / VESSELS: Small amount of gas within the pericardial sac. No other significant abnormality. MEDIASTINUM / ESOPHAGUS: A few small foci of gas are noted in the anterior/superior mediastinum. DIAPHRAGM: Suspected diaphragmatic injury on the left posterior/medial aspect. LYMPH NODES: None enlarged. CHEST WALL: Extensive left chest wall emphysema. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Grade 2 superior splenic laceration. No evidence of active extravasation. Ballistic fragments are noted in the region. ADRENALS: Normal. KIDNEYS: Contrast is noted within the collecting systems. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is not visualized. The colon is normal. PERITONEUM / MESENTERY: A few scattered foci of postsurgical free intraperitoneal air. Small volume free fluid surrounding the liver. Hemoperitoneum in the left upper quadrant centered around the spleen. RETROPERITONEUM: Free fluid in the pelvis. VESSELS: Two left renal arteries. URINARY BLADDER: Collapsed around a Foley balloon. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Scattered foci of soft tissue gas overlying the anterior midline abdomen secondary to exploratory laparotomy. MUSCULOSKELETAL: Comminuted left scapular fractures as pronounced at the inferior aspect. There is extensive associated intramuscular and soft tissue gas and contusion. The humeral head continues to articulate appropriately with the glenoid. Associated comminuted fractures of the lateral/posterior aspect of the left sixth and seventh ribs. There is also comminuted fracture of the base of the left 11th rib with associated T11 left transverse process fracture. THORACIC: VERTEBRA: No compression deformity. T11 transverse process fracture extending to involve the lamina and left inferior facet. Ballistic fragment is noted within the posterior spinal canal at the level of T12. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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MR Brain wo+w contrast 1/25/2022 7:18 PM Clinical information: 71 years Male patient with dizziness and gait disturbance. Comparison: CT head without contrast dated 1/24/2022. Technique: Multiplanar, multisequence MRI of the brain was performed with and without the uneventful administration of intravenous contrast. Patient weight: 190 lbs. IV contrast: ProHance, 10 ml, per protocol. IV contrast injection rate: 0.50 ml per sec. FINDINGS: Cerebral parenchyma: Mild diffuse age-appropriate brain parenchymal volume loss is again seen. Scattered periventricular and subcortical white matter long TR hyperintense signal foci are seen, suggestive of mild chronic microangiopathic disease. No intracranial mass lesion, hemorrhage, or infarction. Ventricular system: No hydrocephalus or midline shift. Tiny cavum septum pellucidum. 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: Mucosal thickening in the right maxillary sinus, unchanged. Visualized orbits: No ocular or retrobulbar pathology. Calvarium and skull base: No osseous destruction. Pituitary and Pineal Glands: Circumscribed, rounded, 0.8 x 0.6 x 0.7 cm mildly T1 hyperintense, T2 hyperintense, nonenhancing suprasellar lesion. Otherwise no discrete pituitary or pineal masses. Soft tissues: No significant abnormality. IMPRESSION: 1. No acute intracranial process or abnormal enhancement identified. 2. Better characterization of circumscribed, rounded, T2 hyperintense nonenhancing suprasellar lesion, with mild internal T1 shortening, favoring a benign Rathke cleft cyst. 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: Cerebral parenchyma: Mild diffuse age-appropriate brain parenchymal volume loss is again seen. Scattered periventricular and subcortical white matter long TR hyperintense signal foci are seen, suggestive of mild chronic microangiopathic disease. No intracranial mass lesion, hemorrhage, or infarction. Ventricular system: No hydrocephalus or midline shift. Tiny cavum septum pellucidum. 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: Mucosal thickening in the right maxillary sinus, unchanged. Visualized orbits: No ocular or retrobulbar pathology. Calvarium and skull base: No osseous destruction. Pituitary and Pineal Glands: Circumscribed, rounded, 0.8 x 0.6 x 0.7 cm mildly T1 hyperintense, T2 hyperintense, nonenhancing suprasellar lesion. Otherwise no discrete pituitary or pineal masses. Soft tissues: No significant abnormality.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube distal tip projects 1.8 cm superior to the carina. Trace secretions surrounding the balloon of the ET tube and within the distal trachea. Ballistic injury to the left lower lobe with laceration and extensive contusion as well as a small residual anterior left pneumothorax. Two left chest tubes are noted one coursing more superiorly and one coursing inferiorly terminating in the anterior costophrenic angle. Numerous ballistic fragments are noted within the left lower lobe. There are faint groundglass densities throughout the right lung. No right pleural effusion or pneumothorax. HEART / VESSELS: Small amount of gas within the pericardial sac. No other significant abnormality. MEDIASTINUM / ESOPHAGUS: A few small foci of gas are noted in the anterior/superior mediastinum. DIAPHRAGM: Suspected diaphragmatic injury on the left posterior/medial aspect. LYMPH NODES: None enlarged. CHEST WALL: Extensive left chest wall emphysema. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Grade 2 superior splenic laceration. No evidence of active extravasation. Ballistic fragments are noted in the region. ADRENALS: Normal. KIDNEYS: Contrast is noted within the collecting systems. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is not visualized. The colon is normal. PERITONEUM / MESENTERY: A few scattered foci of postsurgical free intraperitoneal air. Small volume free fluid surrounding the liver. Hemoperitoneum in the left upper quadrant centered around the spleen. RETROPERITONEUM: Free fluid in the pelvis. VESSELS: Two left renal arteries. URINARY BLADDER: Collapsed around a Foley balloon. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Scattered foci of soft tissue gas overlying the anterior midline abdomen secondary to exploratory laparotomy. MUSCULOSKELETAL: Comminuted left scapular fractures as pronounced at the inferior aspect. There is extensive associated intramuscular and soft tissue gas and contusion. The humeral head continues to articulate appropriately with the glenoid. Associated comminuted fractures of the lateral/posterior aspect of the left sixth and seventh ribs. There is also comminuted fracture of the base of the left 11th rib with associated T11 left transverse process fracture. THORACIC: VERTEBRA: No compression deformity. T11 transverse process fracture extending to involve the lamina and left inferior facet. Ballistic fragment is noted within the posterior spinal canal at the level of T12. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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MR Brain wo+w contrast HISTORY: Evaluation for intracranial hemorrhage. Suspicious history of GBM TECHNIQUE: Multiplanar, multisequence MRI of the brain was performed without and after intravenous contrast. Patient weight: 200 lbs. IV contrast: ProHance, 10 ml, per protocol. COMPARISON: CT of 1/25/2022 FINDINGS: INTRACRANIAL FINDINGS: There is a focus of diffusion restriction involving the posterior limb of left internal capsule most consistent with an acute lacunar infarction. There is a small focus of diffusion restriction the left cerebellum in favor of an acute lacunar infarction. There are multiple old lacunar infarctions involving the bilateral basal ganglia and thalami as well. Surgical changes of the right frontal region is seen. Within the anterior portion of the right frontal lobe there is a resection cavity which has been covered by heterogenous signal parenchyma with mild cortical expansion and hemorrhagic changes. No obvious abnormal enhancement is noted at this location and the linear enhancement within this location is likely prominent vasculature. There is mild diffuse cerebral volume loss. Mild ventriculomegaly is noted. There is extensive white matter T2 and FLAIR hyper signal intensity. There are numerous foci of cortical based susceptibility artifact involving the all cerebral lobes, bilateral cerebellar hemispheres, basal ganglia, thalami and brainstem. In addition, the previously noted focus of hyperdensity deep to the right frontal resection cavity is corresponding to a focus of susceptibility artifact in favor of hemorrhagic changes. EXTRACRANIAL FINDINGS: The orbital contents are unremarkable. There is minimal mucosal thickening of bilateral maxillary sinuses and ethmoidal air cells. IMPRESSION: Postsurgical changes of the right frontal lobe with a resection cavity and associated cortical thickening and heterogenous signal intensity without obvious parenchymal enhancement at this location. Despite the provided history of GBM it appears that the patient is status post partial resection and debulking of a low-grade glioma of right frontal lobe with residual glioma. If the patient can bring the prior MRIs, the possibility of interval disease progression can be evaluated. Mild cerebral volume loss. Advanced white matter T2 and FLAIR hyper signal intensity in favor of advanced microvascular angiopathy. A focus of acute lacunar infarction involving the posterior limb of left internal capsule. A small focus of acute lacunar infarction in left cerebellum. Numerous foci of parenchymal microhemorrhages in the brain cortex, cerebellum and brainstem. Post hemorrhagic changes subject the right frontal lesion corresponding to the focus of CT hyper density. Given distribution of the microhemorrhages in the cerebral hemispheres, findings can be compatible with cerebral amyloid angiopathy. Microhemorrhages of the posterior fossa can be secondary to hypertension. [Please note that diagnosis of the cerebral amyloid angiopathy was made based on the patient's history of no prior radiation. If there is any history of previous brain radiation similar foci of widely spread microhemorrhages can be secondary to numerous cavernoma secondary to radiation].
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FINDINGS: INTRACRANIAL FINDINGS: There is a focus of diffusion restriction involving the posterior limb of left internal capsule most consistent with an acute lacunar infarction. There is a small focus of diffusion restriction the left cerebellum in favor of an acute lacunar infarction. There are multiple old lacunar infarctions involving the bilateral basal ganglia and thalami as well. Surgical changes of the right frontal region is seen. Within the anterior portion of the right frontal lobe there is a resection cavity which has been covered by heterogenous signal parenchyma with mild cortical expansion and hemorrhagic changes. No obvious abnormal enhancement is noted at this location and the linear enhancement within this location is likely prominent vasculature. There is mild diffuse cerebral volume loss. Mild ventriculomegaly is noted. There is extensive white matter T2 and FLAIR hyper signal intensity. There are numerous foci of cortical based susceptibility artifact involving the all cerebral lobes, bilateral cerebellar hemispheres, basal ganglia, thalami and brainstem. In addition, the previously noted focus of hyperdensity deep to the right frontal resection cavity is corresponding to a focus of susceptibility artifact in favor of hemorrhagic changes. EXTRACRANIAL FINDINGS: The orbital contents are unremarkable. There is minimal mucosal thickening of bilateral maxillary sinuses and ethmoidal air cells.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube distal tip projects 1.8 cm superior to the carina. Trace secretions surrounding the balloon of the ET tube and within the distal trachea. Ballistic injury to the left lower lobe with laceration and extensive contusion as well as a small residual anterior left pneumothorax. Two left chest tubes are noted one coursing more superiorly and one coursing inferiorly terminating in the anterior costophrenic angle. Numerous ballistic fragments are noted within the left lower lobe. There are faint groundglass densities throughout the right lung. No right pleural effusion or pneumothorax. HEART / VESSELS: Small amount of gas within the pericardial sac. No other significant abnormality. MEDIASTINUM / ESOPHAGUS: A few small foci of gas are noted in the anterior/superior mediastinum. DIAPHRAGM: Suspected diaphragmatic injury on the left posterior/medial aspect. LYMPH NODES: None enlarged. CHEST WALL: Extensive left chest wall emphysema. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Grade 2 superior splenic laceration. No evidence of active extravasation. Ballistic fragments are noted in the region. ADRENALS: Normal. KIDNEYS: Contrast is noted within the collecting systems. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is not visualized. The colon is normal. PERITONEUM / MESENTERY: A few scattered foci of postsurgical free intraperitoneal air. Small volume free fluid surrounding the liver. Hemoperitoneum in the left upper quadrant centered around the spleen. RETROPERITONEUM: Free fluid in the pelvis. VESSELS: Two left renal arteries. URINARY BLADDER: Collapsed around a Foley balloon. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Scattered foci of soft tissue gas overlying the anterior midline abdomen secondary to exploratory laparotomy. MUSCULOSKELETAL: Comminuted left scapular fractures as pronounced at the inferior aspect. There is extensive associated intramuscular and soft tissue gas and contusion. The humeral head continues to articulate appropriately with the glenoid. Associated comminuted fractures of the lateral/posterior aspect of the left sixth and seventh ribs. There is also comminuted fracture of the base of the left 11th rib with associated T11 left transverse process fracture. THORACIC: VERTEBRA: No compression deformity. T11 transverse process fracture extending to involve the lamina and left inferior facet. Ballistic fragment is noted within the posterior spinal canal at the level of T12. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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MR Brain wo contrast 1/25/2022 3:50 PM Clinical Information: Evaluation for stroke Comparison: CT head dated 1/25/2022, CT angiogram head dated 1/25/2022. 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: Diffusion restriction is noted in the medial aspect of right frontal lobe, indicating recent infarction in the right ACA territory. There are scattered foci of diffusion restriction in the posteromedial aspect of right frontal lobe in the watershed distribution of the right anterior cerebral artery and middle cerebral artery.. No evidence of hemorrhagic transformation is seen in the mentioned infarcted area. Ventricular system seems normal, no evidence of mass effect or midline shift is noted. The visualized paranasal sinuses and mastoid air cells are clear. No acute osseous or soft tissue abnormality. Impression: Recent right ACA territory frontal lobe infarction and smaller acute to subacute infarcts within the right anterior cerebral artery/middle cerebral artery watershed region. No hemorrhagic transformation. 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 the medial aspect of right frontal lobe, indicating recent infarction in the right ACA territory. There are scattered foci of diffusion restriction in the posteromedial aspect of right frontal lobe in the watershed distribution of the right anterior cerebral artery and middle cerebral artery.. No evidence of hemorrhagic transformation is seen in the mentioned infarcted area. Ventricular system seems normal, no evidence of mass effect or midline shift is noted. The visualized paranasal sinuses and mastoid air cells are clear. No acute osseous or soft tissue abnormality.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Nonocclusive pulmonary emboli are noted involving the right lower lobe segmental pulmonary arteries. Bibasilar dependent atelectasis. DISTAL ESOPHAGUS: Moderately sized hiatal hernia increased in size when compared to prior. There is suspected wall thickening of the distal esophagus although incompletely visualized. HEART / VESSELS: Heart is enlarged. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Subcentimeter hypoattenuating lesion in the right kidney is indeterminate. The kidneys are otherwise unremarkable. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Mildly distended stomach. There is new mild distention of the duodenum and proximal jejunum with slow tapering to normal caliber and no significant/definitive transition point. The distal small bowel is normal in caliber. COLON / APPENDIX: The appendix is not visualized. Scattered diverticulosis. Moderate fecal burden in the distal colon. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Bilateral femoral vein DVTs. Replaced right hepatic artery arising from the SMA. Two left renal arteries. URINARY BLADDER: Mild bladder wall thickening, unchanged from prior. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Multilevel discogenic degenerative change.
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EXAM: MR Lumbar Spine wo contrast CLINICAL INFORMATION: Low back pain without radiculopathy or myelopathy. COMPARISON: Lumbar spine radiograph dated 1/3/2022. TECHNIQUE: MR Lumbar Spine wo contrast. FINDINGS: No acute fracture or compression deformity. No significant bone marrow abnormality aside from a scattered regions of prominent intramedullary fat. No spondylolisthesis. The disc spaces are maintained. The conus terminates at L1-L2. There is mild disc desiccation involving the L2-L5 intervertebral disc. T12-L1. No significant disc bulge, spinal canal, or foraminal narrowing. L1-L2: No significant disc bulge, spinal canal, or foraminal narrowing. Minimal facet arthropathy. L2-L3: Central disc protrusion. There is mild associated spinal canal narrowing without compression of the adjacent cauda equina nerve roots. Minimal associated facet arthropathy is noted. No significant foraminal narrowing. L3-L4: Mild broad-based disc bulge more pronounced on the right in the subarticular and foraminal location. No significant foraminal narrowing. However, as the exiting right L3 nerve root courses anteriorly there is abutment and questionable compression from the extruded disc laterally (axial series 5 image 27. L4-L5: Posterior disc herniation without significant spinal canal or foraminal narrowing. Mild facet arthropathy. L5-S1: Posterior disc herniation with annular fissure without significant spinal canal narrowing. There is mild left foraminal narrowing without nerve root compression. Mild to moderate facet arthropathy worse on the right. The visualized soft tissues are unremarkable aside from multiple bilateral renal cysts and a circumscribed aortic left renal vein. CONCLUSION: Degenerative changes most severe at L2-L3 and L3-L4. No significant nerve compression at any level. 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 fracture or compression deformity. No significant bone marrow abnormality aside from a scattered regions of prominent intramedullary fat. No spondylolisthesis. The disc spaces are maintained. The conus terminates at L1-L2. There is mild disc desiccation involving the L2-L5 intervertebral disc. T12-L1. No significant disc bulge, spinal canal, or foraminal narrowing. L1-L2: No significant disc bulge, spinal canal, or foraminal narrowing. Minimal facet arthropathy. L2-L3: Central disc protrusion. There is mild associated spinal canal narrowing without compression of the adjacent cauda equina nerve roots. Minimal associated facet arthropathy is noted. No significant foraminal narrowing. L3-L4: Mild broad-based disc bulge more pronounced on the right in the subarticular and foraminal location. No significant foraminal narrowing. However, as the exiting right L3 nerve root courses anteriorly there is abutment and questionable compression from the extruded disc laterally (axial series 5 image 27. L4-L5: Posterior disc herniation without significant spinal canal or foraminal narrowing. Mild facet arthropathy. L5-S1: Posterior disc herniation with annular fissure without significant spinal canal narrowing. There is mild left foraminal narrowing without nerve root compression. Mild to moderate facet arthropathy worse on the right. The visualized soft tissues are unremarkable aside from multiple bilateral renal cysts and a circumscribed aortic left renal vein.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Normal cerebral cortical volume for patient's age. EXTRA-AXIAL SPACES: Previously noted subtle gyriform hyperattenuation in the high left frontal lobe is no longer visualized, likely artifactual. No extra-axial collections. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Tiny mucus retention cyst in the right maxillary sinus. VESSELS: Normal noncontrast appearance of the vessels.
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15,446 |
RADIOLOGIC EXAM: MR Brain wo+w contrast CLINICAL INFORMATION: Pituitary adenoma, evaluate sella. COMPARISON: MRI brain dated 3/13/2018, 2/2/2017. CT sinus dated 6/20/2018. TECHNIQUE: Multiple images of the pituitary were obtained using the pituitary protocol. Images include dynamic coronal postcontrast images. MR Brain wo+w contrast Patient weight: 198 lbs. IV contrast: ProHance, 19 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: INTRACRANIAL FINDINGS: Interval increase in size of homogeneously enhancing sellar/suprasellar mass, now measuring 2.5 x 3.0 x 2.7 cm in AP by TV by CC (series 8, image 8; series 7, image 6), previously 1.8 x 2.3 x 1.9 cm (series 801, image 8; series 701, image 7). Bilateral cavernous sinus invasion with extension beyond the lateral margins of the cavernous ICAs, increased compared to prior. Bilateral cavernous ICA flow voids remains patent. The mass invades and obliterates the sphenoid sinuses. There is extension towards the right orbital apex. There is a unchanged small pineal cyst. No additional enhancing intraparenchymal lesion. The imaged ventricular system is normal in caliber and configuration. EXTRACRANIAL FINDINGS: The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Complete opacification of the imaged right maxillary sinus with enhancing mucosa, likely inflammatory changes. CONCLUSION: 1. Mild increased size of homogenously enhancing sellar/ suprasellar mass compared to prior MRI from March 2018, likely pituitary macroadenoma, with bilateral cavernous sinus invasion. Invasion into the sphenoid sinuses. Extension towards the right orbital apex could result in right optic nerve symptoms. 2. Complete opacification of the imaged right maxillary sinus with inflammatory 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: INTRACRANIAL FINDINGS: Interval increase in size of homogeneously enhancing sellar/suprasellar mass, now measuring 2.5 x 3.0 x 2.7 cm in AP by TV by CC (series 8, image 8; series 7, image 6), previously 1.8 x 2.3 x 1.9 cm (series 801, image 8; series 701, image 7). Bilateral cavernous sinus invasion with extension beyond the lateral margins of the cavernous ICAs, increased compared to prior. Bilateral cavernous ICA flow voids remains patent. The mass invades and obliterates the sphenoid sinuses. There is extension towards the right orbital apex. There is a unchanged small pineal cyst. No additional enhancing intraparenchymal lesion. The imaged ventricular system is normal in caliber and configuration. EXTRACRANIAL FINDINGS: The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Complete opacification of the imaged right maxillary sinus with enhancing mucosa, likely inflammatory changes.
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FINDINGS: STRUCTURED REPORT: CTA Aorta Runoff 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: Patent. RIGHT ILIAC ARTERIES: No significant abnormality. RIGHT FEMORAL \T\ POPLITEAL ARTERIES: No significant abnormality. RIGHT TIBIAL AND PERONEAL ARTERIES: No significant abnormality. RIGHT FOOT ARTERIES: No significant abnormality. LEFT ILIAC ARTERIES: No significant abnormality. LEFT FEMORAL \T\ POPLITEAL ARTERIES: No significant abnormality. LEFT TIBIAL AND PERONEAL ARTERIES: No significant abnormality. LEFT FOOT ARTERIES: No significant abnormality. ------------------------------------------------------------- LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Focal fat deposition about the falciform ligament. Otherwise Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: The stomach is normal. Small bowel is normal in caliber. Mild fecalization of the terminal ileum. COLON / APPENDIX: The appendix is normal. A few colonic diverticula. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Normal. MUSCULOSKELETAL: Acute ballistic injury to the right thigh with severely comminuted fracture of the mid MR diaphysis. One shaft width posterior dislocation of the distal fracture fragments with mild apex posterior angulation. No significant associated shortening. Innumerable tiny ballistic fragments and osseous fragments are noted scattered throughout this region limiting detection of small foci of active extravasation. Extensive surrounding soft tissue emphysema as well as contusion and a soft tissue defect overlying the anterior/medial aspect of the thigh. Small intramuscular hematoma is noted inferiorly tracking towards the knee. The knee joint is maintained and uninvolved. The distal right lower extremity is unremarkable. Bilateral os navicularis. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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EXAM: MR Brain wo+w contrast CLINICAL INFORMATION: Pituitary adenoma, examination for radiation treatment planning. COMPARISON: Multiple priors most recently dated 11/1/2022. TECHNIQUE: MR Brain wo+w contrast. Patient weight: 205 lbs. IV contrast: ProHance, 10 ml, per protocol. IV contrast injection rate: 0.50 ml per sec. FINDINGS: Postsurgical changes of prior transsphenoidal sellar mass resection. Previously noted left cavernous sinus lesion showing mild hypoenhancement is unchanged in size and appearance when compared to prior and now measures 1.2 x 0.9 cm on axial series 10 image 11 (previously 1.2 x 0.9 cm). There is persistent associated restricted diffusion with this lesion. It also continues to abut the medial aspect of the cavernous sinus as well as the supraclinoid ICA. No associated vascular narrowing or alteration of the expected vascular flow void. There is persistent mild rightward deviation of the pituitary stalk. The optic chiasm does not appear involved and is without significant mass effect from this lesion. No new lesion or other acute intracranial abnormality. Other nonpostsurgical bone marrow shows no abnormal signal. The orbits and globes are normal. Mucous retention cysts within the right maxillary sinus. The visualized soft tissues are unremarkable. Incidental DVA is present within left frontal lobe. Nonspecific white matter signal changes are present within the cerebral hemispheres. CONCLUSION: Redemonstrated and unchanged residual lesion in the sella on the left side and extending to the left cavernous sinus. No new intracranial abnormality. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: Postsurgical changes of prior transsphenoidal sellar mass resection. Previously noted left cavernous sinus lesion showing mild hypoenhancement is unchanged in size and appearance when compared to prior and now measures 1.2 x 0.9 cm on axial series 10 image 11 (previously 1.2 x 0.9 cm). There is persistent associated restricted diffusion with this lesion. It also continues to abut the medial aspect of the cavernous sinus as well as the supraclinoid ICA. No associated vascular narrowing or alteration of the expected vascular flow void. There is persistent mild rightward deviation of the pituitary stalk. The optic chiasm does not appear involved and is without significant mass effect from this lesion. No new lesion or other acute intracranial abnormality. Other nonpostsurgical bone marrow shows no abnormal signal. The orbits and globes are normal. Mucous retention cysts within the right maxillary sinus. The visualized soft tissues are unremarkable. Incidental DVA is present within left frontal lobe. Nonspecific white matter signal changes are present within the cerebral hemispheres.
