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15,900 |
EXAM: MR Knee Right wo contrast CLINICAL INFORMATION: Knee pain and instability COMPARISON: Radiographs dated 12/30/2021 TECHNIQUE: Multiplanar multisequence images were obtained through the knee. Findings: There is mild degenerative fissuring of the articular cartilage along the medial facet of the patella. Tibiofemoral articular cartilage is well maintained. There is a nondisplaced fracture through the subchondral lateral tibial plateau with bone marrow edema extending distally into the tibial metaphysis. There is a trace joint effusion. A small popliteal cyst is present. There is complete tear of the proximal ACL. The PCL is intact. Menisci are unremarkable. The quadriceps and patellar tendons are normal. There is a small amount of fluid tracking along the medial collateral ligament, but the ligament is intact. The patellar retinaculum, iliotibial band, and posterior lateral corner structures are normal. Impression: 1. Complete proximal ACL tear. 2. Grade 1 MCL sprain. 3. Nondisplaced subchondral lateral tibial plateau fracture without intra-articular extension.
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Findings: There is mild degenerative fissuring of the articular cartilage along the medial facet of the patella. Tibiofemoral articular cartilage is well maintained. There is a nondisplaced fracture through the subchondral lateral tibial plateau with bone marrow edema extending distally into the tibial metaphysis. There is a trace joint effusion. A small popliteal cyst is present. There is complete tear of the proximal ACL. The PCL is intact. Menisci are unremarkable. The quadriceps and patellar tendons are normal. There is a small amount of fluid tracking along the medial collateral ligament, but the ligament is intact. The patellar retinaculum, iliotibial band, and posterior lateral corner structures are normal.
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FINDINGS: No intraparenchymal hemorrhage, mass effect or edema. The gray white matter differentiation is maintained. Stable region of encephalomalacia involving the cranial portion of the right frontal/parietal lobes. Unchanged chronic lacunar infarcts of the right thalamus and basal ganglia. Periventricular and subcortical white matter hypodensities are most consistent with chronic microangiopathic ischemic changes. Partially empty sella. No extra axial collections. There is moderate diffuse cerebral atrophy with prominence of the cortical sulci, sylvian fissures and compensatory dilatation of the ventricles. No acute osseous abnormality. The paranasal sinuses, middle ears, and mastoid air cells are clear. The orbits are unremarkable. The visualized soft tissues are unremarkable.
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15,901 |
MR Brain wo+w contrast 1/27/2022 7:51 PM Clinical information: 53 years Female patient with Brain metastases suspected, R91.8 Other nonspecific abnormal finding of lung field Comparison: None available. Technique: Multiplanar, multisequence MRI of the brain was performed before and after the administration of intravenous contrast. Patient weight: 148 lbs. IV contrast: ProHance, 14 ml, per protocol. FINDINGS: Cerebral parenchyma: The brain parenchyma volume is appropriate for patient's age. Confluent hyperintense long TR signal involving the pons. No abnormal enhancement, intracranial mass lesion, hemorrhage, or infarction. Ventricular system: No hydrocephalus or midline shift. Extra axial spaces: No epidural, subdural, or subarachnoid hemorrhage. No basal cistern effacement. Vascular system: No loss of the major vascular flow voids. Visualized paranasal sinuses: Trace left maxillary sinus 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 to suggest metastatic disease. 2. Confluent nonspecific hyperintense long TR signal involving the pons, may represent sequela of hypertensive encephalopathy, early chronic microvascular ischemic disease or pontine myelinolysis in the appropriate clinical setting.
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FINDINGS: Cerebral parenchyma: The brain parenchyma volume is appropriate for patient's age. Confluent hyperintense long TR signal involving the pons. No abnormal enhancement, intracranial mass lesion, hemorrhage, or infarction. Ventricular system: No hydrocephalus or midline shift. Extra axial spaces: No epidural, subdural, or subarachnoid hemorrhage. No basal cistern effacement. Vascular system: No loss of the major vascular flow voids. Visualized paranasal sinuses: Trace left maxillary sinus 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: Examination is limited secondary to motion artifact. CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Confluent areas of groundglass and consolidative opacities in the visualized lower lungs, predominantly within the dependent lower lobes. Mucous plugging within a a few right lower lobar segmental subsegmental airways (for example, series 201, image 6). DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: A few scattered subcentimeter hypoattenuating lesions are too small to accurately characterize, but are statistically likely to represent cysts. Otherwise, no significant abnormality within the limitations of noncontrast technique. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Normal size. Scattered tiny calcified granulomata. ADRENALS: Normal. KIDNEYS: No significant abnormality. No radiopaque nephrolithiasis or hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No significant abnormality in the colon. The appendix is normal PERITONEUM / MESENTERY: No free intraperitoneal fluid. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: Moderate aortoiliac calcific atherosclerosis. URINARY BLADDER: Decompressed around a Foley catheter. Small amount of intraluminal gas. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Osseous mineralization is diffusely decreased. Multilevel degenerative changes in the visualized thoracolumbar spine. Grade 1 degenerative anterolisthesis of L4 on L5. Ankylosis of the SI joints and partial ankylosis of the pubic symphysis.
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15,902 |
MR Cervical Spine wo contrast 1/27/2022 9:49 PM Clinical information: 79 years Female patient with Trauma Spec Inst: eval for cord compression Comparison: CT cervical spine from reformat dated 1/27/2022 at 18:23 hours. Technique: Multiplanar multisequence images of the cervical spine were obtained, without intravenous contrast administration. Findings: The sagittal images demonstrate persistent straightening of the cervical lordosis, with mild retrolisthesis of C4 on C5 and grade 1 anterolisthesis of C5 on C6. The vertebral bodies maintain normal height and marrow signal. The intervertebral discs appear desiccated from decreased T2-weighted signal, with associated severe C3-C4 and C4-C5 disc height loss. The spinal cord is normal in size and signal intensity, without expansile lesions. The spinal ligaments are intact. The craniocervical junction appears within normal limits. C2-C3: The spinal canal and neuroforamina are patent. C3-C4: Disc osteophyte complex resulting in mild spinal canal stenosis, without significant neuroforaminal narrowing. C4-C5: Disc osteophytes complex resulting in severe spinal canal stenosis, without significant neuroforaminal narrowing. C5-C6: No significant spinal canal stenosis or neuroforaminal narrowing. C6-C7: The spinal canal and neuroforamina are patent. C7-T1: No significant spinal canal stenosis or neuroforaminal narrowing. The paraspinal soft tissues appear unremarkable, without organized fluid collections. IMPRESSION: 1. No evidence of acute findings or abnormal spinal cord signal in the cervical spine. In particular, no evidence of acute bony contusions, disc avulsions, ligamentous disruption, intramedullary hemorrhage or abnormal extra-axial fluid collections. 2. Persistent chronic multilevel degenerative changes as described, most significant at C4-C5, resulting in severe spinal canal stenosis, without significant neuroforaminal narrowing.
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Findings: The sagittal images demonstrate persistent straightening of the cervical lordosis, with mild retrolisthesis of C4 on C5 and grade 1 anterolisthesis of C5 on C6. The vertebral bodies maintain normal height and marrow signal. The intervertebral discs appear desiccated from decreased T2-weighted signal, with associated severe C3-C4 and C4-C5 disc height loss. The spinal cord is normal in size and signal intensity, without expansile lesions. The spinal ligaments are intact. The craniocervical junction appears within normal limits. C2-C3: The spinal canal and neuroforamina are patent. C3-C4: Disc osteophyte complex resulting in mild spinal canal stenosis, without significant neuroforaminal narrowing. C4-C5: Disc osteophytes complex resulting in severe spinal canal stenosis, without significant neuroforaminal narrowing. C5-C6: No significant spinal canal stenosis or neuroforaminal narrowing. C6-C7: The spinal canal and neuroforamina are patent. C7-T1: No significant spinal canal stenosis or neuroforaminal narrowing. The paraspinal soft tissues appear unremarkable, without organized fluid collections.
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FINDINGS: VERTEBRA: No acute fracture. Well-circumscribed lucent lesion in the T7 left transverse process, with trabecular thickening, no associated osseous expansion, narrow zone of transition, and no adjacent periostitis or soft tissue mass, nonaggressive appearing. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: No significant abnormality in the paraspinous soft tissues or visualized lung parenchyma. Mosaic attenuation in both lungs is likely related to imaging during expiratory phase. Partially visualized bilateral breast implants. Mild prominence of the extrahepatic biliary tree, measuring up to 8 mm at the porta hepatis and tapering distally. No radiopaque choledocholithiasis or obstructing lesion is identified. ALIGNMENT: No spondylolisthesis.
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15,903 |
MR Lumbar Spine wo contrast 1/28/2022 1:02 AM Clinical Information: rule out ligamentous injury after L2 fx Comparison: CT lumbar spine of 1/27/2022 Technique: T1 sagittal and axial spin echo, sagittal STIR, T2 sagittal and axial fast spin echo, post contrast sagittal and axial T1. Findings: There is multilevel degenerative disc and facet disease. No acute fracture or dislocation. No evidence of ligamentous injury. There is no evidence of a disc herniation or of significant spinal canal or neural foramen stenosis at any level. The conus medullaris and cauda equina appear normal. Conclusion: Mild multilevel degenerative changes. No acute, traumatic findings.