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Findings: There is interval slight increase in size of extra-axial hemorrhages along both cerebral convexities with redistribution of hemorrhage along the tentorial leaflets, left parieto-occipital convexity and hemorrhage in the occipital horns of both lateral ventricles. Small subarachnoid hemorrhage in the suprasellar cistern, anterior interhemispheric fissure and right posterior sylvian fissure appear more prominent. There is also mild increase in size of the bilateral temporal lobe parenchymal hemorrhage with surrounding vasogenic edema. The visualized paranasal sinuses, mastoid air cells and middle ear cavities are clear. Both orbits appear normal.
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15,448 |
RADIOLOGIC EXAM: MR Brain wo+w contrast CLINICAL INFORMATION: Surveillance of brain lesion. Per chart review, admitted 12/29/2021 for acute left hemibody numbness and paresthesia, recently had breakthrough COVID infection in early December now requiring hospitalization but did receive monoclonal antibody therapy. Imaging at that time concerning for acute postviral demyelinating process (possibly in setting of breakthrough COVID) versus neoplastic versus vascular/ischemic. Started on antiepileptic therapy with resolution of symptoms. Initiated high-dose steroid therapy, to be continued as outpatient after discharge. COMPARISON: MRI brain dated 12/26/2021. CT head code stroke dated 12/26/2021. 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: 300 lbs. IV contrast: ProHance, 20 ml, per protocol. FINDINGS: INTRACRANIAL FINDINGS: No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, space-occupying lesion, or mass effect. Postcontrast series demonstrates no focal enhancing lesion. Normal cerebral volume. Persistent multifocal T2/FLAIR hyperintensities with areas of confluence in the left greater than right subcortical, deep cerebral, and periventricular white matter, centered primarily within the left temporal lobe and along the right postcentral gyrus. Also there is minimal enhancement in the deep white matter of the right parietal lobe (series 701 image 23). Findings are overall unchanged compared to prior, with no new or progressive signal abnormality. The mentioned mild enhancement of deep white matter of the right parietal lobe appears more conspicuous since prior study however this finding can be because of different technique. There is a small focus of patchy enhancement involving the chiasm which appears new finding since prior study. Partial empty sella. Prominent Meckel's caves. The ventricular system is normal in caliber and configuration. The basal cisterns are clear. The visualized proximal cerebrovascular flow voids appear normal. EXTRACRANIAL FINDINGS: The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Trace mucosal thickening of the bilateral anterior ethmoid air cells. The paranasal sinuses and mastoid air cells are otherwise clear. Both orbits are unremarkable. CONCLUSION: 1. Persistent multifocal T2/FLAIR hyperintensities with areas of confluence in the left greater than right cerebral white matter, centered primarily within the left temporal lobe and right postcentral gyrus, overall unchanged. Findings again could reflect postviral demyelinating process/ADEM.PML and low-grade brain tumor are felt to be less likely but cannot be excluded so continue follow-up imaging is recommended. 2. A new focus of small mild enhancement of the chiasm concerning for neuritis. Clinical correlation for visual accuracy is recommended. 3. Partial empty sella. Prominent Meckel's caves. Consider clinical correlation for idiopathic intracranial hypertension. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: INTRACRANIAL FINDINGS: No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, space-occupying lesion, or mass effect. Postcontrast series demonstrates no focal enhancing lesion. Normal cerebral volume. Persistent multifocal T2/FLAIR hyperintensities with areas of confluence in the left greater than right subcortical, deep cerebral, and periventricular white matter, centered primarily within the left temporal lobe and along the right postcentral gyrus. Also there is minimal enhancement in the deep white matter of the right parietal lobe (series 701 image 23). Findings are overall unchanged compared to prior, with no new or progressive signal abnormality. The mentioned mild enhancement of deep white matter of the right parietal lobe appears more conspicuous since prior study however this finding can be because of different technique. There is a small focus of patchy enhancement involving the chiasm which appears new finding since prior study. Partial empty sella. Prominent Meckel's caves. The ventricular system is normal in caliber and configuration. The basal cisterns are clear. The visualized proximal cerebrovascular flow voids appear normal. EXTRACRANIAL FINDINGS: The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Trace mucosal thickening of the bilateral anterior ethmoid air cells. The paranasal sinuses and mastoid air cells are otherwise clear. Both orbits are unremarkable.
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Findings: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Stable position of left double-J ureteral stent. No other abnormality. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Small bowel anastomosis are unchanged. No other significant abnormality. COLON / APPENDIX: Stable postsurgical changes in the descending colon. Normal appendix PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: IVC filter in stable position. Postsurgical changes status post saphenous vein graft from the left external iliac to common femoral artery left femoral vein DVT is no longer visualized. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Postsurgical changes from left rectus flap reconstruction in the left inguinal region with interval decrease in associated soft tissue swelling. MUSCULOSKELETAL: Stable posttraumatic changes to the left hemipelvis with retained ballistic fragment posterior to the left iliac bone. No acute osseous abnormality or focal aggressive osseous lesion.
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15,449 |
RADIOLOGIC EXAM: MR Brain wo+w contrast CLINICAL INFORMATION: Pituitary tumor, evaluate sella. Per chart review, history of pituitary adenoma initially diagnosed in 2016 during workup for galactorrhea, treated with Cabergoline therapy due to mild hyperprolactinemia, now discontinued for past 6 months. Prior imaging noted gradual increase in cystic component. COMPARISON: MRI brain dated 1/25/2021, 7/28/2020. TECHNIQUE: Multiple T1 and T2-weighted MR sequence images of the pituitary gland pre- and post administration of intravenous contrast per departmental pituitary protocol. Images include dynamic postcontrast coronal images through the sella. MR Brain wo+w contrast Patient weight: 150 lbs. IV contrast: ProHance, 14 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: No significant interval change in size or appearance of homogenously enhancing sellar/suprasellar mass, now measuring 1.4 x 1.5 x 1.1 cm in AP by TV by CC (series 701, image 8; series 601, image 8), previously 1.4 x 1.5 x 1.1 cm (series 8, image 9; series 7, image 8). Suspected minimal right cavernous sinus invasion with encroachment upon the right cavernous ICA, unchanged. Again seen mild leftward deviation of the pituitary stalk. The cavernous ICA flow voids are otherwise patent. Minimal effacement of the suprasellar cistern without optic chiasm compression. The mass closely approximates the right prechiasmatic optic nerve without definite contact. The imaged brain parenchyma and ventricular system are otherwise within normal limits. The imaged paranasal sinuses and mastoid air cells are clear. CONCLUSION: 1. Stable homogenously enhancing sellar/suprasellar mass, likely pituitary macroadenoma. Suspected minimal right cavernous sinus invasion and encroachment upon the right cavernous ICA without 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: No significant interval change in size or appearance of homogenously enhancing sellar/suprasellar mass, now measuring 1.4 x 1.5 x 1.1 cm in AP by TV by CC (series 701, image 8; series 601, image 8), previously 1.4 x 1.5 x 1.1 cm (series 8, image 9; series 7, image 8). Suspected minimal right cavernous sinus invasion with encroachment upon the right cavernous ICA, unchanged. Again seen mild leftward deviation of the pituitary stalk. The cavernous ICA flow voids are otherwise patent. Minimal effacement of the suprasellar cistern without optic chiasm compression. The mass closely approximates the right prechiasmatic optic nerve without definite contact. The imaged brain parenchyma and ventricular system are otherwise within normal limits. The imaged paranasal sinuses and mastoid air cells are clear.
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Findings: Head CT: There is no acute hemorrhage or brain edema. There is no evidence of acute infarction intracranial mass or hydrocephalus There is no acute calvarial fracture. Maxillofacial CT: There are no acute maxillofacial or mandibular fractures or traumatic TMJ dislocation . There is no evidence of orbital soft tissue injury. The paranasal sinuses, middle ears, mastoid antra, and mastoid air cells are clear. There is a complex fracture of the C2 vertebral body extending into the lateral masses. See dedicated CT of the cervical spine for additional findings.
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15,450 |
MR Brain Partial Study HISTORY: Evaluation for GBM. The patient was confused and unable to hold still. MRI was canceled and no imaging was performed.
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MR Brain Partial Study HISTORY: Evaluation for GBM. The patient was confused and unable to hold still. MRI was canceled and no imaging was performed.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Mild basilar predominant dependent atelectasis. There is also associated mild septal thickening and subpleural cystic change, bilaterally. No pleural effusion, pneumothorax, or focal consolidation. HEART / VESSELS: Heart is enlarged. Coronary artery and valve calcifications. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: Postsurgical change of left axillary lymph node dissection. CHEST WALL: Dystrophic calcification in the left subareolar breast with some surrounding architectural distortion ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Interdigitated fat within the pancreatic head. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Left simple renal cysts. Contrast is noted in the bilateral collecting systems. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is not visualized. Extensive sigmoid diverticulosis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Distended with contrast. REPRODUCTIVE ORGANS: The uterus is present. No adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Anterior fourth and fifth rib fractures as well as the left anterior fifth rib. Advanced degenerative change of both hips, SI joints, and pubic symphysis. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. Moderate discogenic degenerative change. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. Laminectomy changes at L4 and L5. ALIGNMENT: Grade 1 anterolisthesis of L3 on L4 and L4 on L5. DISC SPACES AND FACET JOINTS: No acute injury. Severely advanced discogenic degenerative change of lower lumbar spine and advanced facet arthropathy. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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15,451 |
MR Angio Head wo+w contrast Clinical Information: 69-year-old male. Surveillance of dAVF after embolization Comparison: MR 12/16/2020 and MR 9/17/2014 Technique: MR angiogram of head with and without contrast was obtained. 3-D analysis was performed with multiple MIPs and 3-D rendered reconstructions. Patient weight: 220 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: Intracranial internal carotid arteries: Normal. Anterior cerebral arteries: Anatomic variant with hypoplasia of the right A2 segment. The left A2 segment is the dominant artery for the bilateral ACA territories. Middle cerebral arteries: Normal. Posterior cerebral arteries: Normal. Intracranial vertebral arteries: Normal. Basilar artery: Normal. Patient is status-post embolization in the left posterior fossa without evidence of residual abnormal vascular enhancement. No large aneurysm or vascular malformation identified. Stable ventricular configuration and caliber. Postsurgical occipital craniotomy changes. CONCLUSION: 1. Post-embolization appearance in the left posterior fossa without evidence of residual abnormal vascular enhancement. 2. No new angiographic 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: Intracranial internal carotid arteries: Normal. Anterior cerebral arteries: Anatomic variant with hypoplasia of the right A2 segment. The left A2 segment is the dominant artery for the bilateral ACA territories. Middle cerebral arteries: Normal. Posterior cerebral arteries: Normal. Intracranial vertebral arteries: Normal. Basilar artery: Normal. Patient is status-post embolization in the left posterior fossa without evidence of residual abnormal vascular enhancement. No large aneurysm or vascular malformation identified. Stable ventricular configuration and caliber. Postsurgical occipital craniotomy changes.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Mild basilar predominant dependent atelectasis. There is also associated mild septal thickening and subpleural cystic change, bilaterally. No pleural effusion, pneumothorax, or focal consolidation. HEART / VESSELS: Heart is enlarged. Coronary artery and valve calcifications. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: Postsurgical change of left axillary lymph node dissection. CHEST WALL: Dystrophic calcification in the left subareolar breast with some surrounding architectural distortion ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Interdigitated fat within the pancreatic head. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Left simple renal cysts. Contrast is noted in the bilateral collecting systems. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is not visualized. Extensive sigmoid diverticulosis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Distended with contrast. REPRODUCTIVE ORGANS: The uterus is present. No adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Anterior fourth and fifth rib fractures as well as the left anterior fifth rib. Advanced degenerative change of both hips, SI joints, and pubic symphysis. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. Moderate discogenic degenerative change. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. Laminectomy changes at L4 and L5. ALIGNMENT: Grade 1 anterolisthesis of L3 on L4 and L4 on L5. DISC SPACES AND FACET JOINTS: No acute injury. Severely advanced discogenic degenerative change of lower lumbar spine and advanced facet arthropathy. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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15,452 |
EXAM: MR Bone Pelvis wo+w contrast CLINICAL INFORMATION: Right groin/upper thigh mass COMPARISON: MR, dated 2/17/2021 TECHNIQUE: MR Bone Pelvis wo+w contrast Patient weight: 195 lbs. IV contrast: ProHance, 19 ml, per protocol. IV contrast injection rate: 0.50 ml per sec. FINDINGS: Lobulated right inguinal mass consists of fast 4.7 x 10.6 cm. The mass is within iliopsoas muscle, with lobulations insinuating between lateral circumflex and profunda femoris arteries. These are encased by the fatty mass. The superficial femoral artery surrounded by fat along the short fragment series 7 images 29 and 30). The iliopsoas tendon is nearly surrounded by the mass at the lesser trochanter and then displaced by the mass more proximally. The mass contacts the lesser trochanter at the iliopsoas origin. The mass displaces femoral artery and femoral vein more proximally. The mass extends anteriorly and displaces sartorius and rectus femoris muscles. Adductor compartment is medial to the mass. There are several enlarged enhancing lymph nodes, largest measuring 15 mm in short axis, but does not demonstrate normal fatty hilum. There are no soft tissue signal intensity within the mass to suggest a high-grade component.There are no enlarged iliac nodes. Area of focal enhancement is seen in the anterior acetabulum, with corresponding low signal on T1-weighted images. This shows increased sclerosis on recent CT. Imaged tendons are intact. The sciatic nerves are surrounded by normal fat along their visualized course. There is no free fluid in the pelvis. IMPRESSION: 1. Lobulated fatty mass, encasing and displacing femoral vessels, without aggressive component. Several slightly enlarged asymmetric right inguinal lymph nodes. 2. Enhancing area of sclerosis in the anterior acetabulum with slight corresponding sclerosis. There are no more remote studies for comparison, possibility of metastasis should be entertained,
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FINDINGS: Lobulated right inguinal mass consists of fast 4.7 x 10.6 cm. The mass is within iliopsoas muscle, with lobulations insinuating between lateral circumflex and profunda femoris arteries. These are encased by the fatty mass. The superficial femoral artery surrounded by fat along the short fragment series 7 images 29 and 30). The iliopsoas tendon is nearly surrounded by the mass at the lesser trochanter and then displaced by the mass more proximally. The mass contacts the lesser trochanter at the iliopsoas origin. The mass displaces femoral artery and femoral vein more proximally. The mass extends anteriorly and displaces sartorius and rectus femoris muscles. Adductor compartment is medial to the mass. There are several enlarged enhancing lymph nodes, largest measuring 15 mm in short axis, but does not demonstrate normal fatty hilum. There are no soft tissue signal intensity within the mass to suggest a high-grade component.There are no enlarged iliac nodes. Area of focal enhancement is seen in the anterior acetabulum, with corresponding low signal on T1-weighted images. This shows increased sclerosis on recent CT. Imaged tendons are intact. The sciatic nerves are surrounded by normal fat along their visualized course. There is no free fluid in the pelvis.
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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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15,453 |
EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: Colon cancer, evaluate for metastases. COMPARISON: CT abdomen pelvis dated 1/14/2022 TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 180 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: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: Postsurgical changes from midline sternotomy. ABDOMEN: LIVER: The previously described hypoattenuating lesion in the posterior periphery of segment VI is not well seen or confirmed as a cyst on MRI, possibly due to limitations in spatial resolution on T2-weighted imaging. A small nonenhancing subcentimeter abnormality appearing smaller than on the CT is noted in the same location on the postcontrast T1-weighted fat-suppressed images, including hepatobiliary phase (image 57 series 31, as well as DWI (image 32 series 26). BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. PANCREAS: Normal. SPLEEN: Enlarged. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Small gastric hiatal hernia. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Atherosclerosis centimeter focal narrowing of the SMA at the origin.. BODY WALL: Fat-containing midline ventral abdominal wall hernia. Additional hernia in the right lower quadrant seen only on the coronal may contain colon, incompletely evaluated. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Subcentimeter hypoattenuating CT abnormality is again seen but difficult to fully characterize with hepatobiliary MR due to its very small size. Recommendation is for interval surveillance using CT to assess potential growth. 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: Postsurgical changes from midline sternotomy. ABDOMEN: LIVER: The previously described hypoattenuating lesion in the posterior periphery of segment VI is not well seen or confirmed as a cyst on MRI, possibly due to limitations in spatial resolution on T2-weighted imaging. A small nonenhancing subcentimeter abnormality appearing smaller than on the CT is noted in the same location on the postcontrast T1-weighted fat-suppressed images, including hepatobiliary phase (image 57 series 31, as well as DWI (image 32 series 26). BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. PANCREAS: Normal. SPLEEN: Enlarged. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Small gastric hiatal hernia. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Atherosclerosis centimeter focal narrowing of the SMA at the origin.. BODY WALL: Fat-containing midline ventral abdominal wall hernia. Additional hernia in the right lower quadrant seen only on the coronal may contain colon, incompletely evaluated. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Mild basilar predominant dependent atelectasis. There is also associated mild septal thickening and subpleural cystic change, bilaterally. No pleural effusion, pneumothorax, or focal consolidation. HEART / VESSELS: Heart is enlarged. Coronary artery and valve calcifications. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: Postsurgical change of left axillary lymph node dissection. CHEST WALL: Dystrophic calcification in the left subareolar breast with some surrounding architectural distortion ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Interdigitated fat within the pancreatic head. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Left simple renal cysts. Contrast is noted in the bilateral collecting systems. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is not visualized. Extensive sigmoid diverticulosis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Distended with contrast. REPRODUCTIVE ORGANS: The uterus is present. No adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Anterior fourth and fifth rib fractures as well as the left anterior fifth rib. Advanced degenerative change of both hips, SI joints, and pubic symphysis. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. Moderate discogenic degenerative change. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. Laminectomy changes at L4 and L5. ALIGNMENT: Grade 1 anterolisthesis of L3 on L4 and L4 on L5. DISC SPACES AND FACET JOINTS: No acute injury. Severely advanced discogenic degenerative change of lower lumbar spine and advanced facet arthropathy. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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15,454 |
MRI brain without contrast Clinical Information:Female aged 50 years with headache. Comparison: None available. Technique: Multiplanar, multisequence images of the brain were obtained in the sagittal, axial and coronal planes without the use of intravenous contrast per departmental protocol. Findings: No acute infarct or intracranial hemorrhage. No midline shift, hydrocephalus, mass effect, or other space-occupying lesion. No significant abnormality of the extracranial osseous and soft tissue structures. Mild to moderate mucosal thickening in the ethmoid sinuses, with a small right mucous retention cyst in the right maxillary sinus. Mild additional pansinus mucosal thickening. Conclusion: No acute intracranial process or mass effect by noncontrast evaluation. Mild to moderate mucosal thickening in the ethmoid sinuses, with a small right mucous retention cyst in the right maxillary sinus. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: No acute infarct or intracranial hemorrhage. No midline shift, hydrocephalus, mass effect, or other space-occupying lesion. No significant abnormality of the extracranial osseous and soft tissue structures. Mild to moderate mucosal thickening in the ethmoid sinuses, with a small right mucous retention cyst in the right maxillary sinus. Mild additional pansinus mucosal thickening.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Mild basilar predominant dependent atelectasis. There is also associated mild septal thickening and subpleural cystic change, bilaterally. No pleural effusion, pneumothorax, or focal consolidation. HEART / VESSELS: Heart is enlarged. Coronary artery and valve calcifications. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: Postsurgical change of left axillary lymph node dissection. CHEST WALL: Dystrophic calcification in the left subareolar breast with some surrounding architectural distortion ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Interdigitated fat within the pancreatic head. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Left simple renal cysts. Contrast is noted in the bilateral collecting systems. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is not visualized. Extensive sigmoid diverticulosis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Distended with contrast. REPRODUCTIVE ORGANS: The uterus is present. No adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Anterior fourth and fifth rib fractures as well as the left anterior fifth rib. Advanced degenerative change of both hips, SI joints, and pubic symphysis. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. Moderate discogenic degenerative change. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. Laminectomy changes at L4 and L5. ALIGNMENT: Grade 1 anterolisthesis of L3 on L4 and L4 on L5. DISC SPACES AND FACET JOINTS: No acute injury. Severely advanced discogenic degenerative change of lower lumbar spine and advanced facet arthropathy. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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15,455 |
RADIOLOGIC EXAM: MR Brain wo+w contrast CLINICAL INFORMATION: Neoplasm, cerebellopontine angle (CPA) or brainstem. Per chart review, history of left sensorineural hearing loss, nonpulsatile tinnitus, and worsening ocular migraines/vertigo. Imaging notable for left IAC lesion suspicious for vestibular schwannoma. COMPARISON: None available. TECHNIQUE: Multiple T1 and T2-weighted MR sequence images of the brain and IACs were obtained in the sagittal axial and coronal planes pre- and post administration of intravenous contrast per departmental protocol. Images include dedicated high resolution T2-weighted and postcontrast images through the internal auditory structures. MR Brain wo+w contrast Patient weight: 193 lbs. IV contrast: ProHance, 19 ml, per protocol. FINDINGS: INTRACRANIAL FINDINGS: Nonexpansile enhancing lesion in the left internal auditory canal, measuring 5 x 8 x 4 mm in AP by TV by CC (series 901, image 9; series 801, image 11). The lesion appears indistinguishable from the left vestibulocochlear nerve. The inner ear structures are otherwise normal-appearing. No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, space-occupying lesion, or mass effect. The ventricular system is normal in caliber and configuration. The basal cisterns are clear. The visualized proximal cerebrovascular flow voids appear normal. EXTRACRANIAL FINDINGS: The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Mild left maxillary sinus and trace bilateral anterior ethmoid sinus mucosal thickening. The paranasal sinuses and mastoid air cells are otherwise clear. Both orbits are unremarkable. CONCLUSION: 1. Small nonexpansile, enhancing left IAC lesion indistinguishable from the vestibulocochlear nerve, likely a schwannoma. 2. Mild left maxillary sinus inflammatory mucosal thickening. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: INTRACRANIAL FINDINGS: Nonexpansile enhancing lesion in the left internal auditory canal, measuring 5 x 8 x 4 mm in AP by TV by CC (series 901, image 9; series 801, image 11). The lesion appears indistinguishable from the left vestibulocochlear nerve. The inner ear structures are otherwise normal-appearing. No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, space-occupying lesion, or mass effect. The ventricular system is normal in caliber and configuration. The basal cisterns are clear. The visualized proximal cerebrovascular flow voids appear normal. EXTRACRANIAL FINDINGS: The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Mild left maxillary sinus and trace bilateral anterior ethmoid sinus mucosal thickening. The paranasal sinuses and mastoid air cells are otherwise clear. Both orbits are unremarkable.
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Findings: Head CT: There is no acute hemorrhage or brain edema. There is no evidence of acute infarction intracranial mass or hydrocephalus There is no acute calvarial fracture. Maxillofacial CT: There are no acute maxillofacial or mandibular fractures or traumatic TMJ dislocation . There is no evidence of orbital soft tissue injury. The paranasal sinuses, middle ears, mastoid antra, and mastoid air cells are clear. There is a complex fracture of the C2 vertebral body extending into the lateral masses. See dedicated CT of the cervical spine for additional findings.
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Clinical history:Follow-up pituitary tumor Comparison:MRI 10/5/2021, 6/15/2021 Technique: Multiplanar multisequence MRI images of the pituitary and brain were obtained before and after intravenous contrast administration. Images include dynamic postcontrast coronal images through the pituitary gland. Patient weight: 250 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 2 ml per sec. Findings: There has been no significant change in 13.4 x 13.5 mm hypoenhancing lesion in the left pituitary gland. The lesion continues to abut the left cavernous sinus, without invasion. The stalk is mildly deviated to the right, unchanged. There is preservation of the flow void in the bilateral cavernous ICAs. No mass effect on the optic chiasm. There is no new intracranial findings in the visualized brain. Impression: Unchanged 1.3 cm hyperenhancing pituitary lesion, likely a pituitary macroadenoma.
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Findings: There has been no significant change in 13.4 x 13.5 mm hypoenhancing lesion in the left pituitary gland. The lesion continues to abut the left cavernous sinus, without invasion. The stalk is mildly deviated to the right, unchanged. There is preservation of the flow void in the bilateral cavernous ICAs. No mass effect on the optic chiasm. There is no new intracranial findings in the visualized brain.
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FINDINGS: AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. There is mild to moderate atherosclerosis in the cavernous and supraclinoid ICA. LEFT CAROTID: There is advanced atherosclerotic disease at the carotid bifurcation extending into the proximal ICA with approximately 50% luminal narrowing. There is mild to moderate atherosclerosis in the cavernous and supraclinoid ICA. There is no evidence of irregularity, occlusion or flap to indicate acute arterial injury or dissection. RIGHT VERTEBRAL ARTERY: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. LEFT VERTEBRAL ARTERY: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. No contrast extravasation or pseudoaneurysm is identified. There is soft tissue swelling in the left lateral neck. See separately reported CT of the cervical spine.
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EXAM: MR Prostate wo contrast CLINICAL INFORMATION: Prostate cancer, treatment planning COMPARISON: MRI of the prostate dated 4/9/2021 TECHNIQUE: MR Prostate wo contrast FINDINGS: STRUCTURED REPORT: Prostate MRI Spacer PROSTATE VOLUME: 3.9 cm x 4.0 cm x 4.1 cm (volume 33 cc) SpaceOAR: There has been interval placement of a SpaceOAR hydrogel spacer located between the anterior wall of the rectum and posterior aspect of the prostate gland. Maximum AP measurements of the spacer with respect to the prostate gland are as follows: -- Base: 9 mm (series 2, image 16). -- Mid gland: 9 mm (series 2, image 12). -- Apex. 6 mm (series 2, image nine). LOWER ABDOMEN: BOWEL: No abnormality. PERITONEUM: Normal. OTHER: No other abnormality. PELVIS: VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Hydrogel spacer in the prostate and rectum with measurements as listed. 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: Prostate MRI Spacer PROSTATE VOLUME: 3.9 cm x 4.0 cm x 4.1 cm (volume 33 cc) SpaceOAR: There has been interval placement of a SpaceOAR hydrogel spacer located between the anterior wall of the rectum and posterior aspect of the prostate gland. Maximum AP measurements of the spacer with respect to the prostate gland are as follows: -- Base: 9 mm (series 2, image 16). -- Mid gland: 9 mm (series 2, image 12). -- Apex. 6 mm (series 2, image nine). LOWER ABDOMEN: BOWEL: No abnormality. PERITONEUM: Normal. OTHER: No other abnormality. PELVIS: VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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Findings: There is a hyperdense right MCA with small calcific density the proximal MCA origin. There is loss of gray-white differentiation in the right insular cortex and right frontal operculum. There is no hemorrhage or significant brain edema. There is no intracranial mass or hydrocephalus. There is a small pineal lesion presumed pineal cyst. There is no acute osseous abnormality. Mild mucosal thickening in the right maxillary sinus with small mucus retention cyst. The remaining paranasal sinuses and mastoid air cells are clear.
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MR Brain wo+w contrast 1/25/2022 10:04 AM Clinical Information: Pituitary tumor and meningioma, D35.2 Benign neoplasm of pituitary gland, D32.9 Benign neoplasm of meninges, unspecified Spec Inst: Pituitary tumor AND Meningioma - Evaluate Brain AND sella Comparison: Technique: Diffusion weighted series, T1 sagittal and axial spin echo, T2 axial fast spin echo, axial FLAIR, coronal T2* gradient echo, post contrast axial and coronal T1. Patient weight: 219 lbs. IV contrast: ProHance, 10 ml, per protocol. IV contrast injection rate: 1 ml per sec. Findings: Comparison to MRI from 12/15/2020. There is a well-defined mass in the sella on the right side which encases the cavernous segment of the right internal carotid artery with no compression. There is extension of the mass to the cavernous sinus. There is T1 bright signal within the midline sella No abnormal enhancement within the brain parenchyma. The residual pituitary mass predominantly in the right posterior lateral aspect and measures approximately 2.7 cm in transverse and 2.7 cm in oblique AP dimension with reactive dural thickening of the tentorium. There is also extension of the mass superiorly into the suprasellar cistern on the right side abutting the uncus of the temporal lobe but with no mass effect. The tumor is in close contact and lateral to the right posterior communicating artery. The optic chiasm is unremarkable with no compression. The pituitary stalk is slightly deviated to the left side. There is definite cavernous sinus invasion with tumor lateral to the lateral intercarotid line. Impression: Stable appearing residual tumor in the sella on the right side with extension into the cavernous sinus and medial to the uncus of the right temporal lobe. There is stable extension along the right tentorium.
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Findings: Comparison to MRI from 12/15/2020. There is a well-defined mass in the sella on the right side which encases the cavernous segment of the right internal carotid artery with no compression. There is extension of the mass to the cavernous sinus. There is T1 bright signal within the midline sella No abnormal enhancement within the brain parenchyma. The residual pituitary mass predominantly in the right posterior lateral aspect and measures approximately 2.7 cm in transverse and 2.7 cm in oblique AP dimension with reactive dural thickening of the tentorium. There is also extension of the mass superiorly into the suprasellar cistern on the right side abutting the uncus of the temporal lobe but with no mass effect. The tumor is in close contact and lateral to the right posterior communicating artery. The optic chiasm is unremarkable with no compression. The pituitary stalk is slightly deviated to the left side. There is definite cavernous sinus invasion with tumor lateral to the lateral intercarotid line.
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FINDINGS: 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: Focal occlusion of a right M2 inferior segment branch (image 283, series #407, image 75 of series 408). VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. RIGHT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. SOFT TISSUES: Bilateral small hypoattenuating thyroid nodules, the largest which is in the left thyroid lobe measuring up to 1.2 cm. Biapical centrilobular emphysematous change. CERVICAL SPINE: Anterior spinal fusion hardware from C5 to C6. Normal cervical spine alignment. Mild multilevel discogenic degenerative change of the cervical spine. No aggressive osseous lesions.
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MR Angio Head wo+w contrast Clinical Information: 59-year-old female with left PCA aneurysm status post embolization. Comparison: MRI 1/26/2021, cerebral angiogram 7/27/2020, CTA 7/7/2020. Technique: MR angiogram of head with and without contrast was obtained with multiple MIPs and 3-D rendered reconstructions. Patient weight: 201 lbs. IV contrast: ProHance, 19 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: Intracranial internal carotid arteries: No flow related signal within the visualized ICA portions with reconstitution of the carotid termini from the posterior communicating arteries, similar to prior. Anterior cerebral arteries: Normal. Middle cerebral arteries: Normal. Posterior cerebral arteries: Status-post coiling of left P1 segment aneurysm. No evidence of residual filling or recurrent aneurysm. Distal segments are normally enhancing. Intracranial vertebral arteries: Normal. Basilar artery: Normal. Stable ventricular caliber and configuration. CONCLUSION: 1. Status-post coiling of the left P1 segment aneurysm without evidence of residual filling or recurrent aneurysm. 2. Again vertebrobasilar dominant supply of the cerebral circulation with no flow related signal the visualized ICAs. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: Intracranial internal carotid arteries: No flow related signal within the visualized ICA portions with reconstitution of the carotid termini from the posterior communicating arteries, similar to prior. Anterior cerebral arteries: Normal. Middle cerebral arteries: Normal. Posterior cerebral arteries: Status-post coiling of left P1 segment aneurysm. No evidence of residual filling or recurrent aneurysm. Distal segments are normally enhancing. Intracranial vertebral arteries: Normal. Basilar artery: Normal. Stable ventricular caliber and configuration.
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FINDINGS: 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: Focal occlusion of a right M2 inferior segment branch (image 283, series #407, image 75 of series 408). VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. RIGHT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. SOFT TISSUES: Bilateral small hypoattenuating thyroid nodules, the largest which is in the left thyroid lobe measuring up to 1.2 cm. Biapical centrilobular emphysematous change. CERVICAL SPINE: Anterior spinal fusion hardware from C5 to C6. Normal cervical spine alignment. Mild multilevel discogenic degenerative change of the cervical spine. No aggressive osseous lesions.
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EXAM: CV MR Cardiac w contrast PATIENT DATA Date of Study: 1/26/2022 8:39 AM Referring MD: Nicholas Schroerlucke Height: 182 cm. Patient weight: 105 kg. BSA: 2.30398 Heart Rate: 59 bpm BP:124/81. EGFR 40. The patient's creatinine was 1.7 on 01/26/22. The patient received 20 cc's of gadavist at a rate of 2 ml per second without immediate complication. CLINICAL INFORMATION: Patient studied for evaluation of: Ventricular Tachycardia History: 67 year old man with history of AF currently admitted for VT, CMR requested for evaluation. COMPARISON: No prior CMR TECHNIQUE: CV MR Cardiac w contrast FINDINGS: IMAGING DATA Imaging System: GE 1.5T Overall Image Quality: Excellent CARDIAC MORPHOLOGY AND VENTRICULAR FUNCTION Views: Axial Two chamber Four chamber Short axis LV LVOT Ascending aorta Sequences: FSE 2IR FSE 3IR SSFP FGRE ET perfusion Additional views: delayed contrast enhancement General: Inpatient ECG gated: yes MEASUREMENTS: in millimeters Left Atrium: 41 LV End Diastolic Dimension: 57 LV End Systolic Dimension: 49 LV Posterior Wall: 6 Right Atrium 45 RV End Diastolic Dimension: 51 Interventricular Septum: 12 Left Ventricle (short axis): Volumes in mL, index in mL per square meter End Diastolic Volume: 192 ED index: 85 End Systolic Volume: 86 ES index: 38 Stroke Volume: 106 SV index: 47 Ejection Fraction: 55.2% Morphology: The patient is imaged in multiple planes through the chest using ECG gated spin echo and cine gradient echo technique and postcontrast imaging. The left ventricle is normal in size and overall systolic function. There is mild hypokinesis of the mid inferolateral wall. There is no increased T2 signal to suggest edema. Triple IR images to suppress signal of fat appear normal. The resting first pass gadolinium enhancement is normal. There is a small area of subendocardial and mid myocardial late gadolinium enhancement in the basal and mid anterolateral wall in the distribution of the left circumflex coronary artery. Right Ventricle (short axis): Volumes in mL, index in mL per square meter End Diastolic Volume: 195 ED index: 86 End Systolic Volume: 96 ES index: 43 Stroke Volume: 99 SV index: 44 Ejection Fraction: 50.8% Morphology: The right ventricle has a normal volume and normal wall motion with preserved systolic function. Pericardium: Normal without effusion. Minimal normal pericardial and epicardial fat. Pleural: No pleural effusion noted VALVULAR MORPHOLOGY No significant valvular stenosis or regurgitation noted. Vascular: Visualized portions of the thoracic aorta and pulmonary arterial system are normal. Vessel dimensions: (In mm normal range dimensions mm) Main Pulmonary Artery 28 Aortic Root 35 Aortic Arch 27 [18-37] Right Pulmonary Artery 21 Ascending Aorta 35 [19-37] Left Pulmonary Artery 17 Inferior Vena Cava 10 Descending Aorta 30 [16-29] INCIDENTAL FINDINGS: None CONCLUSION: 1. There is normal left and right ventricular size and systolic function 2. There is small area of subendocardial late gadolinium enhancement in the basal and mid anterolateral wall. This area appears viable based on lack of transmural extent of the late gadolinium. 3. Normal valvular function. Cardiac MRI Technologist: Billy Fisher As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: IMAGING DATA Imaging System: GE 1.5T Overall Image Quality: Excellent CARDIAC MORPHOLOGY AND VENTRICULAR FUNCTION Views: Axial Two chamber Four chamber Short axis LV LVOT Ascending aorta Sequences: FSE 2IR FSE 3IR SSFP FGRE ET perfusion Additional views: delayed contrast enhancement General: Inpatient ECG gated: yes MEASUREMENTS: in millimeters Left Atrium: 41 LV End Diastolic Dimension: 57 LV End Systolic Dimension: 49 LV Posterior Wall: 6 Right Atrium 45 RV End Diastolic Dimension: 51 Interventricular Septum: 12 Left Ventricle (short axis): Volumes in mL, index in mL per square meter End Diastolic Volume: 192 ED index: 85 End Systolic Volume: 86 ES index: 38 Stroke Volume: 106 SV index: 47 Ejection Fraction: 55.2% Morphology: The patient is imaged in multiple planes through the chest using ECG gated spin echo and cine gradient echo technique and postcontrast imaging. The left ventricle is normal in size and overall systolic function. There is mild hypokinesis of the mid inferolateral wall. There is no increased T2 signal to suggest edema. Triple IR images to suppress signal of fat appear normal. The resting first pass gadolinium enhancement is normal. There is a small area of subendocardial and mid myocardial late gadolinium enhancement in the basal and mid anterolateral wall in the distribution of the left circumflex coronary artery. Right Ventricle (short axis): Volumes in mL, index in mL per square meter End Diastolic Volume: 195 ED index: 86 End Systolic Volume: 96 ES index: 43 Stroke Volume: 99 SV index: 44 Ejection Fraction: 50.8% Morphology: The right ventricle has a normal volume and normal wall motion with preserved systolic function. Pericardium: Normal without effusion. Minimal normal pericardial and epicardial fat. Pleural: No pleural effusion noted VALVULAR MORPHOLOGY No significant valvular stenosis or regurgitation noted. Vascular: Visualized portions of the thoracic aorta and pulmonary arterial system are normal. Vessel dimensions: (In mm normal range dimensions mm) Main Pulmonary Artery 28 Aortic Root 35 Aortic Arch 27 [18-37] Right Pulmonary Artery 21 Ascending Aorta 35 [19-37] Left Pulmonary Artery 17 Inferior Vena Cava 10 Descending Aorta 30 [16-29] INCIDENTAL FINDINGS: None
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Findings: Color parametric maps demonstrate elevated time to peak in the right temporal and parietal lobes, volume of 42 mL greater than six seconds. No reduced cerebral blood flow.
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EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: Follow-up hepatic adenoma surveillance COMPARISON: MRI of abdomen dated 5/26/2021 TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 190 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: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Postsurgical changes from interval right hepatectomy and resection of large right hepatic adenoma. Two T2 intermediate signal lesions are again seen in the left hepatic lobe (series 501, image 44 and 37). These lesions are T1 hyperintense on precontrast weighted sequences, display arterial hyperenhancement, and exhibit contrast nonretention on hepatobiliary phase imaging. They are similar in size since the prior MRI, measuring up to 2.2 cm (series 501, image 45). There is a small T2 hyperintense lesion at the resection margin at the hepatic dome, likely representing a resolving postoperative collection/hematoma (series 501, image 45). There is loss of signal of the liver parenchyma on opposed phase, suggestive of steatosis. BILIARY TRACT: Normal. GALLBLADDER: Absent. 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: Postsurgical changes of the anterior abdominal wall. Skin lesions are again seen along the left para midline anterior abdominal wall, possibly representing sebaceous cyst. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Postsurgical changes of interval cholecystectomy and right hepatectomy. Redemonstration of additional smaller adenomas in the left hepatic lobe, grossly stable in size since prior exam. 2. Hepatic steatosis. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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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: Postsurgical changes from interval right hepatectomy and resection of large right hepatic adenoma. Two T2 intermediate signal lesions are again seen in the left hepatic lobe (series 501, image 44 and 37). These lesions are T1 hyperintense on precontrast weighted sequences, display arterial hyperenhancement, and exhibit contrast nonretention on hepatobiliary phase imaging. They are similar in size since the prior MRI, measuring up to 2.2 cm (series 501, image 45). There is a small T2 hyperintense lesion at the resection margin at the hepatic dome, likely representing a resolving postoperative collection/hematoma (series 501, image 45). There is loss of signal of the liver parenchyma on opposed phase, suggestive of steatosis. BILIARY TRACT: Normal. GALLBLADDER: Absent. 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: Postsurgical changes of the anterior abdominal wall. Skin lesions are again seen along the left para midline anterior abdominal wall, possibly representing sebaceous cyst. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: STRUCTURED REPORT: CTA CAP VASCULATURE: CORONARY ARTERIES: There are mild atherosclerotic calcifications of the native coronary arteries. PULMONARY ARTERIES: No central pulmonary embolus. Normal size. ASCENDING THORACIC AORTA: No significant abnormality. AORTIC ARCH: No significant abnormality. ARCH VESSELS: No significant abnormality. DESCENDING THORACIC AORTA: No significant abnormality. ABDOMINAL AORTA: No significant abnormality. CELIAC AXIS: No significant abnormality. SMA: No significant abnormality. RIGHT RENAL: No significant abnormality. LEFT RENAL: No significant abnormality. IMA: No significant abnormality. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. ------------------------------------------------------------- LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: No focal consolidation, pleural effusion, or pneumothorax. Mild dependent atelectasis. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hemangioma is noted at the posterior aspect of the right hepatic lobe. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is not identified. Scattered diverticulosis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is present. Right adnexal simple cyst measures 4.8 x 3.1 cm on axial series 501 image 249. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Mild multilevel discogenic degenerative change.
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EXAM: MR Lumbar Spine wo contrast CLINICAL INFORMATION: Progressive neurologic deficit and low back pain. COMPARISON: Lumbar spine radiograph dated 10/18/2019. TECHNIQUE: MR Lumbar Spine wo contrast. FINDINGS: Interval anterior fixation and intervertebral disc spacers spanning L5-S1. No acute displaced fracture or compression deformity. No abnormal bone marrow signal. No spondylolisthesis. Disc heights are maintained. The conus terminates at L1. T12-L1: No significant disc bulge, spinal canal narrowing, or foraminal narrowing. L1-L2: No significant disc bulge, spinal canal, or foraminal narrowing. L2-L3: No significant disc bulge, spinal canal, or foraminal narrowing. L3-L4: No significant disc bulge, spinal canal, or foraminal narrowing. L4-L5: Mild broad-based disc bulge most pronounced in the subarticular and foraminal regions without nerve root compression. Mild spinal canal narrowing without cauda equina compression. There is associated ligamentum flavum hypertrophy . L5-S1: Posterior disc herniation with mild spinal canal narrowing. No significant foraminal narrowing or nerve root compression. The transiting S1 nerve roots are unimpeded in their course. No abnormal cord or cauda equina signal. The visualized soft tissues and paraspinal musculature are unremarkable. CONCLUSION: Mild multilevel discogenic degenerative change with degenerative changes at L4-L5 and L5-S1. Anterior fusion at L5-S1 with no adequate osseous fusion as of now. 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: Interval anterior fixation and intervertebral disc spacers spanning L5-S1. No acute displaced fracture or compression deformity. No abnormal bone marrow signal. No spondylolisthesis. Disc heights are maintained. The conus terminates at L1. T12-L1: No significant disc bulge, spinal canal narrowing, or foraminal narrowing. L1-L2: No significant disc bulge, spinal canal, or foraminal narrowing. L2-L3: No significant disc bulge, spinal canal, or foraminal narrowing. L3-L4: No significant disc bulge, spinal canal, or foraminal narrowing. L4-L5: Mild broad-based disc bulge most pronounced in the subarticular and foraminal regions without nerve root compression. Mild spinal canal narrowing without cauda equina compression. There is associated ligamentum flavum hypertrophy . L5-S1: Posterior disc herniation with mild spinal canal narrowing. No significant foraminal narrowing or nerve root compression. The transiting S1 nerve roots are unimpeded in their course. No abnormal cord or cauda equina signal. The visualized soft tissues and paraspinal musculature are unremarkable.