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Findings: There is multilevel degenerative disc and facet disease. No acute fracture or dislocation. No evidence of ligamentous injury. There is no evidence of a disc herniation or of significant spinal canal or neural foramen stenosis at any level. The conus medullaris and cauda equina appear normal.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Moderate white matter microangiopathic changes. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal.
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15,904 |
MR Brain wo+w contrast 1/28/2022 8:53 AM Clinical Information: ro subdural empyema Spec Inst: stealth protocol Comparison: CT head of 1/27/2022 Technique: Diffusion weighted series, T1 sagittal and axial spin echo, T2 axial fast spin echo, axial FLAIR, postcontrast T1 axial, coronal, and sagittal. Patient weight: 202 lbs. IV contrast: ProHance, 10 ml, per protocol. Findings: Punctate acute infarcts most pronounced in the left cerebral hemisphere but also involving the right hemisphere and posterior fossa. Scattered small foci of susceptibility without parenchymal hematoma. Trace bilateral convexity subdurals, tentorial subdural blood, and subarachnoid blood is redemonstrated. No rim-enhancing collection to suggest empyema. Conclusion: No rim-enhancing, restricted diffusion to suggest empyema. Punctate acute infarcts in the pattern of an embolic shower. Scattered subdural and subarachnoid blood products similar in appearance to prior CT.
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Findings: Punctate acute infarcts most pronounced in the left cerebral hemisphere but also involving the right hemisphere and posterior fossa. Scattered small foci of susceptibility without parenchymal hematoma. Trace bilateral convexity subdurals, tentorial subdural blood, and subarachnoid blood is redemonstrated. No rim-enhancing collection to suggest empyema.
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Findings: Left frontal approach EVD catheter is unchanged in position. There is small volume hemorrhage along the course of the EVD catheter in the left frontal lobe as well as hemorrhage surrounding the catheter tip in the left lateral ventricle which are new since prior. There is overall mild increase in ventricular size and similar rightward midline shift by 10 mm. Stable edema in the left cerebral hemisphere. Previously seen gas within the ventricle has decreased in size. There is small hemorrhage layering in the occipital horns of both lateral ventricles. There is unchanged position of the right frontal approach ventricular shunt catheter with decompressed right lateral ventricle. Stable size and extent of chronic appearing subdural hemorrhage along the right posterior convexity. Postsurgical changes in the posterior fossa remain unchanged. Mucosal thickening in the maxillary sinuses again seen. Stable appearing right-sided mastoidectomy changes.
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15,905 |
MRI brain with and without contrast Clinical Information: Male aged 44 years. With tinnitus, hearing loss Comparison: CT 2/26/2018 Technique: Multiplanar, multisequence MRI of the brain were obtained in multiple planes pre-and post administration of intravenous contrast per departmental protocol. Patient weight: 175 lbs. IV contrast: ProHance, 8 ml, per protocol. Findings: No definite infarcts are evident along the vestibuloauditory pathways. No cerebellopontine angle cysts or masses. The membranous labyrinth is normal in appearance bilaterally both before and after contrast administration. No abnormal enhancement within the internal auditory canals following contrast administration. The mastoid air cells are clear. External auditory ear canals are patent bilaterally. No acute infarct or intracranial hemorrhage. No abnormal parenchymal or leptomeningeal enhancement. Conclusion: No intracranial process to explain the patient's hearing loss and tinnitus. As the attending 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 definite infarcts are evident along the vestibuloauditory pathways. No cerebellopontine angle cysts or masses. The membranous labyrinth is normal in appearance bilaterally both before and after contrast administration. No abnormal enhancement within the internal auditory canals following contrast administration. The mastoid air cells are clear. External auditory ear canals are patent bilaterally. No acute infarct or intracranial hemorrhage. No abnormal parenchymal or leptomeningeal enhancement.
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FINDINGS: AORTIC ARCH: Patent without flow-limiting stenosis. Normal three vessel aortic arch is noted. RIGHT CAROTID: Long segment narrowing of the cervical ICA. LEFT CAROTID: Mild long segment narrowing of the cervical ICA. RIGHT VERTEBRAL ARTERY: Patent without flow-limiting stenosis. LEFT VERTEBRAL ARTERY: Patent without flow-limiting stenosis. INTRACRANIAL ARTERIES: Smooth narrowing of bilateral intracranial ICAs with severe narrowing and/or short segment of the supraclinoid ICAs.. There is distal reconstitution bilaterally via collateral vessels and the circle of Willis. Postsurgical changes from bilateral EDAS with patent arterial anastomoses. The bilateral ACAs, MCAs and PCAs appear patent, without flow-limiting stenoses or discrete aneurysms. The vertebrobasilar axis is patent without flow-limiting stenoses. NONVASCULAR FINDINGS: No acute intracranial hemorrhage or CT evidence of acute infarction. Chronic encephalomalacia in bilateral ACA-MCA watershed territories. No mass effect or midline shift. Ventricles and basilar cisterns are unremarkable. Postsurgical changes from bilateral pterional craniotomies and EDAS procedures. The orbits are normal. The paranasal sinuses, mastoid air cells, and pneumatized petrous apices are clear. Visualized soft tissues and osseous structures are otherwise unremarkable. Soft tissues of the neck are normal in appearance. Visualized lung apices are clear. Cervical spine is normal in alignment without evidence of acute fracture.
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15,906 |
MR Brain wo+w contrast 1/28/2022 8:20 AM Clinical Information: pituitary adenoma, E03.9 Hypothyroidism, unspecified, D49.7 Neoplasm of unspecified behavior of endocrine glands and other parts of nervous system Spec Inst: pituitary protocol, ho pituitary microadenoma 8x6x5 mm Comparison: None Technique: Diffusion weighted series, T1 sagittal and axial spin echo, T2 axial fast spin echo, axial FLAIR, postcontrast T1 axial, coronal, and sagittal. Patient weight: 225 lbs. IV contrast: ProHance, 10 ml, per protocol. IV contrast injection rate: 0.50 ml per sec. Findings: Dynamic contrast enhanced images demonstrate relatively slow enhancement involving the left aspect of the anterior pituitary. On the routine postcontrast images, this region demonstrates heterogenous enhancement measuring approximately 9 mm TR by 7 mm CC by 10 mm AP. The pituitary stalk is deviated slightly to the right. The optic chiasm is unremarkable. No cavernous sinus invasion is appreciated. Conclusion: Hypoenhancing structure in the left anterior hypophysis suspicious for adenoma.
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Findings: Dynamic contrast enhanced images demonstrate relatively slow enhancement involving the left aspect of the anterior pituitary. On the routine postcontrast images, this region demonstrates heterogenous enhancement measuring approximately 9 mm TR by 7 mm CC by 10 mm AP. The pituitary stalk is deviated slightly to the right. The optic chiasm is unremarkable. No cavernous sinus invasion is appreciated.
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FINDINGS: AORTIC ARCH: Patent without flow-limiting stenosis. Normal three vessel aortic arch is noted. RIGHT CAROTID: Long segment narrowing of the cervical ICA. LEFT CAROTID: Mild long segment narrowing of the cervical ICA. RIGHT VERTEBRAL ARTERY: Patent without flow-limiting stenosis. LEFT VERTEBRAL ARTERY: Patent without flow-limiting stenosis. INTRACRANIAL ARTERIES: Smooth narrowing of bilateral intracranial ICAs with severe narrowing and/or short segment of the supraclinoid ICAs.. There is distal reconstitution bilaterally via collateral vessels and the circle of Willis. Postsurgical changes from bilateral EDAS with patent arterial anastomoses. The bilateral ACAs, MCAs and PCAs appear patent, without flow-limiting stenoses or discrete aneurysms. The vertebrobasilar axis is patent without flow-limiting stenoses. NONVASCULAR FINDINGS: No acute intracranial hemorrhage or CT evidence of acute infarction. Chronic encephalomalacia in bilateral ACA-MCA watershed territories. No mass effect or midline shift. Ventricles and basilar cisterns are unremarkable. Postsurgical changes from bilateral pterional craniotomies and EDAS procedures. The orbits are normal. The paranasal sinuses, mastoid air cells, and pneumatized petrous apices are clear. Visualized soft tissues and osseous structures are otherwise unremarkable. Soft tissues of the neck are normal in appearance. Visualized lung apices are clear. Cervical spine is normal in alignment without evidence of acute fracture.
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15,907 |
EXAM: MR Brain wo contrast 1/28/2022 7:24 AM CLINICAL INFORMATION: Pulsatile tinnitus. Per chart review, new onset headaches and pulsation in ears when headaches become severe. History of cervical stenosis status post left-sided C5-C6 laminectomy in 2013. COMPARISON: MRI brain dated May 15, 2017. TECHNIQUE: Multiplanar, multisequence MRI of the brain was performed without intravenous contrast. FINDINGS: No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, space-occupying lesion, or mass effect. Age-appropriate cerebral volume. Scattered periventricular and subcortical/deep cerebral T2/FLAIR hyperintensities, similar to prior, likely chronic microangiopathic changes. Prominent area of confluent FLAIR hyperintensity in the right frontal periventricular white matter, unchanged from prior, possibly chronic white matter infarct. The ventricles are normal in size. There is no abnormal extra-axial collection. The flow voids at the skull base are normal. Partial empty sella. The cerebellar tonsils are normal in position. The inner ears appear normally developed. The external auditory canals are patent. No mass lesion is identified within the IACs. There is no cerebellopontine angle mass. Cranial nerve VII/cranial nerve VIII complexes appear within normal limits. There is high riding and dominant right jugular bulb. The orbital contents are unremarkable. Trace bilateral ethmoid and frontal sinus mucosal thickening. The visualized paranasal sinuses and mastoid air cells are otherwise well-aerated. _________________________ CONCLUSION 1. No abnormality of the inner ears is identified on this noncontrast examination. 2. High riding right jugular bulb is of uncertain clinical significance,. May present with tinnitus however. As the attending 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 intraparenchymal infarct, hemorrhage, edema, hydrocephalus, space-occupying lesion, or mass effect. Age-appropriate cerebral volume. Scattered periventricular and subcortical/deep cerebral T2/FLAIR hyperintensities, similar to prior, likely chronic microangiopathic changes. Prominent area of confluent FLAIR hyperintensity in the right frontal periventricular white matter, unchanged from prior, possibly chronic white matter infarct. The ventricles are normal in size. There is no abnormal extra-axial collection. The flow voids at the skull base are normal. Partial empty sella. The cerebellar tonsils are normal in position. The inner ears appear normally developed. The external auditory canals are patent. No mass lesion is identified within the IACs. There is no cerebellopontine angle mass. Cranial nerve VII/cranial nerve VIII complexes appear within normal limits. There is high riding and dominant right jugular bulb. The orbital contents are unremarkable. Trace bilateral ethmoid and frontal sinus mucosal thickening. The visualized paranasal sinuses and mastoid air cells are otherwise well-aerated. _________________________
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A CT perfusion study was performed during single pass of 50 cc contrast bolus. Axial images were acquired at 8 axial locations and time-attenuation curves generated from this dataset were utilized to calculate cerebral blood flow, mean transit time, time to peak, and cerebral blood volume maps as well as region of interest specific quantitative data. "Prognostic" color maps were also generated depicting areas of ischemia (voxel values for MTT > 1.4 times mirror image voxels on the contralateral "normal side") in the color green and areas predictive of infarction (CBV values 4.0s) in bilateral cerebral hemispheres without abnormalities in cerebral blood flow or cerebral blood volume.
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15,908 |
EXAM: CV MR Cardiac w contrast PATIENT DATA Date of Study: 1/28/2022 9:01 AM Referring MD: Garima Arora Height: 170 cm. Patient weight: 81 kg. BSA: 1.93 Blood Pressure: 121/70 Heart Rate: 77 bpm. EGFR 60. The patient's creatinine was 0.9 on 01/13/2022. The patient received 16 cc's of Gadavist at a rate of 2 ml per second without immediate complication. CLINICAL INFORMATION: Patient studied for evaluation of: svt, I49.8 Other specified cardiac arrhythmias History: 52 year old woman with SVT and family history of cardiomyopathy COMPARISON: No prior cardiac MR 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 Right two chamber Short axis LV LVOT Ascending aorta RVOT Sequences: FSE 2IR FSE 3IR SSFP FGRE ET Additional views: Delayed Contrast Enhancement, MS Axial, perfusion General: ECG gated: YES MEASUREMENTS: In Millimeters Left Atrium: 32 LV End Diastolic Dimension: 44 LV End Systolic Dimension: 25 LV Posterior Wall: 6 Right Atrium 36 RV End Diastolic Dimension: 36 Interventricular Septum: 8 Left Ventricle (short axis):Volumes in mL, index in mL per square meter End Diastolic Volume: 104 ED Index 54 End Systolic Volume: 37 ES Index 19 Stroke Volume: 67 SV Index 34 Ejection Fraction: 64% Morphology: There is normal left ventricular size and function. There are no regional wall motion abnormalities. There is normal signal intensity on T2 weighted and triple IR sequences. There is normal resting first pass gadolinium enhancement. There is no significant late gadolinium enhancement. Right Ventricle (short axis):Volumes in mL, index in mL per square meter End Diastolic Volume: 104 ED Index 54 End Systolic Volume: 44 ES Index 23 Stroke Volume: 60 SV Index 31 Ejection Fraction: 57.7% Morphology: There is normal right ventricular size and function. There are no regional wall motion abnormalities. There is normal triple IR intensity. Pericardium: The pericardium is normal with no pericardial effusion. There is small amount of normal epicardial fat. Pleural: There is no pleural effusion Visualized vascular structures appear normal. There is a normal aortic arch. The aorta and pulmonary artery are normal in size. The coronary sinus is normal in size. All four pulmonary veins drain into the left atria. VALVULAR MORPHOLOGY There is no significant valvular pathology noted. Vessel dimensions: (In mm normal range dimensions mm) Main Pulmonary Artery 24 Aortic Root 27 Aortic Arch 25 [18-37] Right Pulmonary Artery 16 Ascending Aorta 27 [19-37] Left Pulmonary Artery 13 Inferior Vena Cava 18 Descending Aorta 21 [16-29] INCIDENTAL FINDINGS: none CONCLUSION: 1. Normal cardiac MRI without signs of cardiomyopathy. 2. No evidence of late gadolinium enhancement. 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 Right two chamber Short axis LV LVOT Ascending aorta RVOT Sequences: FSE 2IR FSE 3IR SSFP FGRE ET Additional views: Delayed Contrast Enhancement, MS Axial, perfusion General: ECG gated: YES MEASUREMENTS: In Millimeters Left Atrium: 32 LV End Diastolic Dimension: 44 LV End Systolic Dimension: 25 LV Posterior Wall: 6 Right Atrium 36 RV End Diastolic Dimension: 36 Interventricular Septum: 8 Left Ventricle (short axis):Volumes in mL, index in mL per square meter End Diastolic Volume: 104 ED Index 54 End Systolic Volume: 37 ES Index 19 Stroke Volume: 67 SV Index 34 Ejection Fraction: 64% Morphology: There is normal left ventricular size and function. There are no regional wall motion abnormalities. There is normal signal intensity on T2 weighted and triple IR sequences. There is normal resting first pass gadolinium enhancement. There is no significant late gadolinium enhancement. Right Ventricle (short axis):Volumes in mL, index in mL per square meter End Diastolic Volume: 104 ED Index 54 End Systolic Volume: 44 ES Index 23 Stroke Volume: 60 SV Index 31 Ejection Fraction: 57.7% Morphology: There is normal right ventricular size and function. There are no regional wall motion abnormalities. There is normal triple IR intensity. Pericardium: The pericardium is normal with no pericardial effusion. There is small amount of normal epicardial fat. Pleural: There is no pleural effusion Visualized vascular structures appear normal. There is a normal aortic arch. The aorta and pulmonary artery are normal in size. The coronary sinus is normal in size. All four pulmonary veins drain into the left atria. VALVULAR MORPHOLOGY There is no significant valvular pathology noted. Vessel dimensions: (In mm normal range dimensions mm) Main Pulmonary Artery 24 Aortic Root 27 Aortic Arch 25 [18-37] Right Pulmonary Artery 16 Ascending Aorta 27 [19-37] Left Pulmonary Artery 13 Inferior Vena Cava 18 Descending Aorta 21 [16-29] INCIDENTAL FINDINGS: none
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FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Moderately suboptimal quality with incomplete evaluation of segmental and subsegmental pulmonary arteries secondary to artifact from respiratory motion. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent. Patchy bilateral, peripheral predominant groundglass and consolidative opacities. No pleural effusions or pneumothorax. HEART / OTHER VESSELS: Heart size is normal. No pericardial effusion. Dilatation of the main pulmonary artery, measuring 34 mm in diameter. The thoracic aorta is normal in caliber. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Small hiatal hernia. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. Multilevel degenerative changes in the thoracic spine.