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FINDINGS: Redemonstration of postsurgical changes of right frontotemporal craniotomy. There is unchanged 6 mm subdural hemorrhage underlying the craniotomy. No significant mass effect or midline shift. Redemonstration of left globe rupture and associated orbital fracture. Again seen layering hemorrhagic products in the left maxillary sinus. Stable ventricular caliber and configuration, likely related to chronic parenchymal volume loss.
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Lumbar MRI without contrast Clinical information: 37-year-old male with low back pain Comparison: Radiograph 10/20/2015 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. Vertebral body heights are maintained. Focal T1/T2 hyperintensities in the marrow of T12, L2, L3, suggesting of small hemangiomas. Additional small T2/STIR endplate hyperintensities, anterior predominant at T12 (series 5, image 9), L1 (series 5, image 9), and L4 (series 7, image 9). The conus terminates just below the L1-L2 level. T12-L1: No significant disc bulge. No significant spinal canal or foraminal narrowing. L1-2: Mild left foraminal disc protrusion with mild narrowing of the lateral recess without compression of the transiting nerve root. No significant spinal canal or foraminal narrowing. L2-3: No significant spinal canal or foraminal narrowing. L3-4: Mild diffuse disc bulge with mild foraminal narrowing bilaterally without nerve root compression. No significant spinal canal narrowing. L4-5: Mild diffuse disc bulge with moderate left and mild-moderate right neuroforaminal narrowing. The disc appears to abut the exiting L4 nerve roots (for example series 10, image 16). Mild right lateral recess narrowing. No significant spinal canal narrowing. L5-S1: Mild diffuse disc bulge with moderate foraminal narrowing bilaterally. The disc appears to abut the exiting L5 nerve roots (for example series 10, image eight). No significant spinal canal foraminal narrowing. The paraspinal structures are normal. The remaining osseous and soft tissue structures are normal. No significant abnormalities of the sacroiliac joints. Anterior and posterior ligamentous complexes are intact. CONCLUSION: 1. Small T2/ STIR endplate hyperintensities, anterior predominant at multiple levels as described above. This finding is nonspecific and could reflect Modic type II endplate changes versus small Romanus lesions seen in early inflammatory spondylarthritis. 2. Mild multilevel degenerative changes most prominent at L4-L5, where there is moderate left and mild-to-moderate right neuroforaminal narrowing, abutting the exiting L4 and L5 nerve roots. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: Five nonrib-bearing lumbovertebral bodies. Alignment is normal. Vertebral body heights are maintained. Focal T1/T2 hyperintensities in the marrow of T12, L2, L3, suggesting of small hemangiomas. Additional small T2/STIR endplate hyperintensities, anterior predominant at T12 (series 5, image 9), L1 (series 5, image 9), and L4 (series 7, image 9). The conus terminates just below the L1-L2 level. T12-L1: No significant disc bulge. No significant spinal canal or foraminal narrowing. L1-2: Mild left foraminal disc protrusion with mild narrowing of the lateral recess without compression of the transiting nerve root. No significant spinal canal or foraminal narrowing. L2-3: No significant spinal canal or foraminal narrowing. L3-4: Mild diffuse disc bulge with mild foraminal narrowing bilaterally without nerve root compression. No significant spinal canal narrowing. L4-5: Mild diffuse disc bulge with moderate left and mild-moderate right neuroforaminal narrowing. The disc appears to abut the exiting L4 nerve roots (for example series 10, image 16). Mild right lateral recess narrowing. No significant spinal canal narrowing. L5-S1: Mild diffuse disc bulge with moderate foraminal narrowing bilaterally. The disc appears to abut the exiting L5 nerve roots (for example series 10, image eight). No significant spinal canal foraminal narrowing. The paraspinal structures are normal. The remaining osseous and soft tissue structures are normal. No significant abnormalities of the sacroiliac joints. Anterior and posterior ligamentous complexes are intact.
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FINDINGS: STRUCTURED REPORT: CTA CAP VASCULATURE: CORONARY ARTERIES: There are mild atherosclerotic calcifications of the native coronary arteries. PULMONARY ARTERIES: No central pulmonary embolus. Normal size. ASCENDING THORACIC AORTA: No significant abnormality. AORTIC ARCH: No significant abnormality. ARCH VESSELS: No significant abnormality. DESCENDING THORACIC AORTA: No significant abnormality. ABDOMINAL AORTA: No significant abnormality. CELIAC AXIS: No significant abnormality. SMA: No significant abnormality. RIGHT RENAL: No significant abnormality. LEFT RENAL: No significant abnormality. IMA: No significant abnormality. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. ------------------------------------------------------------- LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: No focal consolidation, pleural effusion, or pneumothorax. Mild dependent atelectasis. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hemangioma is noted at the posterior aspect of the right hepatic lobe. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is not identified. Scattered diverticulosis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is present. Right adnexal simple cyst measures 4.8 x 3.1 cm on axial series 501 image 249. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Mild multilevel discogenic degenerative change.
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CLINICAL HISTORY: Follow-up aneurysm COMPARISON: CTA 10/20/2021, cerebral angiogram 8/30/2021 TECHNIQUE: Axial time-of-flight and postcontrast MR angiography of the brain were performed. Additional 3D post-processing was done with MIP and volume rendered images, which were reviewed for interpretation. Patient weight: 137 lbs. IV contrast: ProHance, 12 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: Interval changes of pipeline device assisted treatment of right ICA aneurysm. No appreciable residual aneurysm. There appears to be narrowing at the distal end of the stent. Relatively preserved flow-related signal in the distal middle cerebral and anterior cerebral arteries. IMPRESSION: Interval changes of pipeline device assisted treatment of right ICA aneurysm. No appreciable residual aneurysm. Appears to be narrowing at the distal end of the stent. This can be further assessed with a CTA or catheter angiogram if clinically desired.
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FINDINGS: Interval changes of pipeline device assisted treatment of right ICA aneurysm. No appreciable residual aneurysm. There appears to be narrowing at the distal end of the stent. Relatively preserved flow-related signal in the distal middle cerebral and anterior cerebral arteries.
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FINDINGS: CT of the head with and without contrast: Please see separately reported same day noncontrast head CT. No abnormal intracranial enhancement within limitations of arterial phase exam. Tiny foci of gas in the left parotid and masticator spaces, likely within small veins. 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: Focal severe narrowing and occlusion of a distal small left MCA branch in the Sylvian fissure (image 385, series #407). VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: Mild atherosclerosis of the proximal ICA without flow-limiting stenosis. No evidence of occlusion or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. RIGHT VERTEBRAL ARTERY: Limited evaluation due to contrast within the spinal veins. Possible focal approximately 50% narrowing at the level of C7 (image 287, series #402), however evaluation is limited due to contrast artifact. No definite evidence of flow-limiting stenosis, occlusion, or aneurysmal dilation. LEFT VERTEBRAL ARTERY: Limited evaluation due to contrast within the spinal veins. There is no definite evidence of stenosis, occlusion, or aneurysmal dilation. SOFT TISSUES: No soft tissue abnormality within the neck. Poststernotomy changes are present. Small pericardial effusion. Irregular consolidation in the left upper lobe with volume loss and extensive associated severe bronchiectasis and left upper lobe atelectasis, stable from 2010 CT chest. CERVICAL SPINE: Normal cervical spine alignment. Mild multilevel discogenic degenerative change. No aggressive osseous lesions.
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EXAM: MR Abdomen wo contrast CLINICAL INFORMATION: Liver lesion, < 1cm, US nondiagnostic, R74.8 Abnormal levels of other serum enzymes Spec Inst: liver mass? gallbladder cyst? COMPARISON: Abdominal ultrasound dated 11/15/2021 TECHNIQUE: MR Abdomen wo contrast FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Cystic lesion containing a single thin internal septation within the anterior wall gallbladder near the neck measures 1.0 x 0.7 cm on T2 axial image 19, series 7. The gallbladder is otherwise unremarkable without evidence of mass, wall thickening, stone, or inflammation. 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: Small cystic lesion within the anterior wall of the gallbladder neck is redemonstrated but nonspecific. Due to its typical location and benign imaging features, a benign congenital lesion such as ciliated cyst of the gallbladder is favored, however mucinous cystic neoplasm of the gallbladder cannot be excluded. Consider continued imaging surveillance versus surgical excision. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Cystic lesion containing a single thin internal septation within the anterior wall gallbladder near the neck measures 1.0 x 0.7 cm on T2 axial image 19, series 7. The gallbladder is otherwise unremarkable without evidence of mass, wall thickening, stone, or inflammation. 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 of the head with and without contrast: Please see separately reported same day noncontrast head CT. No abnormal intracranial enhancement within limitations of arterial phase exam. Tiny foci of gas in the left parotid and masticator spaces, likely within small veins. 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: Focal severe narrowing and occlusion of a distal small left MCA branch in the Sylvian fissure (image 385, series #407). VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: Mild atherosclerosis of the proximal ICA without flow-limiting stenosis. No evidence of occlusion or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. RIGHT VERTEBRAL ARTERY: Limited evaluation due to contrast within the spinal veins. Possible focal approximately 50% narrowing at the level of C7 (image 287, series #402), however evaluation is limited due to contrast artifact. No definite evidence of flow-limiting stenosis, occlusion, or aneurysmal dilation. LEFT VERTEBRAL ARTERY: Limited evaluation due to contrast within the spinal veins. There is no definite evidence of stenosis, occlusion, or aneurysmal dilation. SOFT TISSUES: No soft tissue abnormality within the neck. Poststernotomy changes are present. Small pericardial effusion. Irregular consolidation in the left upper lobe with volume loss and extensive associated severe bronchiectasis and left upper lobe atelectasis, stable from 2010 CT chest. CERVICAL SPINE: Normal cervical spine alignment. Mild multilevel discogenic degenerative change. No aggressive osseous lesions.
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Clinical history:Follow-up right vestibular schwannoma Comparison:MRI 1/22/2021, 1/21/2020 Technique: Multiplanar multisequence pre and postcontrast MRI images of the brain and IACs were obtained. Images include dedicated heavily T2-weighted and postcontrast images through the internal auditory structures. Patient weight: 135 lbs. IV contrast: ProHance, 13 ml, per protocol. . Findings: There has been no significant change in 3 x 4 mm enhancing lesion in the right internal auditory canal (series 801 image eight). There is preserved architecture of bilateral cochlea and semicircular canals. There is no restricted diffusion to suggest an acute infarct. Minor scattered presumed chronic microangiopathic changes. The ventricles are stable in caliber and configuration. Minor scattered paranasal mucosal thickening. Mastoid air cells are clear. The orbits are within normal limits. No suspicious calvarial lesion is noted. Impression: Unchanged 4 mm enhancing lesion in the right internal auditory canal, presumed vestibular schwannoma. No acute intracranial process
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Findings: There has been no significant change in 3 x 4 mm enhancing lesion in the right internal auditory canal (series 801 image eight). There is preserved architecture of bilateral cochlea and semicircular canals. There is no restricted diffusion to suggest an acute infarct. Minor scattered presumed chronic microangiopathic changes. The ventricles are stable in caliber and configuration. 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: There is no acute infarction, hemorrhage, or brain edema. There is no intracranial mass or hydrocephalus. There is diffuse cortical involution with ex vacuo dilatation of the pedicles. Marked enlargement of the inferior medial and superior rectus muscles with chronic remodeling of the right lamina papyracea. There is moderate mucosal thickening in the left maxillary sinus. Postsurgical changes status post partial right ethmoidectomy, right maxillary antrostomy and right middle turbinectomy. The remaining paranasal sinuses and mastoid air cells are clear. There is no acute osseous abnormality.
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COMPARISON: CT, dated 10/15/2021 TECHNIQUE: Multiplanar T1 and T2 weighted sequences of the left thigh were obtained prior to and following uneventful intravenous Gadolinium administration. FINDINGS: Fatty mass is seen in the superior aspect of the surgical bed, measuring approximately 5.6 x 2.3 x 8.0 cm, compared to 5.4 x 1.9 x 5.4 cm.. The mass has no fat plane between the femoral cortex, and displaces anterior compartment muscles. The mass contacts but does not invade superficial femoral vessels. There is no underlying marrow replacement. Incidentally noted tendinosis at the origin of the hamstring tendons. IMPRESSION: Enlarging residual mass in the surgical bed. Still, no high-grade features are present.
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FINDINGS: Fatty mass is seen in the superior aspect of the surgical bed, measuring approximately 5.6 x 2.3 x 8.0 cm, compared to 5.4 x 1.9 x 5.4 cm.. The mass has no fat plane between the femoral cortex, and displaces anterior compartment muscles. The mass contacts but does not invade superficial femoral vessels. There is no underlying marrow replacement. Incidentally noted tendinosis at the origin of the hamstring tendons.
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Findings: Color parametric maps demonstrate elevated time to peak in the left parietal lobe, volume of 6 mL greater than six seconds. There is no reduced cerebral blood flow.
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CLINICAL HISTORY: Follow-up aneurysm COMPARISON: MRA 1/19/2021, 1/14/2020 TECHNIQUE: Axial time-of-flight and postcontrast MR angiography of the brain were performed. Additional 3D post-processing was done with MIP and volume rendered images, which were reviewed for interpretation. Patient weight: 170 lbs. IV contrast: ProHance, 16 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: There are stable changes of coil embolization of ACA aneurysm. Also stable coil embolization changes of right PICA aneurysm. There is no evidence of recurrence. There is no intracranial occlusion of flow-limiting stenosis. Redemonstration of encephalomalacia involving the right frontal lobe and left cerebellar hemisphere. Unchanged shunted ventricular caliber and configuration without hydrocephalus. IMPRESSION: Stable changes of ACA and right PICA aneurysms coil embolization without evidence of recurrence. Stable shunted ventricles, without hydrocephalus
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FINDINGS: There are stable changes of coil embolization of ACA aneurysm. Also stable coil embolization changes of right PICA aneurysm. There is no evidence of recurrence. There is no intracranial occlusion of flow-limiting stenosis. Redemonstration of encephalomalacia involving the right frontal lobe and left cerebellar hemisphere. Unchanged shunted ventricular caliber and configuration without hydrocephalus.
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FINDINGS: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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EXAM:MR Ankle Left wo contrast CLINICAL INFORMATION:Ankle pain with concern for posterior tibialis tendinitis COMPARISON:1/4/2022 TECHNIQUE: Multiplanar multisequence MRI of the left 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 brevis tendon:Normal. Anterior tibiofibular ligament:Normal. Posterior tibiofibular ligament:Normal. Anterior talofibular ligament: Attenuated, consistent with chronic tear. 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. Chronic tear of ATFL, otherwise unremarkable MRI of the left 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 brevis tendon:Normal. Anterior tibiofibular ligament:Normal. Posterior tibiofibular ligament:Normal. Anterior talofibular ligament: Attenuated, consistent with chronic tear. 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. Gray-white matter differentiation is maintained. No evidence of acute infarction. Normal cerebral cortical volume for patient's age. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Paranasal sinuses are clear. VESSELS: Normal noncontrast appearance of the vessels.
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EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: Liver lesion, > 1cm, US nondiagnostic, K76.9 Liver disease, unspecified, K74.60 Unspecified cirrhosis of liver COMPARISON: CT abdomen pelvis dated 9/29/2021 TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 185 lbs. IV contrast: Eovist, 10 ml, per protocol. IV contrast injection rate: 1 ml per sec. FINDINGS: STRUCTURED REPORT: MR HCC Screening IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. No steatosis. T2 hyperintense lesion adjacent to the falciform ligament measuring 1.5 x 1.8 cm on T2 axial image 97, series 3 demonstrates homogenous posterior enhancement with enhancement that follows blood pool on subsequent phases, compatible with a flash filling hemangioma. Additional suspicious enhancing lesion detail below. LIVER LESIONS: - Lesion Number: 1 - Location: Segment(s) 8, at the margin of 4a - Size: 2.7 x 2.4 (Image 55, Series 8) - Enhancement: Nonrim arterial phase hyperenhancement - Vascular invasion: Abuts but does not definitely invade the middle hepatic vein. - Additional major features present: - Enhancing "capsule": Present. - Nonperipheral "washout": Present. - Threshold growth (>= 50% in <= 6 months): Not present. - Other features: Restricted diffusion, intermediate T2 hyperintensity. - LI-RADS: LR-5 LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Right hepatic artery replaced to the SMA, left hepatic artery replaced to left gastric artery. - Portal venous system: Patent intra- and extra-hepatic portal venous system. Extrahepatic trifurcation. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: None. - Other varices or collaterals: None. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: Filling defect within the posterior wall near the neck measures up to 3 mm on T2 axial image 20, series 3. No postcontrast enhancement is detected. LYMPH NODES: None enlarged. SPLEEN: Normal size and appearance. PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Multiple tiny bilateral cortical cysts. Otherwise normal. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered noninflamed diverticula. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Hepatic cirrhosis without stigmata of portal hypertension. 2. Enlarged arterially enhancing lesion which demonstrates pseudocapsule and washout on delayed phase compatible with HCC (LIRADS LR 5), located within segment VIII/IVa. Lesion abuts but does not definitely invade the middle hepatic vein. 3. Right hepatic artery is replaced to the SMA and left hepatic artery is replaced to the left gastric artery. 4. Additional enhancing lesion adjacent to the falciform ligament is compatible with a flash filling hemangioma. 5. Tiny filling defect within the gallbladder which may reflect a small polyp or stone. Attention on follow-up imaging 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: MR HCC Screening IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. No steatosis. T2 hyperintense lesion adjacent to the falciform ligament measuring 1.5 x 1.8 cm on T2 axial image 97, series 3 demonstrates homogenous posterior enhancement with enhancement that follows blood pool on subsequent phases, compatible with a flash filling hemangioma. Additional suspicious enhancing lesion detail below. LIVER LESIONS: - Lesion Number: 1 - Location: Segment(s) 8, at the margin of 4a - Size: 2.7 x 2.4 (Image 55, Series 8) - Enhancement: Nonrim arterial phase hyperenhancement - Vascular invasion: Abuts but does not definitely invade the middle hepatic vein. - Additional major features present: - Enhancing "capsule": Present. - Nonperipheral "washout": Present. - Threshold growth (>= 50% in <= 6 months): Not present. - Other features: Restricted diffusion, intermediate T2 hyperintensity. - LI-RADS: LR-5 LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Right hepatic artery replaced to the SMA, left hepatic artery replaced to left gastric artery. - Portal venous system: Patent intra- and extra-hepatic portal venous system. Extrahepatic trifurcation. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: None. - Other varices or collaterals: None. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: Filling defect within the posterior wall near the neck measures up to 3 mm on T2 axial image 20, series 3. No postcontrast enhancement is detected. LYMPH NODES: None enlarged. SPLEEN: Normal size and appearance. PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Multiple tiny bilateral cortical cysts. Otherwise normal. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered noninflamed diverticula. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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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: Normal. DISTAL ESOPHAGUS: Small hiatal hernia. Esophageal varices, described below. HEART / VESSELS: Coronary artery atherosclerosis. Normal heart size. ABDOMEN and PELVIS: LIVER: Cirrhosis. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Splenomegaly. Interval resolution of perisplenic fluid/hemorrhage. ADRENALS: Normal. KIDNEYS: Unchanged 6 mm nonobstructing calculus in the lower pole of the right kidney. Additional punctate nonobstructing right renal calculi are present. No hydronephrosis. LYMPH NODES: Prominent periportal and periaortic lymph nodes, unchanged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Unchanged mild central mesenteric stranding, likely related to mesenteric congestion. No free intraperitoneal fluid or air. RETROPERITONEUM: Normal. VESSELS: Unchanged dilated portal vein, patent paraumbilical vein, and extensive venous collaterals in the upper abdomen. Extensive distal esophageal varices, unchanged. Scattered mild atherosclerosis of the abdominal aorta and branch vessels. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Anterior abdominal wall venous collaterals, unchanged. MUSCULOSKELETAL: No aggressive osseous lesions. Transitional S1 vertebrae. Mild multilevel discogenic degenerative change, most prominent at S1-S2.
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EXAM: MR Cervical Spine wo contrast 1/25/2022 10:00 AM CLINICAL INFORMATION: Cervical radicular pain. COMPARISON: Cervical spine radiograph dated 8/2/2021. TECHNIQUE: T2 sagittal and axial fast spin spin echo, T1 sagittal spin echo, sagittal STIR, axial T2* gradient echo. FINDINGS: There is straightening of the cervical spine lordotic curvature. Vertebral body heights are preserved. There are no suspicious bone marrow signal abnormalities. The craniovertebral junction appears unremarkable. No cord signal abnormality is identified. Axial images are evaluated on a level by level basis: C2-3: No significant spinal canal or neuroforaminal stenosis. C3-4: No significant spinal canal or neuroforaminal stenosis. C4-5: No significant spinal canal or neuroforaminal stenosis. C5-6: No significant spinal canal or neuroforaminal stenosis. C6-7: Trace disc bulge, though no significant spinal canal or neuroforaminal stenosis. C7-T1: No significant spinal canal or neuroforaminal stenosis. T1-T2: No significant spinal canal or neuroforaminal stenosis. The visualized paraspinal structures appear otherwise within normal limits. The remaining visualized osseous and soft tissue structures demonstrate normal MR signal characteristics. CONCLUSION: 1. No acute cervical spine abnormality to explain patient's radicular pain. 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 straightening of the cervical spine lordotic curvature. Vertebral body heights are preserved. There are no suspicious bone marrow signal abnormalities. The craniovertebral junction appears unremarkable. No cord signal abnormality is identified. Axial images are evaluated on a level by level basis: C2-3: No significant spinal canal or neuroforaminal stenosis. C3-4: No significant spinal canal or neuroforaminal stenosis. C4-5: No significant spinal canal or neuroforaminal stenosis. C5-6: No significant spinal canal or neuroforaminal stenosis. C6-7: Trace disc bulge, though no significant spinal canal or neuroforaminal stenosis. C7-T1: No significant spinal canal or neuroforaminal stenosis. T1-T2: No significant spinal canal or neuroforaminal stenosis. The visualized paraspinal structures appear otherwise within normal limits. The remaining visualized osseous and soft tissue structures demonstrate normal MR signal characteristics.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is normal. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Globes are intact. No fracture. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. FACIAL BONES: Bilateral pterygoid plates are intact. Small upper lip laceration containing two tiny radiopaque fragments, possibly retained foreign bodies or fracture fragments from adjacent maxillary teeth. The left central and lateral maxillary incisors appear eroded, however may be fractured given adjacent radiopaque fragment in the upper lip soft tissues. Numerous dental caries. MANDIBLE: Nondisplaced fracture of the anterior right mandibular body (series 305 image 28). Temporomandibular joints are intact. SINONASAL CAVITIES: Mild mucosal thickening of the bilateral maxillary, sphenoid, and ethmoid sinuses..
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MR Angio Head wo+w contrast Clinical Information: Routine follow up angio head Comparison: MR 1/14/2020, 12/29/2015, CTA 9/25/2007. Technique: MR angiogram of head with and without contrast was obtained with multiple MIPs 3D rendered. Patient weight: 179 lbs. IV contrast: ProHance, 17 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: Basilar artery: Coiling of large basilar tip aneurysm. Pattern of residual filling is overall unchanged. Patchy areas of signal drop, unchanged and likely related to vascular stenting. Intracranial internal carotid arteries: Unchanged medially directed aneurysm near the right ICA terminus (series 2, image 122). Unchanged tiny outpouching extending laterally in the left cavernous ICA (series 2, image 88). Anterior cerebral arteries: Normal. Middle cerebral arteries: Normal. Posterior cerebral arteries: Normal. Intracranial vertebral arteries: Normal. No new vascular abnormality identified. The ventricles are stable in caliber and configuration. CONCLUSION: 1. Unchanged] appearance of the post-coil large basilar tip aneurysm with overall unchanged 7mm residual and pattern of residual filling. Unchanged signal loss involving the stented basilar artery likely related to the stent. 2. Unchanged right ICA terminus aneurysm and left cavernous ICA outpouchings as described above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: Basilar artery: Coiling of large basilar tip aneurysm. Pattern of residual filling is overall unchanged. Patchy areas of signal drop, unchanged and likely related to vascular stenting. Intracranial internal carotid arteries: Unchanged medially directed aneurysm near the right ICA terminus (series 2, image 122). Unchanged tiny outpouching extending laterally in the left cavernous ICA (series 2, image 88). Anterior cerebral arteries: Normal. Middle cerebral arteries: Normal. Posterior cerebral arteries: Normal. Intracranial vertebral arteries: Normal. No new vascular abnormality identified. The ventricles are stable in caliber and configuration.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Patchy groundglass densities in the left upper and right middle lobes. No pleural effusion or pneumothorax. 7 mm groundglass nodule in the right upper lobe on image 127 series 601. Tracheobronchial tree is patent. HEART / VESSELS: Duplicated SVC. Otherwise unremarkable. MEDIASTINUM / ESOPHAGUS: Anterior mediastinal hematoma. DIAPHRAGM: Intact. LYMPH NODES: Mildly prominent mediastinal lymph nodes. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. No acute traumatic injury. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Contrast noted within the bilateral collecting systems. Otherwise unremarkable. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is not visualized. The colon is unremarkable. PERITONEUM / MESENTERY: Mild stranding adjacent to the right lateral aspect of the bladder. RETROPERITONEUM: Small right retroperitoneal hematoma tracking superiorly from the right hip. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing inguinal hernias, bilaterally. Fat-containing umbilical hernia. MUSCULOSKELETAL: Mildly displaced mid sternal fracture. Multiple bilateral rib fractures involving the first, second, and six through eighth ribs on the right as well as the anterior 1st and 2nd left ribs. Chronic right lateral seventh rib fracture. Redemonstrated severely comminuted right femoral neck fracture with comminution extension to involve the right femoral head. There is anterior subluxation of the distal fracture fragments. The right femoral head is displaced superiorly and posteriorly with respect to the right acetabulum. This is associated with comminuted displaced fractures of the medial and posterior acetabular walls as well as the acetabular roof. There is a mildly displaced fracture of the right anterior acetabular wall. Associated minimally displaced right inferior pubic ramus fracture. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: Axial images from lumbar spine reformats were not available at the time of dictation. VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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MRI brain with and without contrast Clinical Information: Male aged 58 years. Follow-up meningioma Comparison: MR 1/26/2021 and 1/3/2013 Technique: Multiplanar, multisequence MRI of the brain were obtained in multiple planes pre-and post administration of intravenous contrast per departmental protocol. Patient weight: 265 lbs. IV contrast: ProHance, 10 ml, per protocol. Findings: Postsurgical appearance of the left greater than right frontal lobes consistent with previous meningioma resection. Adjacent encephalomalacia of the frontal lobe parenchyma, left predominant, is overall unchanged. The nodular enhancement along the right floor of the resection bed measures 8 x 6 mm (series 903, image 16), previously 8 x 6 mm in similar dimensions. The tiny left lateral nodular enhancement measures 3 mm (series 3, image 16) previously measured 2 mm. No new abnormal parenchymal or leptomeningeal enhancement. Unchanged small left DVA of the left cerebellum (series 801, image 15). No acute infarct or intracranial hemorrhage. No midline shift, hydrocephalus, mass effect, or other space-occupying lesion. Mild frontal horn ex vacuo dilatation is unchanged. No significant abnormality of the extracranial osseous and soft tissue structures. Worsening severe opacification of the frontal, ethmoid sinuses. Continued severe opacification of left maxillary sinus. Conclusion: 1. Unchanged postsurgical appearance of previous meningioma resection. Overall unchanged nodular enhancement at the floor of the resection bed with small differences in measurement likely due to technique. No new enhancing mass. 2. Worsening severe opacification of the frontal, ethmoid sinuses. Continued severe opacification of left maxillary sinus. Please Correlate for acute sinusitis of sinusitis 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: Postsurgical appearance of the left greater than right frontal lobes consistent with previous meningioma resection. Adjacent encephalomalacia of the frontal lobe parenchyma, left predominant, is overall unchanged. The nodular enhancement along the right floor of the resection bed measures 8 x 6 mm (series 903, image 16), previously 8 x 6 mm in similar dimensions. The tiny left lateral nodular enhancement measures 3 mm (series 3, image 16) previously measured 2 mm. No new abnormal parenchymal or leptomeningeal enhancement. Unchanged small left DVA of the left cerebellum (series 801, image 15). No acute infarct or intracranial hemorrhage. No midline shift, hydrocephalus, mass effect, or other space-occupying lesion. Mild frontal horn ex vacuo dilatation is unchanged. No significant abnormality of the extracranial osseous and soft tissue structures. Worsening severe opacification of the frontal, ethmoid sinuses. Continued severe opacification of left maxillary sinus.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Patchy groundglass densities in the left upper and right middle lobes. No pleural effusion or pneumothorax. 7 mm groundglass nodule in the right upper lobe on image 127 series 601. Tracheobronchial tree is patent. HEART / VESSELS: Duplicated SVC. Otherwise unremarkable. MEDIASTINUM / ESOPHAGUS: Anterior mediastinal hematoma. DIAPHRAGM: Intact. LYMPH NODES: Mildly prominent mediastinal lymph nodes. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. No acute traumatic injury. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Contrast noted within the bilateral collecting systems. Otherwise unremarkable. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is not visualized. The colon is unremarkable. PERITONEUM / MESENTERY: Mild stranding adjacent to the right lateral aspect of the bladder. RETROPERITONEUM: Small right retroperitoneal hematoma tracking superiorly from the right hip. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing inguinal hernias, bilaterally. Fat-containing umbilical hernia. MUSCULOSKELETAL: Mildly displaced mid sternal fracture. Multiple bilateral rib fractures involving the first, second, and six through eighth ribs on the right as well as the anterior 1st and 2nd left ribs. Chronic right lateral seventh rib fracture. Redemonstrated severely comminuted right femoral neck fracture with comminution extension to involve the right femoral head. There is anterior subluxation of the distal fracture fragments. The right femoral head is displaced superiorly and posteriorly with respect to the right acetabulum. This is associated with comminuted displaced fractures of the medial and posterior acetabular walls as well as the acetabular roof. There is a mildly displaced fracture of the right anterior acetabular wall. Associated minimally displaced right inferior pubic ramus fracture. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: Axial images from lumbar spine reformats were not available at the time of dictation. VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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EXAM: MR Abdomen wo+w contrast, MR Cholangiopancreatography MRCP CLINICAL INFORMATION: Status post liver transplant with elevated LFTs, ascites COMPARISON: MRI abdomen dated 7/23/2021 TECHNIQUE: MR Abdomen wo+w contrast, MR Cholangiopancreatography MRCP Patient weight: 191 lbs. IV contrast: ProHance, 9 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: STRUCTURED REPORT: MRI Abdomen Evaluation is degraded due to dielectric effect from ascites and 3T magnet. LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Postsurgical changes from liver transplant. The transplant liver demonstrates diffusely heterogeneous T2 signal with areas of contour nodularity, concerning for recurrent cirrhosis. As seen on the prior exam, there is a wedge-shaped area of T2 hyperintense signal surrounding a focally dilated peripheral bile duct (series 701, image 40. This area is hypointense on T1-weighted precontrast imaging and demonstrates peripheral arterial enhancement which persists on the portal venous phase. By the equilibrium phase enhancement pattern is similar to that of the adjacent liver parenchyma. This wedge-shaped area of T2 signal abnormality and hyperenhancement is without evidence of restricted diffusion. The portal and hepatic veins are patent. No suspicious hepatic lesion identified. BILIARY TRACT/MRCP: MRCP images are somewhat degraded by ascites. No abnormal biliary dilatation aside from the focally minimally dilated branch in the right posterior liver. No filling defects to suggest choledocholithiasis. GALLBLADDER: Absent. PANCREAS: Not well evaluated due to dielectric effect on T2 sequences. No abnormal enhancement on the postcontrast sequences. SPLEEN: Enlarged. ADRENALS: Normal. KIDNEYS: Mildly prominent lymph node on series 405, image 408, nonspecific. Recommend attention on follow-up exams. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Moderate volume ascites. RETROPERITONEUM: Normal. VESSELS: Small paraesophageal varices and omental collateral vessels. BODY WALL: Body wall edema. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Diffusely heterogeneous T2 signal throughout the transplant liver with nodular contour, suggestive of recurrent cirrhosis. Ascites in collateral vessels may reflect recurrent portal hypertension. 2. Wedge-shaped area of abnormal signal and hyperenhancement in the posterior right hepatic lobe about a focally prominent intrahepatic bile duct, similar to prior exam, and possibly representing sequelae of cholangitis. 3. No dilatation of the common bile duct or evidence of choledocholithiasis. 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 Evaluation is degraded due to dielectric effect from ascites and 3T magnet. LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Postsurgical changes from liver transplant. The transplant liver demonstrates diffusely heterogeneous T2 signal with areas of contour nodularity, concerning for recurrent cirrhosis. As seen on the prior exam, there is a wedge-shaped area of T2 hyperintense signal surrounding a focally dilated peripheral bile duct (series 701, image 40. This area is hypointense on T1-weighted precontrast imaging and demonstrates peripheral arterial enhancement which persists on the portal venous phase. By the equilibrium phase enhancement pattern is similar to that of the adjacent liver parenchyma. This wedge-shaped area of T2 signal abnormality and hyperenhancement is without evidence of restricted diffusion. The portal and hepatic veins are patent. No suspicious hepatic lesion identified. BILIARY TRACT/MRCP: MRCP images are somewhat degraded by ascites. No abnormal biliary dilatation aside from the focally minimally dilated branch in the right posterior liver. No filling defects to suggest choledocholithiasis. GALLBLADDER: Absent. PANCREAS: Not well evaluated due to dielectric effect on T2 sequences. No abnormal enhancement on the postcontrast sequences. SPLEEN: Enlarged. ADRENALS: Normal. KIDNEYS: Mildly prominent lymph node on series 405, image 408, nonspecific. Recommend attention on follow-up exams. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Moderate volume ascites. RETROPERITONEUM: Normal. VESSELS: Small paraesophageal varices and omental collateral vessels. BODY WALL: Body wall edema. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: Limited evaluation of the lower cervical spine and proximal vessels secondary to photon starvation artifact. 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 PITUITARY CLINICAL INFORMATION:61-year-old with pituitary adenoma COMPARISON: MR 1/26/2021 and 1/14/2020 TECHNIQUE: Multiplanar multisequence MRI images of the pituitary gland were obtained using the pituitary protocol. Images include dynamic postcontrast coronal images through the pituitary gland .. Patient weight: 192 lbs. IV contrast: ProHance, 8 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: PITUITARY: Surgical changes of prior transsphenoidal resection. Leftward deviation of the pituitary stalk, unchanged. The right sellar floor enhancing nodule measures 6 x 4 mm (series 801, image 10), previously 6 x 4 mm. The left sellar floor enhancement measures 9 x 7 millimeters (series 801, image 10), previously 9 x 8 mm. No new focal hypoenhancing mass in the pituitary. The optic chiasm and cisternal segments of the optic nerves are maintained. ICAs are normal. WHOLE BRAIN: No new abnormality within the visualized brain. CONCLUSION: Postsurgical changes of transsphenoidal resection. Relatively unchanged small volume residual soft tissue in the sella as described above. Postsurgical changes versus small amount of residual 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: PITUITARY: Surgical changes of prior transsphenoidal resection. Leftward deviation of the pituitary stalk, unchanged. The right sellar floor enhancing nodule measures 6 x 4 mm (series 801, image 10), previously 6 x 4 mm. The left sellar floor enhancement measures 9 x 7 millimeters (series 801, image 10), previously 9 x 8 mm. No new focal hypoenhancing mass in the pituitary. The optic chiasm and cisternal segments of the optic nerves are maintained. ICAs are normal. WHOLE BRAIN: No new abnormality within the visualized brain.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Patchy groundglass densities in the left upper and right middle lobes. No pleural effusion or pneumothorax. 7 mm groundglass nodule in the right upper lobe on image 127 series 601. Tracheobronchial tree is patent. HEART / VESSELS: Duplicated SVC. Otherwise unremarkable. MEDIASTINUM / ESOPHAGUS: Anterior mediastinal hematoma. DIAPHRAGM: Intact. LYMPH NODES: Mildly prominent mediastinal lymph nodes. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. No acute traumatic injury. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Contrast noted within the bilateral collecting systems. Otherwise unremarkable. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is not visualized. The colon is unremarkable. PERITONEUM / MESENTERY: Mild stranding adjacent to the right lateral aspect of the bladder. RETROPERITONEUM: Small right retroperitoneal hematoma tracking superiorly from the right hip. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing inguinal hernias, bilaterally. Fat-containing umbilical hernia. MUSCULOSKELETAL: Mildly displaced mid sternal fracture. Multiple bilateral rib fractures involving the first, second, and six through eighth ribs on the right as well as the anterior 1st and 2nd left ribs. Chronic right lateral seventh rib fracture. Redemonstrated severely comminuted right femoral neck fracture with comminution extension to involve the right femoral head. There is anterior subluxation of the distal fracture fragments. The right femoral head is displaced superiorly and posteriorly with respect to the right acetabulum. This is associated with comminuted displaced fractures of the medial and posterior acetabular walls as well as the acetabular roof. There is a mildly displaced fracture of the right anterior acetabular wall. Associated minimally displaced right inferior pubic ramus fracture. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: Axial images from lumbar spine reformats were not available at the time of dictation. VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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EXAM: MR Pelvis wo contrast CLINICAL INFORMATION: High risk prostate cancer (Gleason 5+5 = 10, PSA = 67), status post androgen deprivation therapy with decline of PSA to 0.28 on 12/22/2021. COMPARISON: MRI of the prostate dated 5/26/2021 and CT abdomen pelvis dated 10/21/2021 TECHNIQUE: MR Pelvis wo contrast FINDINGS: STRUCTURED REPORT: MRI Prostate Prostate: Measurement: 4.3 x 3.3 x 3.7 cm; estimated volume: 27 cc; decreased from prior prostate MRI with a volume of approximately 109 cc Focal lesion(s): Lesion # 1 (index lesion): - Key image: series 4; image 21; - Size: 22 x 27 mm; previously measuring approximately 51 x 54 mm - Location: left; base; anterior central gland; - T2WI: 5; DWI: 5; DCE (early and focal enhancement): unable to determine; - PI-RADS v2.1 score: 5 - Very high (clinically significant cancer is highly likely to be present); - Likelihood of extraprostatic extension: 5 - Highly likely; involvement of the neural vascular bundle on the left is redemonstrated. Suspected bladder wall involvement also noted. - Likelihood of seminal vesicle invasion: 3 - Indeterminate; There is diffuse homogeneous low signal throughout the prostate, consistent with treatment related effects. Bladder: Within normal limits. Adenopathy: No pathologically enlarged lymph nodes. Previously seen enlarged lymph nodes have decreased in size however the superior field of view is not as high as on the prior exam, so some of the pathologic lymph nodes are not included within the field-of-view on the current study. Bones: No aggressive bony lesions. Other: No significant pelvic free fluid. Note: For more details about the Prostate Imaging-Reporting and Data System (PI-RADS) version 2.1, please visit: http://www.acr.org/Quality-Safety/Resources/PIRADS CONCLUSION: 1. Marked interval decrease in size of known prostate cancer indicating a favorable response to androgen deprivation therapy. 2. Overall decrease in size of the prostate gland. 3. No pelvic lymphadenopathy. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: MRI Prostate Prostate: Measurement: 4.3 x 3.3 x 3.7 cm; estimated volume: 27 cc; decreased from prior prostate MRI with a volume of approximately 109 cc Focal lesion(s): Lesion # 1 (index lesion): - Key image: series 4; image 21; - Size: 22 x 27 mm; previously measuring approximately 51 x 54 mm - Location: left; base; anterior central gland; - T2WI: 5; DWI: 5; DCE (early and focal enhancement): unable to determine; - PI-RADS v2.1 score: 5 - Very high (clinically significant cancer is highly likely to be present); - Likelihood of extraprostatic extension: 5 - Highly likely; involvement of the neural vascular bundle on the left is redemonstrated. Suspected bladder wall involvement also noted. - Likelihood of seminal vesicle invasion: 3 - Indeterminate; There is diffuse homogeneous low signal throughout the prostate, consistent with treatment related effects. Bladder: Within normal limits. Adenopathy: No pathologically enlarged lymph nodes. Previously seen enlarged lymph nodes have decreased in size however the superior field of view is not as high as on the prior exam, so some of the pathologic lymph nodes are not included within the field-of-view on the current study. Bones: No aggressive bony lesions. Other: No significant pelvic free fluid. Note: For more details about the Prostate Imaging-Reporting and Data System (PI-RADS) version 2.1, please visit: http://www.acr.org/Quality-Safety/Resources/PIRADS
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Patchy groundglass densities in the left upper and right middle lobes. No pleural effusion or pneumothorax. 7 mm groundglass nodule in the right upper lobe on image 127 series 601. Tracheobronchial tree is patent. HEART / VESSELS: Duplicated SVC. Otherwise unremarkable. MEDIASTINUM / ESOPHAGUS: Anterior mediastinal hematoma. DIAPHRAGM: Intact. LYMPH NODES: Mildly prominent mediastinal lymph nodes. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. No acute traumatic injury. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Contrast noted within the bilateral collecting systems. Otherwise unremarkable. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is not visualized. The colon is unremarkable. PERITONEUM / MESENTERY: Mild stranding adjacent to the right lateral aspect of the bladder. RETROPERITONEUM: Small right retroperitoneal hematoma tracking superiorly from the right hip. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing inguinal hernias, bilaterally. Fat-containing umbilical hernia. MUSCULOSKELETAL: Mildly displaced mid sternal fracture. Multiple bilateral rib fractures involving the first, second, and six through eighth ribs on the right as well as the anterior 1st and 2nd left ribs. Chronic right lateral seventh rib fracture. Redemonstrated severely comminuted right femoral neck fracture with comminution extension to involve the right femoral head. There is anterior subluxation of the distal fracture fragments. The right femoral head is displaced superiorly and posteriorly with respect to the right acetabulum. This is associated with comminuted displaced fractures of the medial and posterior acetabular walls as well as the acetabular roof. There is a mildly displaced fracture of the right anterior acetabular wall. Associated minimally displaced right inferior pubic ramus fracture. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: Axial images from lumbar spine reformats were not available at the time of dictation. VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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15,477 |
MR Brain wo+w contrast 1/25/2022 9:18 PM Clinical information: 66 years Female patient with AMS Comparison: CT head without contrast dated 1/25/2022 at 06:25 hours. Technique: Multiplanar, multisequence MRI of the brain was performed before and after the administration of intravenous contrast. Patient weight: 319 lbs. IV contrast: ProHance, 10 ml, per protocol. FINDINGS: Cerebral parenchyma: Predominantly frontoparietal age-appropriate brain parenchymal volume loss is again seen. Scattered periventricular and subcortical white matter long TR hyperintense signal foci are seen, suggestive of mild chronic microvascular ischemic disease. 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. Unchanged small left middle cranial fossa arachnoid cyst. 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. Calvarium and skull base: No osseous destruction. Minimal dependent bilateral mastoid effusions. Pituitary and Pineal Glands: Unchanged partially empty sella. No mass lesion. Soft tissues: No significant abnormality. IMPRESSION: 1. No acute intracranial process, abnormal enhancement or significant interval change identified, given differences in technique. 2. Persistent age-appropriate brain involution and mild chronic microvascular ischemic disease.
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FINDINGS: Cerebral parenchyma: Predominantly frontoparietal age-appropriate brain parenchymal volume loss is again seen. Scattered periventricular and subcortical white matter long TR hyperintense signal foci are seen, suggestive of mild chronic microvascular ischemic disease. 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. Unchanged small left middle cranial fossa arachnoid cyst. 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. Calvarium and skull base: No osseous destruction. Minimal dependent bilateral mastoid effusions. Pituitary and Pineal Glands: Unchanged partially empty sella. No mass lesion. Soft tissues: No significant abnormality.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is normal. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Globes are intact. No fracture. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. FACIAL BONES: Bilateral pterygoid plates are intact. Small upper lip laceration containing two tiny radiopaque fragments, possibly retained foreign bodies or fracture fragments from adjacent maxillary teeth. The left central and lateral maxillary incisors appear eroded, however may be fractured given adjacent radiopaque fragment in the upper lip soft tissues. Numerous dental caries. MANDIBLE: Nondisplaced fracture of the anterior right mandibular body (series 305 image 28). Temporomandibular joints are intact. SINONASAL CAVITIES: Mild mucosal thickening of the bilateral maxillary, sphenoid, and ethmoid sinuses..