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15,909 |
EXAM: CV MR Cardiac for Function and Morph, CV MR Angio Chest, CV MR for Velocity Flow PATIENT DATA Date of Study: 1/28/2022 12:26 PM Referring MD: Marc Cribbs Height: 175 cm. Patient weight: 142 kg. BSA: 2.50 Heart Rate: 85 bpm. IV contrast: ProHance, 20 ml, per protocol. . The patient received 20 cc's of ProHance at a rate of 2 ml per second without immediate complication. CLINICAL INFORMATION: Patient studied for evaluation of: tof, Q21.3 Tetralogy of Fallot History: 32 year old woman with past medical history of tetrology of fallot with transannular patch and VSD closure in 1990. COMPARISON: No prior CMR TECHNIQUE: CV MR Cardiac for Function and Morph, CV MR Angio Chest, CV MR for Velocity Flow FINDINGS: IMAGING DATA Imaging System: GE 1.5T Overall Image Quality: Excellent CARDIAC MORPHOLOGY AND VENTRICULAR FUNCTION Views: Axial Two chamber Four chamber Right two chamber Short axis LV LVOT Ascending aorta RVOT Sequences: FSE 2IR SSFP Additional views: 3D Contrast Enhanced MRA, MS Axial, Velocity Flow Mapping General: Inpatient Research Pre BP Post BP ECG gated: YES MEASUREMENTS: In Millimeters Left Atrium: 37 LV End Diastolic Dimension: 44 LV End Systolic Dimension: 29 LV Posterior Wall: 6 Right Atrium 48 RV End Diastolic Dimension: 41 Interventricular Septum: 9 Left Ventricle (short axis):Volumes in mL, index in mL per square meter End Diastolic Volume: 103 ED Index 41 End Systolic Volume: 40 ES Index 16 Stroke Volume: 63 SV index 25 Ejection Fraction: 61% Morphology: There is normal left ventricular size and function without regional wall motion abnormalities. There is no VSD visualized. Right Ventricle (short axis):Volumes in mL, index in mL per square meter End Diastolic Volume: 170 ED Index 68 End Systolic Volume: 90 ES index 36 Stroke Volume: 80 SV Index 32 Ejection Fraction: 47.1% Morphology: There is normal right ventricular size and function. Pericardium: Normal pericardium with no pericardial effusion. There is notable epicardial and pericardial fat. Pleural: No pleural effusion noted Atria: The atrial appear visually normal in size. Atrial septum appears normal. The coronary sinus is normal in size. VALVULAR MORPHOLOGY Valve: Mitral: No significant stenosis or regurgitation Aortic: No significant stenosis or regurgitation Tricuspid: No significant stenosis or regurgitation Pulmonary: Bioprosthetic valve is present No significant stenosis. Mild regurgitation. Phase Contrast: Ao flow: 90 ml PA flow:75 (FF87 BF 12)ml CO: 3.9 l/min QpQs: 0.8 The aorta and aortic arch is normal. Arch vessels: The brachiocephalic and left common carotid arteries have a common ostia. This is a normal variant. There is no aortic coarctation. The four pulmonary veins drain into the left atria. Vessel dimensions: (In mm normal range dimensions mm) Main Pulmonary Artery 31x36 Aortic Root STJ 34x35 Aortic Arch 25 [18-37] Right Pulmonary Artery 17 Ascending Aorta 33 [19-37] Left Pulmonary Artery 20 Inferior Vena Cava 26 Descending Aorta 17 [16-29] INCIDENTAL FINDINGS: there is sternal wire susceptibility artifact present CONCLUSION: 1. There is surgical repair of tetrology of Fallot 2. The left and right ventricles are normal in size and function. 3. The pulmonary artery is mildly dilated with mild pulmonary regurgitation. 4. No intracardiac shunting is seen 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: IMAGING DATA Imaging System: GE 1.5T Overall Image Quality: Excellent CARDIAC MORPHOLOGY AND VENTRICULAR FUNCTION Views: Axial Two chamber Four chamber Right two chamber Short axis LV LVOT Ascending aorta RVOT Sequences: FSE 2IR SSFP Additional views: 3D Contrast Enhanced MRA, MS Axial, Velocity Flow Mapping General: Inpatient Research Pre BP Post BP ECG gated: YES MEASUREMENTS: In Millimeters Left Atrium: 37 LV End Diastolic Dimension: 44 LV End Systolic Dimension: 29 LV Posterior Wall: 6 Right Atrium 48 RV End Diastolic Dimension: 41 Interventricular Septum: 9 Left Ventricle (short axis):Volumes in mL, index in mL per square meter End Diastolic Volume: 103 ED Index 41 End Systolic Volume: 40 ES Index 16 Stroke Volume: 63 SV index 25 Ejection Fraction: 61% Morphology: There is normal left ventricular size and function without regional wall motion abnormalities. There is no VSD visualized. Right Ventricle (short axis):Volumes in mL, index in mL per square meter End Diastolic Volume: 170 ED Index 68 End Systolic Volume: 90 ES index 36 Stroke Volume: 80 SV Index 32 Ejection Fraction: 47.1% Morphology: There is normal right ventricular size and function. Pericardium: Normal pericardium with no pericardial effusion. There is notable epicardial and pericardial fat. Pleural: No pleural effusion noted Atria: The atrial appear visually normal in size. Atrial septum appears normal. The coronary sinus is normal in size. VALVULAR MORPHOLOGY Valve: Mitral: No significant stenosis or regurgitation Aortic: No significant stenosis or regurgitation Tricuspid: No significant stenosis or regurgitation Pulmonary: Bioprosthetic valve is present No significant stenosis. Mild regurgitation. Phase Contrast: Ao flow: 90 ml PA flow:75 (FF87 BF 12)ml CO: 3.9 l/min QpQs: 0.8 The aorta and aortic arch is normal. Arch vessels: The brachiocephalic and left common carotid arteries have a common ostia. This is a normal variant. There is no aortic coarctation. The four pulmonary veins drain into the left atria. Vessel dimensions: (In mm normal range dimensions mm) Main Pulmonary Artery 31x36 Aortic Root STJ 34x35 Aortic Arch 25 [18-37] Right Pulmonary Artery 17 Ascending Aorta 33 [19-37] Left Pulmonary Artery 20 Inferior Vena Cava 26 Descending Aorta 17 [16-29] INCIDENTAL FINDINGS: there is sternal wire susceptibility artifact present
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Mild age-appropriate diffuse parenchymal volume loss. Periventricular white matter hypoattenuation consistent with chronic microangiopathic changes. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. VENTRICULAR SYSTEM: Normal. ORBITS: Bilateral pseudophakia. SINUSES: Paranasal sinuses are clear. VESSELS: Scattered atherosclerosis of the bilateral carotid siphons.
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15,910 |
EXAM: CV MR Cardiac for Function and Morph, CV MR Angio Chest, CV MR for Velocity Flow PATIENT DATA Date of Study: 1/28/2022 12:26 PM Referring MD: Marc Cribbs Height: 175 cm. Patient weight: 142 kg. BSA: 2.50 Heart Rate: 85 bpm. IV contrast: ProHance, 20 ml, per protocol. . The patient received 20 cc's of ProHance at a rate of 2 ml per second without immediate complication. CLINICAL INFORMATION: Patient studied for evaluation of: tof, Q21.3 Tetralogy of Fallot History: 32 year old woman with past medical history of tetrology of fallot with transannular patch and VSD closure in 1990. COMPARISON: No prior CMR TECHNIQUE: CV MR Cardiac for Function and Morph, CV MR Angio Chest, CV MR for Velocity Flow FINDINGS: IMAGING DATA Imaging System: GE 1.5T Overall Image Quality: Excellent CARDIAC MORPHOLOGY AND VENTRICULAR FUNCTION Views: Axial Two chamber Four chamber Right two chamber Short axis LV LVOT Ascending aorta RVOT Sequences: FSE 2IR SSFP Additional views: 3D Contrast Enhanced MRA, MS Axial, Velocity Flow Mapping General: Inpatient Research Pre BP Post BP ECG gated: YES MEASUREMENTS: In Millimeters Left Atrium: 37 LV End Diastolic Dimension: 44 LV End Systolic Dimension: 29 LV Posterior Wall: 6 Right Atrium 48 RV End Diastolic Dimension: 41 Interventricular Septum: 9 Left Ventricle (short axis):Volumes in mL, index in mL per square meter End Diastolic Volume: 103 ED Index 41 End Systolic Volume: 40 ES Index 16 Stroke Volume: 63 SV index 25 Ejection Fraction: 61% Morphology: There is normal left ventricular size and function without regional wall motion abnormalities. There is no VSD visualized. Right Ventricle (short axis):Volumes in mL, index in mL per square meter End Diastolic Volume: 170 ED Index 68 End Systolic Volume: 90 ES index 36 Stroke Volume: 80 SV Index 32 Ejection Fraction: 47.1% Morphology: There is normal right ventricular size and function. Pericardium: Normal pericardium with no pericardial effusion. There is notable epicardial and pericardial fat. Pleural: No pleural effusion noted Atria: The atrial appear visually normal in size. Atrial septum appears normal. The coronary sinus is normal in size. VALVULAR MORPHOLOGY Valve: Mitral: No significant stenosis or regurgitation Aortic: No significant stenosis or regurgitation Tricuspid: No significant stenosis or regurgitation Pulmonary: Bioprosthetic valve is present No significant stenosis. Mild regurgitation. Phase Contrast: Ao flow: 90 ml PA flow:75 (FF87 BF 12)ml CO: 3.9 l/min QpQs: 0.8 The aorta and aortic arch is normal. Arch vessels: The brachiocephalic and left common carotid arteries have a common ostia. This is a normal variant. There is no aortic coarctation. The four pulmonary veins drain into the left atria. Vessel dimensions: (In mm normal range dimensions mm) Main Pulmonary Artery 31x36 Aortic Root STJ 34x35 Aortic Arch 25 [18-37] Right Pulmonary Artery 17 Ascending Aorta 33 [19-37] Left Pulmonary Artery 20 Inferior Vena Cava 26 Descending Aorta 17 [16-29] INCIDENTAL FINDINGS: there is sternal wire susceptibility artifact present CONCLUSION: 1. There is surgical repair of tetrology of Fallot 2. The left and right ventricles are normal in size and function. 3. The pulmonary artery is mildly dilated with mild pulmonary regurgitation. 4. No intracardiac shunting is seen 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: IMAGING DATA Imaging System: GE 1.5T Overall Image Quality: Excellent CARDIAC MORPHOLOGY AND VENTRICULAR FUNCTION Views: Axial Two chamber Four chamber Right two chamber Short axis LV LVOT Ascending aorta RVOT Sequences: FSE 2IR SSFP Additional views: 3D Contrast Enhanced MRA, MS Axial, Velocity Flow Mapping General: Inpatient Research Pre BP Post BP ECG gated: YES MEASUREMENTS: In Millimeters Left Atrium: 37 LV End Diastolic Dimension: 44 LV End Systolic Dimension: 29 LV Posterior Wall: 6 Right Atrium 48 RV End Diastolic Dimension: 41 Interventricular Septum: 9 Left Ventricle (short axis):Volumes in mL, index in mL per square meter End Diastolic Volume: 103 ED Index 41 End Systolic Volume: 40 ES Index 16 Stroke Volume: 63 SV index 25 Ejection Fraction: 61% Morphology: There is normal left ventricular size and function without regional wall motion abnormalities. There is no VSD visualized. Right Ventricle (short axis):Volumes in mL, index in mL per square meter End Diastolic Volume: 170 ED Index 68 End Systolic Volume: 90 ES index 36 Stroke Volume: 80 SV Index 32 Ejection Fraction: 47.1% Morphology: There is normal right ventricular size and function. Pericardium: Normal pericardium with no pericardial effusion. There is notable epicardial and pericardial fat. Pleural: No pleural effusion noted Atria: The atrial appear visually normal in size. Atrial septum appears normal. The coronary sinus is normal in size. VALVULAR MORPHOLOGY Valve: Mitral: No significant stenosis or regurgitation Aortic: No significant stenosis or regurgitation Tricuspid: No significant stenosis or regurgitation Pulmonary: Bioprosthetic valve is present No significant stenosis. Mild regurgitation. Phase Contrast: Ao flow: 90 ml PA flow:75 (FF87 BF 12)ml CO: 3.9 l/min QpQs: 0.8 The aorta and aortic arch is normal. Arch vessels: The brachiocephalic and left common carotid arteries have a common ostia. This is a normal variant. There is no aortic coarctation. The four pulmonary veins drain into the left atria. Vessel dimensions: (In mm normal range dimensions mm) Main Pulmonary Artery 31x36 Aortic Root STJ 34x35 Aortic Arch 25 [18-37] Right Pulmonary Artery 17 Ascending Aorta 33 [19-37] Left Pulmonary Artery 20 Inferior Vena Cava 26 Descending Aorta 17 [16-29] INCIDENTAL FINDINGS: there is sternal wire susceptibility artifact present
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Brain parenchymal volume is appropriate for age. Gray-white differentiation is maintained. EXTRA-AXIAL SPACES: No acute extra-axial collection. Partially empty sella. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Bilateral lens replacements. The orbits are otherwise unremarkable. SINUSES: Mucous retention cysts in bilateral maxillary sinuses. Patchy opacification of the ethmoid air cells. MASTOIDS: Clear. SOFT TISSUE: Unremarkable.
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15,911 |
EXAM: CV MR Cardiac for Function and Morph, CV MR Angio Chest, CV MR for Velocity Flow PATIENT DATA Date of Study: 1/28/2022 12:26 PM Referring MD: Marc Cribbs Height: 175 cm. Patient weight: 142 kg. BSA: 2.50 Heart Rate: 85 bpm. IV contrast: ProHance, 20 ml, per protocol. . The patient received 20 cc's of ProHance at a rate of 2 ml per second without immediate complication. CLINICAL INFORMATION: Patient studied for evaluation of: tof, Q21.3 Tetralogy of Fallot History: 32 year old woman with past medical history of tetrology of fallot with transannular patch and VSD closure in 1990. COMPARISON: No prior CMR TECHNIQUE: CV MR Cardiac for Function and Morph, CV MR Angio Chest, CV MR for Velocity Flow FINDINGS: IMAGING DATA Imaging System: GE 1.5T Overall Image Quality: Excellent CARDIAC MORPHOLOGY AND VENTRICULAR FUNCTION Views: Axial Two chamber Four chamber Right two chamber Short axis LV LVOT Ascending aorta RVOT Sequences: FSE 2IR SSFP Additional views: 3D Contrast Enhanced MRA, MS Axial, Velocity Flow Mapping General: Inpatient Research Pre BP Post BP ECG gated: YES MEASUREMENTS: In Millimeters Left Atrium: 37 LV End Diastolic Dimension: 44 LV End Systolic Dimension: 29 LV Posterior Wall: 6 Right Atrium 48 RV End Diastolic Dimension: 41 Interventricular Septum: 9 Left Ventricle (short axis):Volumes in mL, index in mL per square meter End Diastolic Volume: 103 ED Index 41 End Systolic Volume: 40 ES Index 16 Stroke Volume: 63 SV index 25 Ejection Fraction: 61% Morphology: There is normal left ventricular size and function without regional wall motion abnormalities. There is no VSD visualized. Right Ventricle (short axis):Volumes in mL, index in mL per square meter End Diastolic Volume: 170 ED Index 68 End Systolic Volume: 90 ES index 36 Stroke Volume: 80 SV Index 32 Ejection Fraction: 47.1% Morphology: There is normal right ventricular size and function. Pericardium: Normal pericardium with no pericardial effusion. There is notable epicardial and pericardial fat. Pleural: No pleural effusion noted Atria: The atrial appear visually normal in size. Atrial septum appears normal. The coronary sinus is normal in size. VALVULAR MORPHOLOGY Valve: Mitral: No significant stenosis or regurgitation Aortic: No significant stenosis or regurgitation Tricuspid: No significant stenosis or regurgitation Pulmonary: Bioprosthetic valve is present No significant stenosis. Mild regurgitation. Phase Contrast: Ao flow: 90 ml PA flow:75 (FF87 BF 12)ml CO: 3.9 l/min QpQs: 0.8 The aorta and aortic arch is normal. Arch vessels: The brachiocephalic and left common carotid arteries have a common ostia. This is a normal variant. There is no aortic coarctation. The four pulmonary veins drain into the left atria. Vessel dimensions: (In mm normal range dimensions mm) Main Pulmonary Artery 31x36 Aortic Root STJ 34x35 Aortic Arch 25 [18-37] Right Pulmonary Artery 17 Ascending Aorta 33 [19-37] Left Pulmonary Artery 20 Inferior Vena Cava 26 Descending Aorta 17 [16-29] INCIDENTAL FINDINGS: there is sternal wire susceptibility artifact present CONCLUSION: 1. There is surgical repair of tetrology of Fallot 2. The left and right ventricles are normal in size and function. 3. The pulmonary artery is mildly dilated with mild pulmonary regurgitation. 4. No intracardiac shunting is seen 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: IMAGING DATA Imaging System: GE 1.5T Overall Image Quality: Excellent CARDIAC MORPHOLOGY AND VENTRICULAR FUNCTION Views: Axial Two chamber Four chamber Right two chamber Short axis LV LVOT Ascending aorta RVOT Sequences: FSE 2IR SSFP Additional views: 3D Contrast Enhanced MRA, MS Axial, Velocity Flow Mapping General: Inpatient Research Pre BP Post BP ECG gated: YES MEASUREMENTS: In Millimeters Left Atrium: 37 LV End Diastolic Dimension: 44 LV End Systolic Dimension: 29 LV Posterior Wall: 6 Right Atrium 48 RV End Diastolic Dimension: 41 Interventricular Septum: 9 Left Ventricle (short axis):Volumes in mL, index in mL per square meter End Diastolic Volume: 103 ED Index 41 End Systolic Volume: 40 ES Index 16 Stroke Volume: 63 SV index 25 Ejection Fraction: 61% Morphology: There is normal left ventricular size and function without regional wall motion abnormalities. There is no VSD visualized. Right Ventricle (short axis):Volumes in mL, index in mL per square meter End Diastolic Volume: 170 ED Index 68 End Systolic Volume: 90 ES index 36 Stroke Volume: 80 SV Index 32 Ejection Fraction: 47.1% Morphology: There is normal right ventricular size and function. Pericardium: Normal pericardium with no pericardial effusion. There is notable epicardial and pericardial fat. Pleural: No pleural effusion noted Atria: The atrial appear visually normal in size. Atrial septum appears normal. The coronary sinus is normal in size. VALVULAR MORPHOLOGY Valve: Mitral: No significant stenosis or regurgitation Aortic: No significant stenosis or regurgitation Tricuspid: No significant stenosis or regurgitation Pulmonary: Bioprosthetic valve is present No significant stenosis. Mild regurgitation. Phase Contrast: Ao flow: 90 ml PA flow:75 (FF87 BF 12)ml CO: 3.9 l/min QpQs: 0.8 The aorta and aortic arch is normal. Arch vessels: The brachiocephalic and left common carotid arteries have a common ostia. This is a normal variant. There is no aortic coarctation. The four pulmonary veins drain into the left atria. Vessel dimensions: (In mm normal range dimensions mm) Main Pulmonary Artery 31x36 Aortic Root STJ 34x35 Aortic Arch 25 [18-37] Right Pulmonary Artery 17 Ascending Aorta 33 [19-37] Left Pulmonary Artery 20 Inferior Vena Cava 26 Descending Aorta 17 [16-29] INCIDENTAL FINDINGS: there is sternal wire susceptibility artifact present
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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: Surgically absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal aside from left upper pole renal cyst. Otherwise normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. The appendix is normal. PERITONEUM / MESENTERY: No free fluid or free air. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is present. Bilateral ovaries appear normal. BODY WALL: Tiny fat-containing periumbilical hernia. Otherwise unremarkable. MUSCULOSKELETAL: No evidence of aggressive osseous lesion or acute fracture.