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EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: hereditary leiomyomatosis COMPARISON: MRI of abdomen dated 12/29/2020 TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 206 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Small cyst between the right and middle hepatic veins. No suspicious hepatic lesion identified. Normal liver morphology. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: No evidence of renal cell carcinoma or other abnormality in the abdomen. 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: Small cyst between the right and middle hepatic veins. No suspicious hepatic lesion identified. Normal liver morphology. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: Limited evaluation of the lower cervical spine and proximal vessels secondary to photon starvation artifact. 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:Follow-up pituitary tumor Comparison:MRI 2/23/2021, 10/14/2020 Technique: Multiplanar multisequence MRI images of the pituitary were obtained before and after intravenous contrast administration. Images include dynamic postcontrast coronal images through the pituitary gland. Patient weight: 219 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 2 ml per sec. Findings: Redemonstration of postsurgical changes of transsphenoidal approach pituitary tumor resection. There is fat packing along the floor of the sella. There is continued leftward deviation of the mid pituitary stalk. Decreased size of the 5x3 mm hypoenhancing tissue in the left sella, previously 9 x 4 mm. There is no evidence of cavernous sinus invasion. There is preservation of the flow void in the bilateral cavernous ICAs. Unchanged downward tenting of the optic chiasm. There is no new intracranial findings in the visualized brain. Impression: Status posts transsphenoidal surgery. Decreased size of the 5 mm hypoenhancing soft tissue in the left sella, small residual tumor versus postsurgical changes.
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Findings: Redemonstration of postsurgical changes of transsphenoidal approach pituitary tumor resection. There is fat packing along the floor of the sella. There is continued leftward deviation of the mid pituitary stalk. Decreased size of the 5x3 mm hypoenhancing tissue in the left sella, previously 9 x 4 mm. There is no evidence of cavernous sinus invasion. There is preservation of the flow void in the bilateral cavernous ICAs. Unchanged downward tenting of the optic chiasm. There is no new intracranial findings in the visualized brain.
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FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Basilar atelectasis and mild volume loss in the left hemithorax. 4 mm nodule in the right major fissure and 4 mm nodule along the right minor fissure, likely fissural lymph nodes. Calcified granuloma in the right lower lobe. No pleural effusion or pneumothorax. The tracheobronchial tree is patent. HEART / VESSELS: Stent within the LAD. No other significant abnormality. MEDIASTINUM / ESOPHAGUS: Small sliding-type hiatal hernia LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Pancreatic steatosis. No other significant abnormality. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Punctate nonobstructing right lower pole renal calculus. Small hypodense right renal lesions are too small to characterize but likely with simple cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Postsurgical changes status post sleeve gastrectomy. Remainder of the bowel is normal in appearance. COLON / APPENDIX: No abnormality. Appendix is surgically absent. PERITONEUM / MESENTERY: Trace free fluid in the pelvis. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is surgically absent. No adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No abnormality of focal aggressive osseous lesion. Moderate to severe degenerative disc disease at L5-S1
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15,480 |
CLINICAL HISTORY: Follow-up aneurysm COMPARISON: MRA 1/12/2021, 4/22/2020, CT 7/6/2020 TECHNIQUE: Axial time-of-flight and postcontrast MR angiography of the brain were performed. Additional 3D post-processing was done with MIP and volume rendered images, which were reviewed for interpretation. Patient weight: 146 lbs. IV contrast: ProHance, 14 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: There are stable changes of coiling of left P-comm aneurysm. There is no evidence of recurrence. There is no intracranial aneurysm, or flow-limiting stenosis. Stable shunted ventricles, without hydrocephalus. IMPRESSION: Status post coil embolization of the left P-comm aneurysm. No evidence of recurrence. No new angiographic findings. Stable shunted ventricles without hydrocephalus
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FINDINGS: There are stable changes of coiling of left P-comm aneurysm. There is no evidence of recurrence. There is no intracranial aneurysm, or flow-limiting stenosis. Stable shunted ventricles, without hydrocephalus.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Normal cerebral cortical volume for patient's age. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. Small midline parietal scalp contusion. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. Chronic defect of the left medial orbital floor. SINUSES: Moderate mucosal thickening of the right maxillary sinus. Small mucous retention cyst in the left maxillary and right sphenoid sinuses. VESSELS: Normal noncontrast appearance of the vessels.
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Clinical Information: Evaluation for brain metastases, comparison with prior MRI Comparison: MRI dated 8/24/2021 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: 130 lbs. IV contrast injection rate: 0.50 ml per sec. Findings: There are scattered areas of periventricular and deep white matter FLAIR hyper signal intensity, likely due to microangiopathic changes. Again noted is an area of FLAIR hyper signal intensity around the aqueduct of Sylvius, unchanged since prior study. The patient is status post right parietal approach ventricular shunt catheter placement with its tip is located in the stable position in the right lateral ventricle. There is diffuse pachymeningeal enhancement, unchanged since prior study, likely due to intracranial hypotension. A stable area of contrast enhancement around the aqueduct of Sylvius is again noted, which has not significantly changed since prior study. No intracranial mass, mass effect, edema, hemorrhage, hydrocephalus, or evidence of acute infarction is seen. The visualized paranasal sinuses and mastoid air cells are clear. Mucous retention cysts in right sphenoid sinus is seen in association with mild mucosal thickening in bilateral ethmoid air cells. No acute osseous or soft tissue abnormality. Impression: 1. No acute intracranial abnormality. 2. Residual post treatment scarring in the region of the pineal gland/periaqueductal region of the midbrain. Stable post shunting related pachymeningeal enhancement. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: There are scattered areas of periventricular and deep white matter FLAIR hyper signal intensity, likely due to microangiopathic changes. Again noted is an area of FLAIR hyper signal intensity around the aqueduct of Sylvius, unchanged since prior study. The patient is status post right parietal approach ventricular shunt catheter placement with its tip is located in the stable position in the right lateral ventricle. There is diffuse pachymeningeal enhancement, unchanged since prior study, likely due to intracranial hypotension. A stable area of contrast enhancement around the aqueduct of Sylvius is again noted, which has not significantly changed since prior study. No intracranial mass, mass effect, edema, hemorrhage, hydrocephalus, or evidence of acute infarction is seen. The visualized paranasal sinuses and mastoid air cells are clear. Mucous retention cysts in right sphenoid sinus is seen in association with mild mucosal thickening in bilateral ethmoid air cells. No acute osseous or soft tissue abnormality.
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FINDINGS: BONES/JOINTS: Displaced fracture through the left femoral neck with comminuted fracture of the right acetabulum. Acetabular fractures involve the posterior wall, roof, and extend into the puboacetabular junction. Femoral head is superiorly and posteriorly displaced and posteriorly angulated within the fractured acetabulum. Although detail is limited, there appear to be small impaction fractures along the anterior posterior femoral head. Minimally displaced right inferior pubic ramus fracture. Pubic symphysis is maintained. No displaced sacral fracture or fracture of the left hip appreciated. SOFT TISSUES: Hematoma and stranding in the soft tissues around the fractures.
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15,482 |
RADIOLOGIC EXAM: MR Brain wo+w contrast CLINICAL INFORMATION: Pituitary tumor, Pituitary protocol. Per chart review, history of pituitary macroadenoma complicated by apoplexy, concern for acromegaly. COMPARISON: MRI brain dated 1/26/2021, 9/23/2020. TECHNIQUE: Multiple T1 and T2-weighted MR sequence images of the pituitary 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: 179 lbs. IV contrast: ProHance, 8 ml, per protocol. IV contrast injection rate: 1 ml per sec. FINDINGS: Trace interval decrease in size of hypoenhancing right sellar lesion, now measuring 8 x 6 x 4 mm in AP by TV by CC (series 11, image 10; series 10, image 8), previously 8 x 8 x 5 mm on MRI from January 2021 (series 801, image 10; series 701, image 10). Marked interval decrease in size compared to initial MRI from September 2020. The lesion again closely approximates the right cavernous ICA without significant encasement. The imaged brain parenchyma and ventricular system are otherwise within normal limits. The imaged paranasal sinuses and mastoid air cells are clear. CONCLUSION: 1. Trace interval decrease in size of hypoenhancing right sellar lesion compared to MRI from January 2021, and marked involution compared to September 2020. 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 interval decrease in size of hypoenhancing right sellar lesion, now measuring 8 x 6 x 4 mm in AP by TV by CC (series 11, image 10; series 10, image 8), previously 8 x 8 x 5 mm on MRI from January 2021 (series 801, image 10; series 701, image 10). Marked interval decrease in size compared to initial MRI from September 2020. The lesion again closely approximates the right cavernous ICA without significant encasement. The imaged brain parenchyma and ventricular system are otherwise within normal limits. The imaged paranasal sinuses and mastoid air cells are clear.
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FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Positive for pulmonary embolus. - Pulmonary Embolus Distribution: Right lower lobe segmental branches (image 74, series #401 and image 27, series #405). - Pulmonary Artery Diameter: Mildly enlarged measuring 3.1 cm, unchanged from prior exam. - Ascending Aortic Diameter: Normal. - RV:LV Ratio: Normal. - Interventricular Septum: Normal. - Contrast reflux into IVC: No significant abnormality. LUNGS / AIRWAYS / PLEURA: Unchanged peripheral and basilar predominant subpleural reticulation and honeycombing with associated central and peripheral bronchiectasis. New focal consolidation in the right middle lobe. No pneumothorax or pleural effusion. Central airways are patent. HEART / OTHER VESSELS: Normal heart size. Trace pericardial effusion. MEDIASTINUM / ESOPHAGUS: Patulous, fluid-filled esophagus. LYMPH NODES: Enlarged mediastinal and lymph nodes, unchanged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Unchanged right hemidiaphragm elevation with the colon hepatic flexure anterior to the liver, consistent with Chilaiditi syndrome. Large amount of stool in the colon, unchanged. MUSCULOSKELETAL: No significant abnormality.
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15,483 |
EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: Evaluate the liver for surgical planning using Eovist. COMPARISON: CT abdomen and pelvis dated 12/15/2021. TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 129 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: Hepatic metastasis in segment VIII is redemonstrated, perhaps minimally increased in size measuring 2.1 x 1.6 cm (series 7, image 17), previously measuring 1.4 x 1.5 cm, though some of the difference in measurement likely due to differences in technique. No additional focal hepatic lesion is identified. Mild loss of parenchymal signal on the opposed phase sequences is suggestive of hepatic steatosis. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Multifocal cortical scarring of the left kidney. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Right hepatic artery arises from the SMA. Atherosclerosis. BODY WALL: Postsurgical changes of anterior abdominal wall. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Redemonstration of segmental VIII hepatic metastasis without additional suspicious hepatic lesion identified. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Hepatic metastasis in segment VIII is redemonstrated, perhaps minimally increased in size measuring 2.1 x 1.6 cm (series 7, image 17), previously measuring 1.4 x 1.5 cm, though some of the difference in measurement likely due to differences in technique. No additional focal hepatic lesion is identified. Mild loss of parenchymal signal on the opposed phase sequences is suggestive of hepatic steatosis. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Multifocal cortical scarring of the left kidney. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Right hepatic artery arises from the SMA. Atherosclerosis. BODY WALL: Postsurgical changes of anterior abdominal wall. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Unchanged encephalomalacia in the right precentral gyrus, right occipital lobe and right cerebellum. Moderate diffuse parenchymal volume loss. Periventricular white matter hypoattenuation consistent with chronic microangiopathic changes. EXTRA-AXIAL SPACES: No extra-axial collections. SKULL AND SKULL BASE: No acute fracture. Bilateral mastoid air cells are clear. VENTRICULAR SYSTEM: Normal. ORBITS: Bilateral pseudophakia. SINUSES: Paranasal sinuses are clear. VESSELS: Normal noncontrast appearance of the vessels.
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15,484 |
CLINICAL HISTORY: Altered mental status COMPARISON: CT head and face performed on 1/12/2022, CT head 1/20/2022 TECHNIQUE: Multiplanar multisequence images of the brain were obtained without intravenous contrast.. FINDINGS: There is no restricted diffusion to suggest an acute infarct. There is no evidence of acute hemorrhage on the susceptibility weighted images. There is a small cortical encephalomalacia involving the posterior left temporal lobe. There are mild periventricular predominant chronic microangiopathic changes. Ventricular caliber and configuration are stable, consistent with mild central predominant chronic parenchymal volume loss. There are small amount of hemorrhagic products in the right sphenoid sinus. There is mild to moderate opacification of the ethmoid air cells. Severe opacification of the right greater than left mastoid air cells The orbits are within normal limits. Fractures are best assessed on the previously performed CT imaging. IMPRESSION: 1. No acute intracranial process. 2. Small cortical encephalomalacia involving the posterior left temporal lobe.
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FINDINGS: There is no restricted diffusion to suggest an acute infarct. There is no evidence of acute hemorrhage on the susceptibility weighted images. There is a small cortical encephalomalacia involving the posterior left temporal lobe. There are mild periventricular predominant chronic microangiopathic changes. Ventricular caliber and configuration are stable, consistent with mild central predominant chronic parenchymal volume loss. There are small amount of hemorrhagic products in the right sphenoid sinus. There is mild to moderate opacification of the ethmoid air cells. Severe opacification of the right greater than left mastoid air cells The orbits are within normal limits. Fractures are best assessed on the previously performed CT imaging.
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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: Unremarkable for unenhanced technique. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Unremarkable for unenhanced technique. SPLEEN: Normal for technique. ADRENALS: Right adrenal adenoma. Left adrenal gland is unremarkable for unenhanced technique. KIDNEYS: Evaluation is limited due to respiratory motion artifact. Hyperattenuating lesion of the posterior right interpolar kidney measuring approximately 2.9 x 2.8 cm (series 3 image 98). There are additional smaller areas of hyperattenuation throughout the right kidney. No hydroureteronephrosis or radiopaque urinary tract calculi bilaterally. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No free intraperitoneal air or fluid. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerotic calcifications of aortoiliac vessels without aneurysmal dilatation. A right right external iliac vein. The common femoral vein central venous catheter is seen with tip terminating at the right common iliac vein. URINARY BLADDER: Collapsed around a Foley catheter. REPRODUCTIVE ORGANS: Prostatomegaly. BODY WALL: Small fat-containing periumbilical hernia. MUSCULOSKELETAL: No aggressive osseous lesion or acute fracture. Advanced intervertebral disc space narrowing with vacuum phenomena at L2-L3 and L4-5.
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15,485 |
MR Breast Bilateral wo Contrast Implant CLINICAL INFORMATION: History of left breast invasive ductal carcinoma status post bilateral total mastectomies with silicone implant reconstructions. Examination performed to evaluate implant integrity. TECHNIQUE: Axial T2 STIR, axial T2 fat saturated, and sagittal T2 water saturation sequences were obtained of the bilateral breasts without intravenous contrast. A dedicated 8 channel breast imaging coil was utilized. COMPARISON: Prior breast MR exams including most recent breast MR dated 9/20/2019 FINDINGS: There are changes of bilateral mastectomies with silicone implant reconstructions. The bilateral silicone implants are intact without evidence of intra or extracapsular rupture. There is no suspicious periimplant fluid. IMPRESSION: Postsurgical changes from bilateral total mastectomies with implant reconstructions. The bilateral silicone implants are intact. Malignancy is not excluded on the basis of this examination. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: There are changes of bilateral mastectomies with silicone implant reconstructions. The bilateral silicone implants are intact without evidence of intra or extracapsular rupture. There is no suspicious periimplant fluid.
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FINDINGS: VASCULATURE: Scattered vascular calcifications. Descending thoracic aorta: No aneurysm, dissection, or stenosis. Abdominal aorta: No aneurysm, dissection, or stenosis. Celiac axis: Active extravasation is noted appearing to arise from the GDA stump off of the common hepatic artery best appreciated on axial series 6 image 92 and axial series 12 image 95. Proximal to this portion there is a significant focal narrowing of the common hepatic artery best appreciated on axial series 6 image 95. Superior mesenteric artery: No aneurysm, dissection, or stenosis. Right renal: Single right renal artery. No aneurysm, dissection, or stenosis. Left renal: Single left renal artery. No aneurysm, dissection, or stenosis. Inferior mesenteric artery: No aneurysm, dissection, or stenosis. Right Common Iliac artery: No aneurysm, dissection, or stenosis. Right External Iliac artery: No aneurysm, dissection, or stenosis. Right Internal Iliac artery: No aneurysm, dissection, or stenosis. Proximal Right Femoral arteries: No aneurysm, dissection, or stenosis. Left Common Iliac artery: No aneurysm, dissection, or stenosis. Left External Iliac artery: No aneurysm, dissection, or stenosis. Left Internal Iliac artery: No aneurysm, dissection, or stenosis. Proximal Left Femoral arteries: No aneurysm, dissection, or stenosis. ------------------------------------------------------------- LOWER CHEST: LUNG BASES: Atelectasis secondary to pleural effusions. PLEURA: Bilateral left greater than right pleural effusions DISTAL ESOPHAGUS: Esophagogastric catheter in place HEART: Partially visualized central venous catheters terminating in the right atrium ABDOMEN and PELVIS: LIVER: Mild periportal edema. BILIARY TRACT: Mild intrahepatic biliary ductal dilatation leading to the hepaticojejunostomy. GALLBLADDER: Absent. PANCREAS: Postsurgical changes of Whipple. The remaining distal pancreas are unremarkable. SPLEEN: Normal. ADRENALS: Symmetric hyperenhancement of the adrenal glands which can be seen with shock. KIDNEYS: Simple right renal cyst. Punctate nonobstructing right lower pole renal calculus. LYMPH NODES: Similar Periportal and and peripancreatic adenopathy. Enlarged mesenteric lymph nodes are also seen STOMACH / SMALL BOWEL: Esophagogastric tube distal tip terminates within the gastric body. Postsurgical changes of Whipple. Diffuse mucosal hyperemia throughout the small bowel. No pneumatosis. COLON / APPENDIX: The appendix appears prominent, similar to prior. Diffuse hyperemia of the colonic mucosa. PERITONEUM / MESENTERY: Multiple tiny foci of free intraperitoneal air likely related to postoperative status, decreased since prior exam. New large volume hemoperitoneum. Three peritoneal surgical drains are similarly positioned. RETROPERITONEUM: Mild retroperitoneal edema. OTHER VESSELS: Right femoral approach central venous catheter is noted. IVC is collapsed. The main portal vein, SMV, and splenic veins appear compressed. URINARY BLADDER: Collapsed around a Foley balloon. Small amount of intraluminal gas. REPRODUCTIVE ORGANS: Prostatomegaly. BODY WALL: Scattered body wall edema. MUSCULOSKELETAL: Mild multilevel discogenic degenerative change.