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15,912 |
EXAM: CV MR Cardiac w contrast, CV MR for Velocity Flow PATIENT DATA Date of Study: 1/28/2022 1:59 PM Referring MD: Efstathia Andrikopoulou Height: 157 cm. Patient weight: 68 kg. BSA: 1.72208 Blood Pressure: 125/80 Heart Rate: 67 bpm. EGFR 60. The patient's creatinine was .8 on 11-03-2021. The patient received 13 cc's of gadavist at a rate of 2 ml per second without immediate complication. CLINICAL INFORMATION: Patient studied for evaluation of: myocarditis, I51.4 Myocarditis, unspecified History: 6 year old woman with past medical history of coronary artery disease, HTN, HLD, obesity, COPD, aortic insufficiency. COMPARISON: CMR 1/6/2020 TECHNIQUE: CV MR Cardiac w contrast, CV MR for Velocity Flow. Height: 157 cm. Patient weight: 68 kg. BSA: 1.72208 Blood Pressure: 125/80 Heart Rate: 67 bpm. FINDINGS: IMAGING DATA Imaging System: GE 1.5T Overall Image Quality: Excellent CARDIAC MORPHOLOGY AND VENTRICULAR FUNCTION Views: Axial Two chamber Four chamber Short axis LV LVOT Ascending aorta RVOT Short T2, phase contrast flow velocity mapping, perfusion delayed enhancement Sequences: FSE 2IR FSE 3IR SSFP FGRE ET Additional views: General: ECG gated: yes MEASUREMENTS: in millimeters Left Atrium: 28 LV End Diastolic Dimension: 43 LV End Systolic Dimension: 24 LV Posterior Wall: 11 Right Atrium 44 RV End Diastolic Dimension: 35 Interventricular Septum: 11 Left Ventricle (short axis): Volumes in mL, index in mL per square meter End Diastolic Volume: 92 ED index=55 End Systolic Volume: 36 ES index=21 Stroke Volume:56 SV index=34 Ejection Fraction: 61% Morphology: There is normal left ventricular size and function with normal wall motion. There is normal resting first pass gadolinium perfusion. There is no abnormal late gadolinium enhancement. Triple IR weighted images appear normal. Right Ventricle (short axis): Volumes in mL, index in mL per square meter End Diastolic Volume: 102 ED index=61 End Systolic Volume: 53 ES index=31 Stroke Volume: 49 SV index=30 Ejection Fraction: 49% Morphology: The right ventricle appears normal in size. Pericardium: Thickness: 2mm (1-3 mm) Effusion: none Pleural: There is no pleural effusion VALVULAR MORPHOLOGY Valve: Mitral: No significant stenosis or regurgitation. Aortic: There is a central regurgitant jet which appears mild to moderate. Regurgitation: Fraction: Stenosis: Tricuspid: No significant stenosis or regurgitation. Pulmonary: No significant stenosis or regurgitation. Atria: Both atria appear normal in size. The interatrial septum appears intact but aneurysmal. There are four pulmonary veins draining in to the left atria. The coronary sinus appears normal in size. The visualized portions of the thoracic aorta appear normal. Vessel dimensions: (In mm normal range dimensions mm) Main Pulmonary Artery 35 Aortic Root 27 Aortic Arch 25 [18-37] Right Pulmonary Artery 22 Ascending Aorta 31 [19-37] Left Pulmonary Artery 20 Inferior Vena Cava 30 Descending Aorta 22 [16-29] INCIDENTAL FINDINGS: none CONCLUSION: 1. There is normal left and right ventricular size and function. 2. There is mild to moderate aortic insufficiency. 3. The pulmonary artery is mildly dilated at 34x32mm 4. There is no evidence of LGE 5. Compared to prior CMR 1/2020, there is no significant change Cardiac MRI Technologist: Cathy Gunn As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: IMAGING DATA Imaging System: GE 1.5T Overall Image Quality: Excellent CARDIAC MORPHOLOGY AND VENTRICULAR FUNCTION Views: Axial Two chamber Four chamber Short axis LV LVOT Ascending aorta RVOT Short T2, phase contrast flow velocity mapping, perfusion delayed enhancement Sequences: FSE 2IR FSE 3IR SSFP FGRE ET Additional views: General: ECG gated: yes MEASUREMENTS: in millimeters Left Atrium: 28 LV End Diastolic Dimension: 43 LV End Systolic Dimension: 24 LV Posterior Wall: 11 Right Atrium 44 RV End Diastolic Dimension: 35 Interventricular Septum: 11 Left Ventricle (short axis): Volumes in mL, index in mL per square meter End Diastolic Volume: 92 ED index=55 End Systolic Volume: 36 ES index=21 Stroke Volume:56 SV index=34 Ejection Fraction: 61% Morphology: There is normal left ventricular size and function with normal wall motion. There is normal resting first pass gadolinium perfusion. There is no abnormal late gadolinium enhancement. Triple IR weighted images appear normal. Right Ventricle (short axis): Volumes in mL, index in mL per square meter End Diastolic Volume: 102 ED index=61 End Systolic Volume: 53 ES index=31 Stroke Volume: 49 SV index=30 Ejection Fraction: 49% Morphology: The right ventricle appears normal in size. Pericardium: Thickness: 2mm (1-3 mm) Effusion: none Pleural: There is no pleural effusion VALVULAR MORPHOLOGY Valve: Mitral: No significant stenosis or regurgitation. Aortic: There is a central regurgitant jet which appears mild to moderate. Regurgitation: Fraction: Stenosis: Tricuspid: No significant stenosis or regurgitation. Pulmonary: No significant stenosis or regurgitation. Atria: Both atria appear normal in size. The interatrial septum appears intact but aneurysmal. There are four pulmonary veins draining in to the left atria. The coronary sinus appears normal in size. The visualized portions of the thoracic aorta appear normal. Vessel dimensions: (In mm normal range dimensions mm) Main Pulmonary Artery 35 Aortic Root 27 Aortic Arch 25 [18-37] Right Pulmonary Artery 22 Ascending Aorta 31 [19-37] Left Pulmonary Artery 20 Inferior Vena Cava 30 Descending Aorta 22 [16-29] INCIDENTAL FINDINGS: none
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Mild dependent atelectatic changes. Calcified granuloma in the left upper lobe and partially visualized calcified left hilar lymph nodes are likely sequela of prior granulomatous disease. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Scattered hypoattenuating lesions of varying size throughout the liver are too small to characterize, but are statistically likely to represent cysts. Otherwise, no significant abnormality. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal size. Scattered tiny calcified granulomata. ADRENALS: Normal. KIDNEYS: Symmetric contrast enhancement. Obstructing 5 mm calculus at the right ureterovesical junction with mild upstream right hydroureter with urothelial thickening and enhancement as well as mild periureteral stranding. Punctate nonobstructing calculus in the interpolar left kidney. No left hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No significant abnormality in the colon. The appendix is not definitely visualized. PERITONEUM / MESENTERY: No free intracranial fluid. No pneumoperitoneum. RETROPERITONEUM: Right periureteral stranding, as above. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous abnormality is identified.
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15,913 |
EXAM: MR Brain wo+w contrast CLINICAL INFORMATION: New/worsening positional headache. COMPARISON: None. TECHNIQUE: MR Brain wo+w contrast. Patient weight: 225 lbs. IV contrast: ProHance, 20 ml, per protocol. FINDINGS: No abnormal restricted diffusion. No significant abnormal T2 or FLAIR signal. The ventricles are normal in size without midline shift. Basal cisterns are maintained. Expected vascular flow voids are unremarkable. The midline structures are unremarkable. No tonsillar ectopia or other herniation. No abnormal susceptibility signal dropout. On postcontrast sequences there is no abnormal parenchymal, leptomeningeal, or pachymeningeal enhancement. No extra-axial collection. No abnormal marrow signal. The middle ears, mastoid air cells, and paranasal sinuses are clear. The orbits and globes are unremarkable. No significant soft tissue abnormality aside from parotid lymph nodes.. CONCLUSION: No acute intracranial abnormality or findings to explain the patient's worsening positional headache. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: No abnormal restricted diffusion. No significant abnormal T2 or FLAIR signal. The ventricles are normal in size without midline shift. Basal cisterns are maintained. Expected vascular flow voids are unremarkable. The midline structures are unremarkable. No tonsillar ectopia or other herniation. No abnormal susceptibility signal dropout. On postcontrast sequences there is no abnormal parenchymal, leptomeningeal, or pachymeningeal enhancement. No extra-axial collection. No abnormal marrow signal. The middle ears, mastoid air cells, and paranasal sinuses are clear. The orbits and globes are unremarkable. No significant soft tissue abnormality aside from parotid lymph nodes..