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CLINICAL INFORMATION: Routine follow up, Cerebral aneurysm. Per chart review, history of basilar apex aneurysm status post coil embolization in 2016, presenting for surveillance imaging. Recent MRA without signs of treated aneurysm recanalization. Additional history of cerebrovascular occlusive disease status post left vertebral artery stent placement in 2013. COMPARISON: 1/26/2021, 1/20/2020 TECHNIQUE: Axial time-of-flight and postcontrast MR angiography of the brain were performed. Additional 3D post-processing was done with MIP and volume rendered images, which were reviewed for interpretation. Patient weight: 170 lbs. IV contrast: ProHance, 16 ml, per protocol. IV contrast injection rate: 1 ml per sec. FINDINGS: ANTERIOR CIRCULATION: Intracranial portion of ICAs are patent with foci of atherosclerosis but without obvious narrowing. There is severe narrowing at the terminus portion of the right ICA. Severe stenosis of the right proximal M1 segment with distal reconstitution but relative paucity of flow in the right MCA distribution, overall unchanged. There is markedly decreased flow signal within the bilateral A1 segments consistent with diffuse severe narrowing/near total occlusion. The left A2 segment appears occluded after its origin. The right ACA is patent but with areas of mild to moderate narrowing at proximal portion of the right A2 segment. The left MCA is normal in course, caliber, and contour. VERTEBROBASILAR SYSTEM: Stable postsurgical changes from basilar tip aneurysm coil embolization. No evidence of aneurysm refilling. Severe stenosis/occlusion of the right intracranial vertebral artery with reconstitution prior to the basilar confluence, likely retrograde filling. The left PCA demonstrate poor flow with moderate diffuse narrowing. There is diffuse narrowing and poor flow signal within the right PCA after P2 segment. _________________________ CONCLUSION: 1. No refilling of the previously coiled basilar tip aneurysm. 2. Severe stenosis of the right ICA terminus, and right proximal M1 segment, severe narrowing/near complete occlusion of bilateral A1 segments, and right V4 segment, overall unchanged. No visible flow within the left ACA which appears occluded. Narrowing at the proximal right A2 segment. Poor flow signal within the bilateral PCAs. Intracranial vascular narrowing is not significantly changed since prior MR angiogram. 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: ANTERIOR CIRCULATION: Intracranial portion of ICAs are patent with foci of atherosclerosis but without obvious narrowing. There is severe narrowing at the terminus portion of the right ICA. Severe stenosis of the right proximal M1 segment with distal reconstitution but relative paucity of flow in the right MCA distribution, overall unchanged. There is markedly decreased flow signal within the bilateral A1 segments consistent with diffuse severe narrowing/near total occlusion. The left A2 segment appears occluded after its origin. The right ACA is patent but with areas of mild to moderate narrowing at proximal portion of the right A2 segment. The left MCA is normal in course, caliber, and contour. VERTEBROBASILAR SYSTEM: Stable postsurgical changes from basilar tip aneurysm coil embolization. No evidence of aneurysm refilling. Severe stenosis/occlusion of the right intracranial vertebral artery with reconstitution prior to the basilar confluence, likely retrograde filling. The left PCA demonstrate poor flow with moderate diffuse narrowing. There is diffuse narrowing and poor flow signal within the right PCA after P2 segment. _________________________
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FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Basilar atelectasis and mild volume loss in the left hemithorax. 4 mm nodule in the right major fissure and 4 mm nodule along the right minor fissure, likely fissural lymph nodes. Calcified granuloma in the right lower lobe. No pleural effusion or pneumothorax. The tracheobronchial tree is patent. HEART / VESSELS: Stent within the LAD. No other significant abnormality. MEDIASTINUM / ESOPHAGUS: Small sliding-type hiatal hernia LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Pancreatic steatosis. No other significant abnormality. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Punctate nonobstructing right lower pole renal calculus. Small hypodense right renal lesions are too small to characterize but likely with simple cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Postsurgical changes status post sleeve gastrectomy. Remainder of the bowel is normal in appearance. COLON / APPENDIX: No abnormality. Appendix is surgically absent. PERITONEUM / MESENTERY: Trace free fluid in the pelvis. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is surgically absent. No adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No abnormality of focal aggressive osseous lesion. Moderate to severe degenerative disc disease at L5-S1
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EXAM: MR Abdomen wo+w contrast, MR Pelvis wo+w contrast, MR Cholangiopancreatography MRCP CLINICAL INFORMATION: Status post liver kidney transplant COMPARISON: None. TECHNIQUE: MR Abdomen wo+w contrast, MR Pelvis wo+w contrast, MR Cholangiopancreatography MRCP Patient weight: 230 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: STRUCTURED REPORT: MRI Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Trace right pleural effusion. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: Mitral valve replacement. ABDOMEN and PELVIS: LIVER: Postsurgical changes of liver transplant. Questionably nodular liver contour. There are a couple small foci of peripheral enhancement with central nonenhancement scattered in the right hepatic lobe, for example on series 1201, images 48 and possibly in the left hepatic lobe on image 43, however, this may represent susceptibility artifact from adjacent surgical material/stomach. There is loss of signal within the hepatic parenchyma on the opposed phase sequences, suggestive of hepatic steatosis. Simple fluid signal intensity along the falciform ligament. No arterially enhancing lesion with washout is identified to suggest hepatocellular carcinoma. BILIARY TRACT/MRCP: The common bile duct is prominent in size measuring approximately 1.1 cm. There is mild stricturing at the hepatic hilum, likely at the anastomosis) series 1301, image 46). Pneumobilia throughout the common bile duct and intrahepatic ducts is again noted. There is mild biliary epithelial enhancement involving the common bile duct and confluence, possibly related to the presence of biliary stents. GALLBLADDER: No abnormality. PANCREAS: Additional subcentimeter cystic focus in the pancreatic neck, possibly representing a side branch IPMN (series 401, image 17). No main pancreatic ductal dilatation. SPLEEN: Enlarged ADRENALS: Normal. KIDNEYS: Subcentimeter cysts involve the native right kidney. Left iliac fossa transplant kidney is unremarkable without hydronephrosis. Homogeneous enhancement. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Trace ill-defined fluid in the right and left upper quadrant. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Incompletely imaged but appears normal. REPRODUCTIVE ORGANS: Not included within the field-of-view. BODY WALL: Postsurgical changes of the anterior abdominal wall and left anterior pelvic wall. Flank edema. Trace free fluid in the pelvis. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Postsurgical changes of liver transplant with a few tiny rim-enhancing foci in the hepatic parenchyma, suggestive of microabscesses. 2. Mild narrowing of the common bile duct at the anastomosis, otherwise no evidence of biliary stricture with patent biliary stents, as evidenced by pneumobilia. Mild biliary epithelial enhancement involving the common bile duct and confluence may be reactive secondary to biliary stent; however, ascending cholangitis is possible. 3. No suspicious lesion to suggest the presence of hepatocellular carcinoma of the transplant liver. 4. Unremarkable appearance of the transplant kidney. 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 Pelvis LOWER CHEST: LUNG BASES / PLEURA: Trace right pleural effusion. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: Mitral valve replacement. ABDOMEN and PELVIS: LIVER: Postsurgical changes of liver transplant. Questionably nodular liver contour. There are a couple small foci of peripheral enhancement with central nonenhancement scattered in the right hepatic lobe, for example on series 1201, images 48 and possibly in the left hepatic lobe on image 43, however, this may represent susceptibility artifact from adjacent surgical material/stomach. There is loss of signal within the hepatic parenchyma on the opposed phase sequences, suggestive of hepatic steatosis. Simple fluid signal intensity along the falciform ligament. No arterially enhancing lesion with washout is identified to suggest hepatocellular carcinoma. BILIARY TRACT/MRCP: The common bile duct is prominent in size measuring approximately 1.1 cm. There is mild stricturing at the hepatic hilum, likely at the anastomosis) series 1301, image 46). Pneumobilia throughout the common bile duct and intrahepatic ducts is again noted. There is mild biliary epithelial enhancement involving the common bile duct and confluence, possibly related to the presence of biliary stents. GALLBLADDER: No abnormality. PANCREAS: Additional subcentimeter cystic focus in the pancreatic neck, possibly representing a side branch IPMN (series 401, image 17). No main pancreatic ductal dilatation. SPLEEN: Enlarged ADRENALS: Normal. KIDNEYS: Subcentimeter cysts involve the native right kidney. Left iliac fossa transplant kidney is unremarkable without hydronephrosis. Homogeneous enhancement. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Trace ill-defined fluid in the right and left upper quadrant. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Incompletely imaged but appears normal. REPRODUCTIVE ORGANS: Not included within the field-of-view. BODY WALL: Postsurgical changes of the anterior abdominal wall and left anterior pelvic wall. Flank edema. Trace free fluid in the pelvis. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: STRUCTURED REPORT: CTA Aorta Runoff VASCULATURE: Abdominal aorta: No aneurysm, dissection, or stenosis. Right Common Iliac artery: No aneurysm, dissection, or stenosis. Right External Iliac artery: No aneurysm, dissection, or stenosis. Right Internal Iliac artery: No aneurysm, dissection, or stenosis. Proximal Right Femoral arteries: No aneurysm, dissection, or stenosis. Right Common Femoral artery: No aneurysm, dissection, or stenosis. Right Deep Femoral artery: No aneurysm, dissection, or stenosis. Right Superficial Femoral artery: No aneurysm, dissection, or stenosis. Right Popliteal artery: No aneurysm, dissection, or stenosis. Right Anterior Tibial artery: No aneurysm, dissection, or stenosis. Patent into the foot. Right Posterior Tibial artery: No aneurysm, dissection, or stenosis. Patent into the foot. Right Peroneal artery: No aneurysm, dissection, or stenosis. Patent to the level of the ankle. Right Foot Arteries: The foot is supplied by patent anterior and posterior tibial arteries. Left Common Iliac artery: No aneurysm, dissection, or stenosis. Left External Iliac artery: No aneurysm, dissection, or stenosis. Left Internal Iliac artery: No aneurysm, dissection, or stenosis. Proximal Left Femoral arteries: No aneurysm, dissection, or stenosis. Left Common Femoral artery: No aneurysm, dissection, or stenosis. Left Deep Femoral artery: No aneurysm, dissection, or stenosis. Left Superficial Femoral artery: No aneurysm, dissection, or stenosis. Left Popliteal artery: No aneurysm, dissection, or stenosis. Left Anterior Tibial artery: No aneurysm, dissection, or stenosis. Patent into the foot. Left Posterior Tibial artery: No aneurysm, dissection, or stenosis. Patent into the foot. Left Peroneal artery: No aneurysm, dissection, or stenosis. Patent to the level of the ankle. Left Foot Arteries: The foot is supplied by patent anterior and posterior tibial arteries. ------------------------------------------------------------- PELVIS: BOWEL: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Redemonstrated right inferior retroperitoneal hematoma associated with the right acetabular fracture. OTHER VESSELS: Stranding surrounding the right internal and external iliac vessels. URINARY BLADDER: Normal with excreted contrast. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing right inguinal hernia. MUSCULOSKELETAL: Redemonstrated right femoral neck and right acetabular fractures without significant interval change to fracture fragment alignment. Redemonstrated right inferior pubic ramus fracture. There is a mildly displaced intra-articular fracture of the posterior tibial plateau. Moderate size right lipohemarthrosis. Right patella appears laterally subluxed. Contusion overlies the anterior right proximal tibia and patellar tendon. Severely comminuted distal left femoral metadiaphyseal fracture with extensive intra-articular extension. Mild posterior dislocation of the distal fracture fragments. No significant shortening. No definitive associated tibial plateau fractures. Associated lipohemarthrosis. Moderate surrounding soft tissue swelling and contusion. Postsurgical changes of prior proximal tibial fixation. Bilateral accessory navicular bones.
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15,488 |
EXAM: MULTIPARAMETRIC MRI OF THE PROSTATE W AND WO IV CONTRAST CLINICAL INDICATION: elevated PSA, R97.20 Elevated prostate specific antigen [PSA] TECHNIQUE: Multiplanar T1-, T2-, and diffusion-weighted imaging of the pelvis were performed on a 3 Tesla scanner. Axial T1-weighted images were obtained before, during, and after administration of intravenous contrast. Patient weight: 184 lbs. IV contrast: ProHance, 17 ml, per protocol. IV contrast injection rate: 2.50 ml per sec. COMPARISON: None. FINDINGS: STRUCTURED REPORT: MRI Prostate PROSTATE: Measurement: 3.6 x 5.0 x 4.4 cm; estimated volume: 41 cc Focal lesion(s): Lesion # 1 (index lesion): - Key image: image 19; series 4 - Size: 13 x 14 mm - Location: left; mid; posterolateral peripheral zone - T2WI: 3; DWI: 1; DCE (early and focal enhancement): negative - PI-RADS v2.1 score: 3 - Intermediate (the presence of clinically significant cancer is equivocal) - Likelihood of extraprostatic extension: 1 - Highly unlikely - Likelihood of seminal vesicle invasion: 1 - Highly unlikely Diffuse prostate abnormalities: Diffusely striated appearance of the peripheral zone on T2WI may reflect prostatitis Other prostate findings: None. VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. BLADDER: Within normal limits. OTHER PELVIC FINDINGS: None. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. Note: For more details about the Prostate Imaging-Reporting and Data System (PI-RADS) version 2.1, please visit: http://www.acr.org/Quality-Safety/Resources/PIRADS CONCLUSION: 1. T2 heterogeneous lesion within the left mid posterior lateral peripheral zone is minimally increased in size today, however demonstrates no postcontrast enhancement or diffusion restriction (PIRADS 3). 2. No additional suspicious lesions throughout the prostate. 3. Mild to moderate BPH with mild prostatitis. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: MRI Prostate PROSTATE: Measurement: 3.6 x 5.0 x 4.4 cm; estimated volume: 41 cc Focal lesion(s): Lesion # 1 (index lesion): - Key image: image 19; series 4 - Size: 13 x 14 mm - Location: left; mid; posterolateral peripheral zone - T2WI: 3; DWI: 1; DCE (early and focal enhancement): negative - PI-RADS v2.1 score: 3 - Intermediate (the presence of clinically significant cancer is equivocal) - Likelihood of extraprostatic extension: 1 - Highly unlikely - Likelihood of seminal vesicle invasion: 1 - Highly unlikely Diffuse prostate abnormalities: Diffusely striated appearance of the peripheral zone on T2WI may reflect prostatitis Other prostate findings: None. VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. BLADDER: Within normal limits. OTHER PELVIC FINDINGS: None. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. Note: For more details about the Prostate Imaging-Reporting and Data System (PI-RADS) version 2.1, please visit: http://www.acr.org/Quality-Safety/Resources/PIRADS
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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 LUNGS / AIRWAYS / PLEURA: Peripheral and basilar predominant patchy opacities throughout both lungs. No pleural effusion or pneumothorax. Airways are patent. HEART / OTHER VESSELS: The heart is mildly enlarged. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No significant abnormality.
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15,489 |
EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: EXAM: MR Abdomen wo+w contrast 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 Abdomen wo+w contrast Patient weight: 213 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 2 ml per sec. 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. COMPARISON: None. TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 213 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: CONCLUSION:
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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: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Normal cerebral cortical volume for patient's age. Empty sella. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Near complete opacification of the bilateral ethmoid and sphenoid sinuses with mild mucosal thickening of the bilateral maxillary sinuses. Hyperattenuating contents within the right ethmoid air cells which may be secondary to proteinaceous contents or fungal colonization. VESSELS: Normal noncontrast appearance of the vessels.
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15,490 |
EXAM: MR Abdomen wo+w contrast, MR Pelvis wo+w contrast, MR Cholangiopancreatography MRCP CLINICAL INFORMATION: Status post liver kidney transplant COMPARISON: None. TECHNIQUE: MR Abdomen wo+w contrast, MR Pelvis wo+w contrast, MR Cholangiopancreatography MRCP Patient weight: 230 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: STRUCTURED REPORT: MRI Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Trace right pleural effusion. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: Mitral valve replacement. ABDOMEN and PELVIS: LIVER: Postsurgical changes of liver transplant. Questionably nodular liver contour. There are a couple small foci of peripheral enhancement with central nonenhancement scattered in the right hepatic lobe, for example on series 1201, images 48 and possibly in the left hepatic lobe on image 43, however, this may represent susceptibility artifact from adjacent surgical material/stomach. There is loss of signal within the hepatic parenchyma on the opposed phase sequences, suggestive of hepatic steatosis. Simple fluid signal intensity along the falciform ligament. No arterially enhancing lesion with washout is identified to suggest hepatocellular carcinoma. BILIARY TRACT/MRCP: The common bile duct is prominent in size measuring approximately 1.1 cm. There is mild stricturing at the hepatic hilum, likely at the anastomosis) series 1301, image 46). Pneumobilia throughout the common bile duct and intrahepatic ducts is again noted. There is mild biliary epithelial enhancement involving the common bile duct and confluence, possibly related to the presence of biliary stents. GALLBLADDER: No abnormality. PANCREAS: Additional subcentimeter cystic focus in the pancreatic neck, possibly representing a side branch IPMN (series 401, image 17). No main pancreatic ductal dilatation. SPLEEN: Enlarged ADRENALS: Normal. KIDNEYS: Subcentimeter cysts involve the native right kidney. Left iliac fossa transplant kidney is unremarkable without hydronephrosis. Homogeneous enhancement. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Trace ill-defined fluid in the right and left upper quadrant. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Incompletely imaged but appears normal. REPRODUCTIVE ORGANS: Not included within the field-of-view. BODY WALL: Postsurgical changes of the anterior abdominal wall and left anterior pelvic wall. Flank edema. Trace free fluid in the pelvis. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Postsurgical changes of liver transplant with a few tiny rim-enhancing foci in the hepatic parenchyma, suggestive of microabscesses. 2. Mild narrowing of the common bile duct at the anastomosis, otherwise no evidence of biliary stricture with patent biliary stents, as evidenced by pneumobilia. Mild biliary epithelial enhancement involving the common bile duct and confluence may be reactive secondary to biliary stent; however, ascending cholangitis is possible. 3. No suspicious lesion to suggest the presence of hepatocellular carcinoma of the transplant liver. 4. Unremarkable appearance of the transplant kidney. 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 Pelvis LOWER CHEST: LUNG BASES / PLEURA: Trace right pleural effusion. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: Mitral valve replacement. ABDOMEN and PELVIS: LIVER: Postsurgical changes of liver transplant. Questionably nodular liver contour. There are a couple small foci of peripheral enhancement with central nonenhancement scattered in the right hepatic lobe, for example on series 1201, images 48 and possibly in the left hepatic lobe on image 43, however, this may represent susceptibility artifact from adjacent surgical material/stomach. There is loss of signal within the hepatic parenchyma on the opposed phase sequences, suggestive of hepatic steatosis. Simple fluid signal intensity along the falciform ligament. No arterially enhancing lesion with washout is identified to suggest hepatocellular carcinoma. BILIARY TRACT/MRCP: The common bile duct is prominent in size measuring approximately 1.1 cm. There is mild stricturing at the hepatic hilum, likely at the anastomosis) series 1301, image 46). Pneumobilia throughout the common bile duct and intrahepatic ducts is again noted. There is mild biliary epithelial enhancement involving the common bile duct and confluence, possibly related to the presence of biliary stents. GALLBLADDER: No abnormality. PANCREAS: Additional subcentimeter cystic focus in the pancreatic neck, possibly representing a side branch IPMN (series 401, image 17). No main pancreatic ductal dilatation. SPLEEN: Enlarged ADRENALS: Normal. KIDNEYS: Subcentimeter cysts involve the native right kidney. Left iliac fossa transplant kidney is unremarkable without hydronephrosis. Homogeneous enhancement. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Trace ill-defined fluid in the right and left upper quadrant. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Incompletely imaged but appears normal. REPRODUCTIVE ORGANS: Not included within the field-of-view. BODY WALL: Postsurgical changes of the anterior abdominal wall and left anterior pelvic wall. Flank edema. Trace free fluid in the pelvis. MUSCULOSKELETAL: No significant abnormality.
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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: Normal. DISTAL ESOPHAGUS: Small hiatal hernia. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Previously noted right adrenal nodule is better appreciated on the prior exam. KIDNEYS: The right kidney is surgically absent. No definitive CT evidence of recurrence within the limitations of a noncontrast exam. The left kidney is normal. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix and colon are unremarkable aside from scattered colonic diverticula. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered vascular calcifications. Otherwise unremarkable for technique. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is absent. No adnexal mass. BODY WALL: Fat-containing umbilical hernia. MUSCULOSKELETAL: Mild multilevel discogenic degenerative change.
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15,491 |
EXAM: MR Brain wo+w contrast CLINICAL INFORMATION: Pituitary mass. COMPARISON: Multiple priors most recently dated 12/2/2021. TECHNIQUE: MR Brain wo+w contrast. Patient weight: 223 lbs. IV contrast: ProHance, 20 ml, per protocol. FINDINGS: Relatively hypoenhancing T2 hypointense lesion within the right aspect of the sella extending to involve the right cavernous sinus is redemonstrated and not significantly changed when compared to prior now measuring 1.8 x 1.4 cm (previously 1.8 x 1.4 cm). Persistent increased T1 signal along the left lateral aspect of this lesion shows slight interval decrease in conspicuity when compared to prior. No significant associated mass effect is noted on the adjacent optic chiasm. No abnormal increased signal within the optic chiasm or prechiasmatic right optic nerve. There is persistent abutment to the cavernous portion of the right ICA without associated vascular narrowing or loss of the expected vascular flow void. No abnormal bone marrow signal. Heterogeneous contents are noted within the right sphenoid sinus. There is also mucosal thickening involving the bilateral maxillary sinuses. The visualized orbits are normal.The visualized soft tissues are unremarkable. CONCLUSION: Redemonstrated right sellar mass involving the right cavernous sinus is unchanged in size when compared to prior with expected interval evolution of the previously noted increased T1 signal along its left lateral aspect likely resolving blood products. There is persistent abutment to the cavernous portion of the right internal carotid artery as well as the optic chiasm without significant mass effect. 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: Relatively hypoenhancing T2 hypointense lesion within the right aspect of the sella extending to involve the right cavernous sinus is redemonstrated and not significantly changed when compared to prior now measuring 1.8 x 1.4 cm (previously 1.8 x 1.4 cm). Persistent increased T1 signal along the left lateral aspect of this lesion shows slight interval decrease in conspicuity when compared to prior. No significant associated mass effect is noted on the adjacent optic chiasm. No abnormal increased signal within the optic chiasm or prechiasmatic right optic nerve. There is persistent abutment to the cavernous portion of the right ICA without associated vascular narrowing or loss of the expected vascular flow void. No abnormal bone marrow signal. Heterogeneous contents are noted within the right sphenoid sinus. There is also mucosal thickening involving the bilateral maxillary sinuses. The visualized orbits are normal.The visualized soft tissues are unremarkable.
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Findings: Persistent tiny focus of air in the right temporal convexity. No evidence of intra-axial or extra-axial hemorrhage. Unchanged appearance of arachnoid cyst in left middle cranial fossa. No brain edema, mass effect or midline shift. Redemonstration of right temporal bone fracture. Persistent bilateral mastoid effusions.
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15,492 |
EXAM: MULTIPARAMETRIC MRI OF THE PROSTATE W AND WO IV CONTRAST CLINICAL INDICATION: Prostate cancer, active surveillance, low risk of prostate cancer (Gleason 3+3 = 6, grade group 1) diagnosed by TRUS biopsy on 2/27/2019. Most recent biopsy on 6/23/2020 revealed 5/13 cores positive for grade group 1 cancer (left lateral mid gland, left apex, right lateral mid gland, right lateral apex, and targeted lesion from prior MRI) PSA trend: 10/19/2021: 5.56 ng/mL (outside facility) 04/19/2021: 4.72 ng/mL (outside facility) 02/26/2020 : 6.39 ng/mL 08/29/2019 : 4.49 ng/mL (outside facility) 11/01/2018 : 4.12 ng/mL (outside facility) 11/03/2017 : 4.09 ng/mL (outside facility) TECHNIQUE: Multiplanar T1-, T2-, and diffusion-weighted imaging of the pelvis were performed on a 3 Tesla scanner. Axial T1-weighted images were obtained before, during, and after administration of intravenous contrast. Patient weight: 193 lbs. IV contrast: ProHance, 19 ml, per protocol. IV contrast injection rate: 2.50 ml per sec. COMPARISON: MRI of the prostate dated 2/26/2020 FINDINGS: STRUCTURED REPORT: MRI Prostate PROSTATE: Measurement: 5.6 x 4.4 x 5.9 cm; estimated volume: 76 cc, PSA density = 0.07 Focal lesion(s): 3. A previously described fourth small lesion in the anterior central gland is not identifiable today. Lesion # 1 (index lesion): - Key image: image 14; series 501 - Size: 15 mm, unchanged from prior - Location: left; mid; anterior peripheral zone - T2WI: 5 ; DWI: 5; DCE (early and focal enhancement): negative - PI-RADS v2.1 score: 5 - Very high (clinically significant cancer is highly likely to be present) - Likelihood of extraprostatic extension: 2 - Unlikely - Likelihood of seminal vesicle invasion: 1 - Highly unlikely Lesion # 2: - Key image: image 10; series 501 - Size: 6 mm, unchanged from prior - Location: left; apex; posterolateral peripheral zone - T2WI: 4 ; DWI: 3; DCE (early and focal enhancement): negative - PI-RADS v2.1 score: 3 - Intermediate (the presence of clinically significant cancer is equivocal) - Likelihood of extraprostatic extension: 1 - Highly unlikely - Likelihood of seminal vesicle invasion: 1 - Highly unlikely Lesion # 3: - Key image: image 10; series 501 - Size: 13 mm perhaps minimally increased in size since the prior exam. - Location: right; mid; anterior central gland - T2WI:4; DWI: 4; DCE (early and focal enhancement): negative - PI-RADS v2.1 score: 4 - High (clinically significant cancer is likely to be present) - Likelihood of extraprostatic extension: 2 - Unlikely - Likelihood of seminal vesicle invasion: 2 - Unlikely Diffuse prostate abnormalities: Diffusely striated appearance of the peripheral zone on T2WI may reflect prostatitis Other prostate findings: None. VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. BLADDER: Within normal limits. OTHER PELVIC FINDINGS: None. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. Note: For more details about the Prostate Imaging-Reporting and Data System (PI-RADS) version 2.1, please visit: http://www.acr.org/Quality-Safety/Resources/PIRADS CONCLUSION: Focal prostate lesions as listed, grossly unchanged in size from the prior exam, aside from the PI-RADS 4 lesion in the right apex anterior central gland, which may be minimally increased in size. No suspicious pelvic lymphadenopathy or evidence of extraprostatic 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: STRUCTURED REPORT: MRI Prostate PROSTATE: Measurement: 5.6 x 4.4 x 5.9 cm; estimated volume: 76 cc, PSA density = 0.07 Focal lesion(s): 3. A previously described fourth small lesion in the anterior central gland is not identifiable today. Lesion # 1 (index lesion): - Key image: image 14; series 501 - Size: 15 mm, unchanged from prior - Location: left; mid; anterior peripheral zone - T2WI: 5 ; DWI: 5; DCE (early and focal enhancement): negative - PI-RADS v2.1 score: 5 - Very high (clinically significant cancer is highly likely to be present) - Likelihood of extraprostatic extension: 2 - Unlikely - Likelihood of seminal vesicle invasion: 1 - Highly unlikely Lesion # 2: - Key image: image 10; series 501 - Size: 6 mm, unchanged from prior - Location: left; apex; posterolateral peripheral zone - T2WI: 4 ; DWI: 3; DCE (early and focal enhancement): negative - PI-RADS v2.1 score: 3 - Intermediate (the presence of clinically significant cancer is equivocal) - Likelihood of extraprostatic extension: 1 - Highly unlikely - Likelihood of seminal vesicle invasion: 1 - Highly unlikely Lesion # 3: - Key image: image 10; series 501 - Size: 13 mm perhaps minimally increased in size since the prior exam. - Location: right; mid; anterior central gland - T2WI:4; DWI: 4; DCE (early and focal enhancement): negative - PI-RADS v2.1 score: 4 - High (clinically significant cancer is likely to be present) - Likelihood of extraprostatic extension: 2 - Unlikely - Likelihood of seminal vesicle invasion: 2 - Unlikely Diffuse prostate abnormalities: Diffusely striated appearance of the peripheral zone on T2WI may reflect prostatitis Other prostate findings: None. VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. BLADDER: Within normal limits. OTHER PELVIC FINDINGS: None. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. Note: For more details about the Prostate Imaging-Reporting and Data System (PI-RADS) version 2.1, please visit: http://www.acr.org/Quality-Safety/Resources/PIRADS
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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: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: 2.2 x 1.2 cm fat density right adrenal nodule either representing an adenoma or myelolipoma. KIDNEYS: Multiple right and left simple renal cysts. Multiple bilateral small nonobstructing renal calculi are noted the largest of which is within the right kidney and measures 3 mm. The right ureter is mildly prominent and shows a small amount of adjacent inflammatory stranding. At the distal aspect of the right ureter there is a small calculus measuring 3.5 mm. Minimal associated hydronephrosis and borderline hydroureter. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix and colon are normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Mild inflammatory stranding adjacent to the right ureter. VESSELS: Unremarkable for technique. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Trace hydroceles. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Moderate degenerative change at L2-L3 with associated bilateral L2 pars defects.