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FINDINGS: BONES/JOINTS: Total knee arthroplasty changes. Spiral fracture of the distal femoral diaphysis with approximately one shaft width lateral displacement of the distal fracture fragment and slight posterior apex angulation. The distal femoral fracture extends to the cranial margin of the femoral component. The total knee arthroplasty. There is mild lucency surrounding the tibial component, but no periprosthetic fractures identified involving the tibial component. SOFT TISSUES: Moderate hemarthrosis and moderate-sized popliteal cyst. Soft tissue edema and contusions of the knee.
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15,914 |
EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: History of cirrhosis. Right hepatic lobe hypoechoic area/lesion seen on abdominal sonogram 12/5/2021; the patient presents for follow-up examination. COMPARISON: Incomplete MR examination 1/10/2022 and abdominal sonogram 12/5/2021; MR abdomen 6/8/2021 TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 195 lbs. IV contrast: ProHance, 8 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: STRUCTURED REPORT: MR HCC Screening IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. No steatosis. LIVER LESIONS: - Lesion Number: 1 - Location: Segment(s) 5 - Size: 3.0 x 1.9 cm (Image 53, Series 12) - Enhancement: Nonrim arterial phase hyperenhancement - Vascular invasion: No - Additional major features present: 0 - Enhancing "capsule": Not present. - Nonperipheral "washout": Not present. - Threshold growth (>= 50% in <= 6 months): Not present. - Other features: Mildly T2 hyperintense, T1 hypointense. This lesion remains hyperenhancing relative to the hepatic parenchyma. - LI-RADS: LR-4 Unchanged arterial hyperperfusion along the gallbladder fossa. Unchanged cysts in the anterior right hepatic lobe along the gallbladder fossa. Peripheral wedge-shaped arterial hyperenhancement (image 35, series 10) and focal subcentimeter arterial hyperenhancement in the right hepatic dome (image 80, series 10) without corresponding washout or pseudocapsule favor perfusion anomalies (LR 3). No arterially enhancing lesion with washout kinetics. LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Right hepatic artery is replaced to the superior mesenteric artery. Right and left hepatic arteries are patent. - 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 Screening IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. No steatosis. LIVER LESIONS: - Lesion Number: 1 - Location: Segment(s) 5 - Size: 3.0 x 1.9 cm (Image 53, Series 12) - Enhancement: Nonrim arterial phase hyperenhancement - Vascular invasion: No - Additional major features present: 0 - Enhancing "capsule": Not present. - Nonperipheral "washout": Not present. - Threshold growth (>= 50% in <= 6 months): Not present. - Other features: Mildly T2 hyperintense, T1 hypointense. This lesion remains hyperenhancing relative to the hepatic parenchyma. - LI-RADS: LR-4 Unchanged arterial hyperperfusion along the gallbladder fossa. Unchanged cysts in the anterior right hepatic lobe along the gallbladder fossa. Peripheral wedge-shaped arterial hyperenhancement (image 35, series 10) and focal subcentimeter arterial hyperenhancement in the right hepatic dome (image 80, series 10) without corresponding washout or pseudocapsule favor perfusion anomalies (LR 3). No arterially enhancing lesion with washout kinetics. LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Right hepatic artery is replaced to the superior mesenteric artery. Right and left hepatic arteries are patent. - 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: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Positive for pulmonary embolus. - Pulmonary Embolus Distribution: Multiple linear nonocclusive filling defects extending from the distal aspect of the right main pulmonary artery into the right lower lobe and right upper lobe lobar and segmental arteries. Filling defects are also noted at the distal aspects of multiple subsegmental branches in the left lower lobe. - Pulmonary Artery Diameter: Normal. - Ascending Aortic Diameter: Normal. - RV:LV Ratio: Normal. - Interventricular Septum: Normal. - Contrast reflux into IVC: No significant abnormality. LUNGS / AIRWAYS / PLEURA: Prominent secretions in the proximal trachea. Extensive mucous plugging in the bronchus intermedius and right middle lobe bronchi with complete occlusion of the right lower lobe bronchus. There is associated complete collapse of the right lower lobe. Apical predominant emphysema. No pleural effusion or pneumothorax. HEART / OTHER VESSELS: Right IJ central venous catheter terminating at the cavoatrial junction. No other significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No significant abnormality.
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15,915 |
EXAM:MR Shoulder Left wo contrast CLINICAL INFORMATION:Left shoulder pain COMPARISON:Prior shoulder MRI dated 2/9/2017. TECHNIQUE:Multiplanar multisequence images were obtained through the left shoulder Findings: There is an intermediate grade partial articular surface tear of the supraspinatus tendon, approximately 1.2 cm central to the insertion. The tear extends through approximately 40% of the tendon thickness. The infraspinatus, teres minor, and subscapularis are unremarkable. There is no significant fluid in the subacromial/subdeltoid bursa. The long head biceps tendon is intact and properly positioned within the bicipital groove. The glenoid labrum is unremarkable. There are moderate hypertrophic degenerative changes of the acromioclavicular joint. A moderate joint effusion is present in the AC joint. The type II acromion shows no abnormal downsloping. Impression: 1. Intermediate grade partial articular surface tear of the critical zone of the supraspinatus tendon. 2. Moderate AC joint degenerative changes including moderate size effusion.
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Findings: There is an intermediate grade partial articular surface tear of the supraspinatus tendon, approximately 1.2 cm central to the insertion. The tear extends through approximately 40% of the tendon thickness. The infraspinatus, teres minor, and subscapularis are unremarkable. There is no significant fluid in the subacromial/subdeltoid bursa. The long head biceps tendon is intact and properly positioned within the bicipital groove. The glenoid labrum is unremarkable. There are moderate hypertrophic degenerative changes of the acromioclavicular joint. A moderate joint effusion is present in the AC joint. The type II acromion shows no abnormal downsloping.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: There is complete occlusion of the bronchus intermedius with narrowing of the right upper lobe bronchus. There is partial aeration of the right upper lobe with complete atelectatic collapse of the lower and middle lobes. Intermittent mucus plugging is also noted at the left base. Patchy groundglass nodularity is noted throughout both lungs with a predominance for the left lower lobe and left lingula. Small right and trace left pleural effusions. HEART / VESSELS: Coronary calcifications. The heart size is normal. The main pulmonary artery is mildly dilated. Otherwise unremarkable for technique. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Numerous calcified hilar and mediastinal lymph nodes. CHEST WALL: Normal. UPPER ABDOMEN: Partially visualized gastric bypass surgical change. Otherwise unremarkable. MUSCULOSKELETAL: Right shoulder arthroplasty hardware.
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15,916 |
MR Brain wo+w contrast 1/28/2022 8:32 AM Clinical Information: Evaluation for vertigo after traumatic head injury. Comparison: Technique: Multiplanar MR imaging was performed with and without contrast as per department protocol. Findings: Inner ear structures appear unremarkable. There is diffuse cerebral cerebral volume loss, secondary to atrophic changes. There are also scattered areas of periventricular and deep white matter FLAIR hyper signal intensity, secondary to microangiopathic changes. No intracranial mass, mass effect, edema, hemorrhage, hydrocephalus, or evidence of acute infarction is seen. Evidence of mildly enlarged sella is noted, dedicated pituitary imaging for better evaluation is recommended. The visualized paranasal sinuses and mastoid air cells are clear. No acute osseous or soft tissue abnormality. Impression: No acute intracranial abnormality. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: Inner ear structures appear unremarkable. There is diffuse cerebral cerebral volume loss, secondary to atrophic changes. There are also scattered areas of periventricular and deep white matter FLAIR hyper signal intensity, secondary to microangiopathic changes. No intracranial mass, mass effect, edema, hemorrhage, hydrocephalus, or evidence of acute infarction is seen. Evidence of mildly enlarged sella is noted, dedicated pituitary imaging for better evaluation is recommended. The visualized paranasal sinuses and mastoid air cells are clear. No acute osseous or soft tissue abnormality.
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FINDINGS: BONES/JOINTS: No acute fracture or malalignment. Partially imaged left total hip arthroplasty without evidence of hardware complication in the imaged portions. SOFT TISSUES: No large hematoma or fluid collection. Diverticulosis without acute diverticulitis.