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15,493 |
EXAM: MR Angio Head wo contrast 1/25/2022 9:54 AM CLINICAL INFORMATION: F/u aneurysms. Per chart review, history of unruptured small bilateral ICA aneurysms, presenting for annual surveillance. COMPARISON: MRI/MRA brain dated 1/26/2021, 8/19/2019. TECHNIQUE: MRA of the head was performed without intravenous contrast utilizing 3-D time-of-flight technique. Multiple MIP images were generated. FINDINGS: INTERNAL CAROTID ARTERIES: No significant interval change in size or appearance of tiny 2.5 mm outpouchings projecting superiorly from the bilateral supraclinoid ICAs, likely paraophthalmic artery aneurysms (series 401, images 67 and 64). Otherwise normal in course, caliber, and contour. CEREBRAL ARTERIES: Normal in course, caliber, and contour. VERTEBROBASILAR SYSTEM: Mild to moderate narrowings in the right posterior cerebral artery. There is no evidence of vascular malformation or large vessel occlusion. Right posteromedial cerebellar hemisphere chronic lacunar infarct and bilateral basal ganglia dilated perivascular spaces, unchanged. The imaged ventricular system is normal in caliber. Cavum septum pellucidum et vergae, incidental variant. _________________________ CONCLUSION: 1. Stable-appearing bilateral paraophthalmic artery aneurysms arising from the supraclinoid ICAs, measuring up to 2.5 mm on the right side. 2. Mild to moderate narrowings in the right posterior cerebral artery. 3. Right cerebellar hemisphere chronic lacunar infarct, unchanged. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: INTERNAL CAROTID ARTERIES: No significant interval change in size or appearance of tiny 2.5 mm outpouchings projecting superiorly from the bilateral supraclinoid ICAs, likely paraophthalmic artery aneurysms (series 401, images 67 and 64). Otherwise normal in course, caliber, and contour. CEREBRAL ARTERIES: Normal in course, caliber, and contour. VERTEBROBASILAR SYSTEM: Mild to moderate narrowings in the right posterior cerebral artery. There is no evidence of vascular malformation or large vessel occlusion. Right posteromedial cerebellar hemisphere chronic lacunar infarct and bilateral basal ganglia dilated perivascular spaces, unchanged. The imaged ventricular system is normal in caliber. Cavum septum pellucidum et vergae, incidental variant. _________________________
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Findings: There is large area loss of gray-white differentiation in the right MCA territory involving the right frontal and parietal lobes. There is also loss of gray-white infiltration in the left frontal lobe suggestive of left MCA territory infarction. There is no acute hemorrhage or significant mass effect. The vessels are diffusely hyperdense likely secondary to recent contrast administration. There is no intracranial mass or hydrocephalus. There is no acute osseous abnormality. There is mucosal thickening within the right maxillary, ethmoid and bilateral sphenoid sinuses. There is a small to moderate-sized left maxillary sinus extension cysts. The mastoid air cells are clear.
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15,494 |
EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: 65-year-old man with history of hepatitis C cirrhosis and previously treated hepatocellular carcinoma (sequential TACE and ablation in April 2020), undergoing evaluation for potential transplantation. COMPARISON: 10/19/2021 TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 160 lbs. IV contrast: ProHance, 15 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: STRUCTURED REPORT: MR HCC Follow-up IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. No steatosis. A few subcentimeter nonenhancing cysts are unchanged. No perfusional abnormalities are noted (previous report described dome LR 3 lesion). TREATED LIVER LESIONS: - Lesion Number: 1 - Description: Ablation defect 4.3 x 2.6 cm (image 48 series 605); was 4.2 x 2.4 cm (image 214 series 1003) on 10/19/2021. - Location: Segment(s) lateral VI - Size of largest enhancing portion of the mass: Along the anterior superior margin, a 1.3 x 0.9 cm focus of arterial phase enhancement is seen (image 60 series 603-T1 arterial); was 1.1 x 0.6 cm (image 242 series 1003). - Enhancement: Nodular, masslike, or thick irregular tissue in or along the treated lesion - Additional features: - Arterial phase hyperenhancement: Present. - Washout: Not present. - Enhancement similar to pretreatment: Not present. - Vascular invasion: No - LI-RADS: LR-TR Equivocal, unchanged UNTREATED OR NEW LIVER LESION(S): None LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: Small (
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FINDINGS: STRUCTURED REPORT: MR HCC Follow-up IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. No steatosis. A few subcentimeter nonenhancing cysts are unchanged. No perfusional abnormalities are noted (previous report described dome LR 3 lesion). TREATED LIVER LESIONS: - Lesion Number: 1 - Description: Ablation defect 4.3 x 2.6 cm (image 48 series 605); was 4.2 x 2.4 cm (image 214 series 1003) on 10/19/2021. - Location: Segment(s) lateral VI - Size of largest enhancing portion of the mass: Along the anterior superior margin, a 1.3 x 0.9 cm focus of arterial phase enhancement is seen (image 60 series 603-T1 arterial); was 1.1 x 0.6 cm (image 242 series 1003). - Enhancement: Nodular, masslike, or thick irregular tissue in or along the treated lesion - Additional features: - Arterial phase hyperenhancement: Present. - Washout: Not present. - Enhancement similar to pretreatment: Not present. - Vascular invasion: No - LI-RADS: LR-TR Equivocal, unchanged UNTREATED OR NEW LIVER LESION(S): None LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: Small (
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Findings: Examination is markedly limited secondary to abnormal selection of arterial vessel on the superior slab acquisition (image 7 series 2011) Color parametric maps demonstrate large right MCA territory perfusion mismatch. There is reduced cerebral blood flow in the right MCA territory volume of one 25 mL greater than 70% reduction. There is Mismatch volume of 199. Prognostic maps demonstrate large region of completed infarction involving the right MCA territory.
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15,495 |
EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: Hepatocellular carcinoma surveillance. COMPARISON: MRI of abdomen dated 10/19/2021 TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 200 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: STRUCTURED REPORT: MR HCC Screening IMAGE QUALITY: Satisfactory except that the postcontrast sequences are degraded by motion artifact. LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. No steatosis. Postsurgical changes from left hepatectomy. While the postcontrast sequences are degraded by motion artifact, there is no definite focal lesion demonstrating arterial hyperenhancement or washout. LIVER LESIONS: None LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: None. - Other varices or collaterals: None. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: Sludge in the gallbladder. LYMPH NODES: None enlarged. SPLEEN: Normal size and appearance. PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Bilateral renal cysts. No hydronephrosis. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Unchanged 2 cm cystic lesion posterior to the right crux of the diaphragm (series 501, image 21), likely lymphocele. OTHER VESSELS: No significant abnormality. BODY WALL: Postsurgical changes of the anterior abdominal wall. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Postsurgical changes from left hepatectomy without new suspicious hepatic lesion identified. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: MR HCC Screening IMAGE QUALITY: Satisfactory except that the postcontrast sequences are degraded by motion artifact. LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. No steatosis. Postsurgical changes from left hepatectomy. While the postcontrast sequences are degraded by motion artifact, there is no definite focal lesion demonstrating arterial hyperenhancement or washout. LIVER LESIONS: None LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: None. - Other varices or collaterals: None. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: Sludge in the gallbladder. LYMPH NODES: None enlarged. SPLEEN: Normal size and appearance. PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Bilateral renal cysts. No hydronephrosis. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Unchanged 2 cm cystic lesion posterior to the right crux of the diaphragm (series 501, image 21), likely lymphocele. OTHER VESSELS: No significant abnormality. BODY WALL: Postsurgical changes of the anterior abdominal wall. MUSCULOSKELETAL: No significant abnormality.
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Findings: The nasopharynx and oropharynx are normal in appearance. The base of the tongue and lymphoid tissue within Waldeyer's ring are unremarkable. Tracheostomy tube in place. The hypopharynx and larynx otherwise appear normal. No discrete mass or lymphadenopathy is identified in the neck. The parotid, submandibular, and thyroid glands appear normal. Included portions of the brain and skull base appear normal. The visualized paranasal sinuses and mastoid air cells are clear. Postsurgical changes from C6-T1 ACDF. Loss of the normal cervical lordosis. Chronic fracture deformity of the right clavicle.
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15,496 |
RADIOLOGIC EXAM: MR Brain wo+w contrast CLINICAL INFORMATION: Prolactinoma, evaluate sella. COMPARISON: MRI brain dated 1/19/2021, 1/14/2020. TECHNIQUE: Multiple T1 and T2-weighted MR sequence images of the pituitary were obtained in the sagittal axial and coronal planes pre- and post administration of intravenous contrast per departmental pituitary protocol. MR Brain wo+w contrast Patient weight: 180 lbs. IV contrast: ProHance, 17 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: No significant interval change in size or appearance of hypoenhancing right sellar lesion with slight right cavernous sinus invasion, now measuring 8 x 6 x 6 mm in AP by TV by CC (series 8, image 11; series 7, image 7), previously 8 x 5 x 6 mm (series 11, image 10; series 10, image 7). The lesion demonstrates mild encroachment upon the right cavernous ICA with less than 180 degree encasement. The bilateral cavernous ICAs are otherwise patent. The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. The imaged paranasal sinuses and mastoid air cells are clear. CONCLUSION: 1. Stable subcentimeter hypoenhancing right sellar lesion with slight right cavernous sinus invasion and mild right cavernous ICA encasement, likely pituitary adenoma. 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 significant interval change in size or appearance of hypoenhancing right sellar lesion with slight right cavernous sinus invasion, now measuring 8 x 6 x 6 mm in AP by TV by CC (series 8, image 11; series 7, image 7), previously 8 x 5 x 6 mm (series 11, image 10; series 10, image 7). The lesion demonstrates mild encroachment upon the right cavernous ICA with less than 180 degree encasement. The bilateral cavernous ICAs are otherwise patent. The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. The imaged paranasal sinuses and mastoid air cells are clear.
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FINDINGS: BRAIN PARENCHYMA: Unchanged small right frontal lobe hemorrhagic contusion. No new intraparenchymal hemorrhage. Gray-white matter differentiation is maintained. No evidence of acute infarction. Normal cerebral cortical volume. EXTRA-AXIAL SPACES: Interval improvement in the small subarachnoid hemorrhage layering in the right hemisphere cortical sulci. No new extra-axial collections. SKULL AND SKULL BASE: Nondisplaced left temporal parietal calvarial fracture extending into the left mastoid air cells. Left mastoid effusion. Right mastoid air cells are clear. Evolving left parietotemporal hematoma and left periorbital hematoma. Soft tissue swelling about the right parieto-occipital scalp. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Mild mucosal thickening of the bilateral ethmoid and sphenoid sinuses. VESSELS: Normal noncontrast appearance of the vessels.
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15,497 |
EXAM: MR Lumbar Spine wo+w contrast CLINICAL INFORMATION: Male patient 47 years with cf spinal compression TECHNIQUE: Sagittal T2, sagittal T1, sagittal STIR, axial T2 and axial T1-weighted images of the lumbar spine were obtained without intravenous gadolinium. In addition sagittal T1 and axial T1-weighted images were obtained after the intravenous administration of gadolinium. Technique: Patient weight: 356 lbs. IV contrast: ProHance, 10 ml, per protocol. COMPARISON: Lumbar spine radiographs dated 1/24/2022 FINDINGS: There is no loss of height of the lumbar vertebrae and no malalignment. There is a small T1 and T2 hyperintense lesion within the L3 and also within the T11 vertebral body likely representing incidental hemangioma. There is no prevertebral soft tissue swelling Conus medullaris terminates at the L1 level. Visualized inferior thoracic spinal cord is unremarkable. Nerve roots of the cauda equina appear within normal limits. There is disc desiccation and mild loss of disc height at both L3-L4 and L4-L5. Degenerative changes will be described below. T12-L1. No disc herniation. There is mild bilateral facet arthropathy. No central canal narrowing or neural foraminal narrowing L1-L2: No disc herniation. Mild bilateral facet arthropathy. No central canal narrowing or neural foraminal narrowing. L2-L3: No disc herniation. There is mild bilateral facet arthropathy. No central canal narrowing or neural foraminal narrowing. L3-L4: Broad disc bulge lateralized to the left. There is mild central canal narrowing. There is moderate bilateral facet arthropathy with fluid in the facet joints. There is also left foraminal disc protrusion. There is mild to moderate left neural foraminal narrowing and mild right neural foraminal narrowing. There is no exiting nerve root impingement L4-L5: Broad disc bulge. There is a small superimposed right foraminal disc protrusion. There is moderate bilateral hypertrophic facet arthropathy with fluid in the facet joints. There is moderate right and mild left neural foraminal narrowing without exiting nerve root impingement. There may be contact of the exiting right L4 nerve root. L5-S1: No disc herniation. There is no significant facet arthropathy. Postcontrast images demonstrate no abnormal osseous enhancement. There is however significant enhancement involving the right greater than left L3-L4 facet joints reflecting synovitis on degenerative basis. There is also mild enhancement of the L4-L5 facet joints bilaterally representing synovitis on degenerative basis, CONCLUSION: 01. Significant facet arthropathy of the lumbar spine, greatest at L3-L4. There is significant enhancement of the facet joints bilaterally at this level, particularly on the right reflecting active synovitis on degenerative basis. There is also synovitis on degenerative basis at L4-L5-1 lesser extent. 02. There is moderate right-sided neural foraminal narrowing at L4-L5 with possible contact but no definite impingement of the exiting right L4 nerve root. There is mild neural foraminal narrowing on the left at this level and bilaterally at L3-L4. There is no significant spinal canal narrowing.
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FINDINGS: There is no loss of height of the lumbar vertebrae and no malalignment. There is a small T1 and T2 hyperintense lesion within the L3 and also within the T11 vertebral body likely representing incidental hemangioma. There is no prevertebral soft tissue swelling Conus medullaris terminates at the L1 level. Visualized inferior thoracic spinal cord is unremarkable. Nerve roots of the cauda equina appear within normal limits. There is disc desiccation and mild loss of disc height at both L3-L4 and L4-L5. Degenerative changes will be described below. T12-L1. No disc herniation. There is mild bilateral facet arthropathy. No central canal narrowing or neural foraminal narrowing L1-L2: No disc herniation. Mild bilateral facet arthropathy. No central canal narrowing or neural foraminal narrowing. L2-L3: No disc herniation. There is mild bilateral facet arthropathy. No central canal narrowing or neural foraminal narrowing. L3-L4: Broad disc bulge lateralized to the left. There is mild central canal narrowing. There is moderate bilateral facet arthropathy with fluid in the facet joints. There is also left foraminal disc protrusion. There is mild to moderate left neural foraminal narrowing and mild right neural foraminal narrowing. There is no exiting nerve root impingement L4-L5: Broad disc bulge. There is a small superimposed right foraminal disc protrusion. There is moderate bilateral hypertrophic facet arthropathy with fluid in the facet joints. There is moderate right and mild left neural foraminal narrowing without exiting nerve root impingement. There may be contact of the exiting right L4 nerve root. L5-S1: No disc herniation. There is no significant facet arthropathy. Postcontrast images demonstrate no abnormal osseous enhancement. There is however significant enhancement involving the right greater than left L3-L4 facet joints reflecting synovitis on degenerative basis. There is also mild enhancement of the L4-L5 facet joints bilaterally representing synovitis on degenerative basis,
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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. Main pulmonary artery is normal in size. LUNGS / AIRWAYS / PLEURA: Diffuse mosaic attenuation of the lungs with intralobular septal thickening throughout,. There are areas of peripheral groundglass opacity within the lateral segment middle lobe and lingula. No dense consolidation bilaterally. Small bilateral pleural effusions with adjacent passive atelectasis. HEART / OTHER VESSELS: Mild cardiomegaly with left atrial dilatation. Trace pericardial effusion. Moderate calcifications versus stenting of the LAD. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Imaged portions of superior abdomen are unremarkable for arterial phase technique. MUSCULOSKELETAL: No evidence for aggressive osseous lesion or acute fracture. Small benign fibro-osseous lesion the right lateral sixth noted.
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15,498 |
MR Breast Screening wo+w contrast Clinical Information: Other, N60.92 Unspecified benign mammary dysplasia of left breast, Z80.3 Family history of malignant neoplasm of breast Spec Inst: +personal hx of ADH, +family hx of breast cancer, LT risk >20% Technique: Three plane localizer, T1 axial, FSE T2 fat sat axial, pre and post contrast vibrant sequence with 3D reconstructions and time intensity curves. Delayed post contrast sagittals. Patient weight: 153 lbs. IV contrast: ProHance, 14 ml, per protocol. IV contrast injection rate: 2 ml per sec. Comparison: Mammogram 1/25/2022 Amount of fibroglandular tissue: Scattered fibroglandular tissue Background enhancement: Minimal Findings: Right breast: There is an enhancing mass at 3:00 right breast, measuring 2 x 3 x 5 mm (Series 400 image #127, Series 6 image #142). Left breast: There are no suspicious masses or suspicious enhancement in the left breast. Lymph nodes: No axillary lymphadenopathy on either side. No internal mammary lymphadenopathy on either side. Conclusion: Right breast: 5 mm enhancing mass at 3:00 right breast. Further evaluation with ultrasound is recommended. If no ultrasound correlate, six months follow-up MRI is recommended. BI-RADS 3: Probably benign findings Left breast: No MRI evidence of malignancy. BI-RADS 1: Negative Final BIRADS; BI-RADS 3: Probably benign findings
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Findings: Right breast: There is an enhancing mass at 3:00 right breast, measuring 2 x 3 x 5 mm (Series 400 image #127, Series 6 image #142). Left breast: There are no suspicious masses or suspicious enhancement in the left breast. Lymph nodes: No axillary lymphadenopathy on either side. No internal mammary lymphadenopathy on either side.
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FINDINGS: BONES/JOINTS: Severely comminuted and displaced fractures of the distal femur, extending from the diaphysis to the trochlea and articular surface of both femoral condyles. Mild impaction with slight medial angulation of the distal femoral condyles, in relation to the femoral diaphysis. Proximal tibial hardware is associated with remote healed proximal tibial fracture. There is subtle articular surface lucency along the anterior medial tibial plateau, concerning for acute on chronic fracture. Within the limits of the study, no additional acute displaced tibial, fibular, or patellar fracture SOFT TISSUES: Hematoma around the fractures. No involvement of the distal femoral or popliteal vasculature. Lipohemarthrosis.
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15,499 |
EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: Splenic lesions COMPARISON: CT dated 12/21/2021. 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: Tiny cyst in the anterior right hepatic lobe (series 7, image 15). No suspicious hepatic lesion identified.. BILIARY TRACT: Normal. Excretion is seen into the normal caliber biliary system at 15 minutes. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Spleen is enlarged measuring approximately 16 cm. There are three splenic lesions identified, the largest measuring up to 4.0 cm long axis. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: Multiple enlarged retroperitoneal lymph nodes are present, for example a left periaortic lymph node measures approximately 2.4 x 1.6 cm (series 553, image 43). The adenopathy was seen in part on the inferior images of the chest CT, however this region was not fully evaluated in order to be able to determine interval growth. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Hypoenhancing splenic lesions, splenomegaly, and retroperitoneal adenopathy. Although the constellation of findings could be related to metastatic disease, lymphoma is in the differential as well, and retroperitoneal lymph node sampling may be of benefit to distinguish between the two possibilities. 2. Incidental findings as above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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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: Tiny cyst in the anterior right hepatic lobe (series 7, image 15). No suspicious hepatic lesion identified.. BILIARY TRACT: Normal. Excretion is seen into the normal caliber biliary system at 15 minutes. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Spleen is enlarged measuring approximately 16 cm. There are three splenic lesions identified, the largest measuring up to 4.0 cm long axis. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: Multiple enlarged retroperitoneal lymph nodes are present, for example a left periaortic lymph node measures approximately 2.4 x 1.6 cm (series 553, image 43). The adenopathy was seen in part on the inferior images of the chest CT, however this region was not fully evaluated in order to be able to determine interval growth. 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: There are evolving postsurgical changes from resection of falcotentorial/pineal region mass. There is prominent right posterior parafalcine extra-axial fluid collection with interval resolution of previously seen gas in this region. Right frontal approach EVD catheter is unchanged in position with its tip terminating in the frontal of right lateral ventricle close to foramen of Monro. Ventricular size is overall stable. There is improving edema in the right parietotemporal white matter.
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