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15,917 |
MR Breast Diagnostic Bil wo+w contrast CLINICAL INFORMATION: rightmasspapilloma, N63.0 Unspecified lump in unspecified breast. TECHNIQUE: T1 axial, FSE T2 fat sat axial, pre and post contrast vibrant sequence with 3D reconstructions and time intensity curves. Delayed post contrast axials. A dedicated 8 channel breast imaging coil was utilized. Patient weight: 290 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: Prior studies including most recent biopsy images from December 2021 and prior mammography exams dating from 2015 FINDINGS: All measurements provided in the format AP, TV, CC dimensions Breast tissue is scattered fibroglandular tissue. Postcontrast administration there is moderate background enhancement. RIGHT BREAST: Focal nonmass enhancement in the right breast at 3:00 anterior depth measures 6 x 6 mm around the biopsy marker from stereotactic procedure. No suspicious enhancement. Postbiopsy changes are noted. LEFT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. BILATERAL Innumerable scattered bilateral foci are similar in appearance. None stands out from background. These do limit detection of small invasive cancers. All have similar kinetic features. These all may represent tiny intraductal papillomas, fibroadenomas, or benign background. Internal mammary nodes are normal. Axillary lymph nodes are normal. EXTRAMAMMARY: There is no suspicious abnormality in the visualized lung fields. Visualized upper abdomen unremarkable. Marrow signal is normal. IMPRESSION: RIGHT BREAST: No MRI evidence of malignancy.: BI-RADS 2: Benign LEFT BREAST: No MRI evidence of malignancy.: BI-RADS 2: Benign Overall BI-RADS assessment: BI-RADS 2: Benign
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FINDINGS: All measurements provided in the format AP, TV, CC dimensions Breast tissue is scattered fibroglandular tissue. Postcontrast administration there is moderate background enhancement. RIGHT BREAST: Focal nonmass enhancement in the right breast at 3:00 anterior depth measures 6 x 6 mm around the biopsy marker from stereotactic procedure. No suspicious enhancement. Postbiopsy changes are noted. LEFT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. BILATERAL Innumerable scattered bilateral foci are similar in appearance. None stands out from background. These do limit detection of small invasive cancers. All have similar kinetic features. These all may represent tiny intraductal papillomas, fibroadenomas, or benign background. Internal mammary nodes are normal. Axillary lymph nodes are normal. EXTRAMAMMARY: There is no suspicious abnormality in the visualized lung fields. Visualized upper abdomen unremarkable. Marrow signal is normal.
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FINDINGS: AORTIC ARCH: Patent without flow-limiting stenosis. Common origin of the brachiocephalic and left common carotid arteries. RIGHT CAROTID: Calcified and non-calcified atherosclerotic disease of the carotid bulb and proximal ICA with approximately 50% luminal narrowing of the proximal ICA. LEFT CAROTID: Calcified and non-calcified atherosclerotic disease of the carotid bulb and proximal ICA with approximately 50% luminal narrowing of the proximal ICA. RIGHT VERTEBRAL ARTERY: Patent without flow-limiting stenosis. LEFT VERTEBRAL ARTERY: Patent without flow-limiting stenosis. INTRACRANIAL ARTERIES: Near complete occlusion of the branches of superior division of M2 sylvian segment of the left MCA with distal reconstitution (sagittal series 410, image 28, 30; axial series 408, image 69). The bilateral ACAs, PCAs and right MCA appear patent, without flow-limiting stenoses or discrete aneurysms. The vertebrobasilar axis is mildly tortuous, without flow-limiting stenoses. NONVASCULAR FINDINGS: Please see same-day CT head without contrast for dedicated nonvascular intracranial findings. Soft tissue of the neck are unremarkable. Multilevel discogenic degenerative changes of the cervical spine. No acute osseous abnormality. Visualized lung apices are clear.
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15,918 |
EXAM: MR Knee Left wo contrast CLINICAL INFORMATION: Knee pain COMPARISON: Prior left knee MRI dated 12/16/2021 TECHNIQUE: Multiplanar multisequence images were obtained through the left knee using Visionaire protocol. Findings: There is extensive patellofemoral articular cartilage loss, with full thickness defects over the medial patellar facet. There is severe articular cartilage loss throughout the medial and lateral tibiofemoral compartments with associated large marginal osteophytes. There is a large joint effusion with scattered osteochondral debris. No popliteal cyst is seen. There is severe myxoid degenerative change of the anterior and posterior cruciate ligaments. There is complete maceration of the anterior horn and body of the lateral meniscus. There is a large, predominantly horizontal tear of the posterior horn and body of the medial meniscus. The quadriceps and patellar tendons are intact. The medial collateral ligament, patellar retinaculum, iliotibial band, and posterior lateral corner structures are unremarkable. Impression: 1. Severe tricompartment osteoarthrosis unchanged from the prior study. 2. Large joint effusion with extensive osteochondral debris, also stable. 3. Complex medial and lateral meniscal tears. 4. Severe myxoid degenerative change of the cruciate ligaments which may be functionally insufficient.
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Findings: There is extensive patellofemoral articular cartilage loss, with full thickness defects over the medial patellar facet. There is severe articular cartilage loss throughout the medial and lateral tibiofemoral compartments with associated large marginal osteophytes. There is a large joint effusion with scattered osteochondral debris. No popliteal cyst is seen. There is severe myxoid degenerative change of the anterior and posterior cruciate ligaments. There is complete maceration of the anterior horn and body of the lateral meniscus. There is a large, predominantly horizontal tear of the posterior horn and body of the medial meniscus. The quadriceps and patellar tendons are intact. The medial collateral ligament, patellar retinaculum, iliotibial band, and posterior lateral corner structures are unremarkable.
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FINDINGS: AORTIC ARCH: Patent without flow-limiting stenosis. Common origin of the brachiocephalic and left common carotid arteries. RIGHT CAROTID: Calcified and non-calcified atherosclerotic disease of the carotid bulb and proximal ICA with approximately 50% luminal narrowing of the proximal ICA. LEFT CAROTID: Calcified and non-calcified atherosclerotic disease of the carotid bulb and proximal ICA with approximately 50% luminal narrowing of the proximal ICA. RIGHT VERTEBRAL ARTERY: Patent without flow-limiting stenosis. LEFT VERTEBRAL ARTERY: Patent without flow-limiting stenosis. INTRACRANIAL ARTERIES: Near complete occlusion of the branches of superior division of M2 sylvian segment of the left MCA with distal reconstitution (sagittal series 410, image 28, 30; axial series 408, image 69). The bilateral ACAs, PCAs and right MCA appear patent, without flow-limiting stenoses or discrete aneurysms. The vertebrobasilar axis is mildly tortuous, without flow-limiting stenoses. NONVASCULAR FINDINGS: Please see same-day CT head without contrast for dedicated nonvascular intracranial findings. Soft tissue of the neck are unremarkable. Multilevel discogenic degenerative changes of the cervical spine. No acute osseous abnormality. Visualized lung apices are clear.
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15,919 |
MR Breast Screening wo+w contrast CLINICAL INFORMATION: FH of breast cancer, Z80.3 Family history of malignant neoplasm of breast, D24.1 Benign neoplasm of right breast Spec Inst: LEEDS, LT rsk >50%. TECHNIQUE: T1 axial, FSE T2 fat sat axial, pre and post contrast vibrant sequence with 3D reconstructions. Fast scan. A dedicated 8 channel breast imaging coil was utilized. Patient weight: 146 lbs. IV contrast: ProHance, 14 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: Prior studies with most recent MRI from 2021 FINDINGS: All measurements provided in the format AP, TV, CC dimensions Breast tissue is heterogeneous fibroglandular tissue. Postcontrast administration there is moderate background enhancement. RIGHT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. LEFT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. BILATERAL Scattered bilateral foci are similar in appearance. None stands out from background. These do limit detection of small invasive cancers. Internal mammary nodes are normal. Axillary lymph nodes are normal. EXTRAMAMMARY: There is no suspicious abnormality in the visualized lung fields. Visualized upper abdomen unremarkable. Marrow signal is normal. IMPRESSION: RIGHT BREAST: No MRI evidence of malignancy. BI-RADS 2: Benign LEFT BREAST: No MRI evidence of malignancy. BI-RADS 2: Benign Overall BI-RADS assessment: BI-RADS 2: Benign
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FINDINGS: All measurements provided in the format AP, TV, CC dimensions Breast tissue is heterogeneous fibroglandular tissue. Postcontrast administration there is moderate background enhancement. RIGHT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. LEFT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. BILATERAL Scattered bilateral foci are similar in appearance. None stands out from background. These do limit detection of small invasive cancers. Internal mammary nodes are normal. Axillary lymph nodes are normal. EXTRAMAMMARY: There is no suspicious abnormality in the visualized lung fields. Visualized upper abdomen unremarkable. Marrow signal is normal.
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Findings: There is no intracranial hemorrhage or acute infarction. There is diffuse brain volume loss with commensurate ex vacuo ventricular dilatation. Mild white matter microangiopathic changes. Chronic lacunar infarct in left basal ganglia. Gray-white matter differentiation is overall maintained.
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15,920 |
RADIOLOGIC EXAM: MR Brain wo+w contrast CLINICAL INFORMATION: Dizziness, Spec Inst: IAC Protocol. Per chart review, ENT electronystagmogram (ENG) positive for left beating nystagmus. Patient complains of left-sided migraines. COMPARISON: MRI brain dated 7/18/2011. TECHNIQUE: MR Brain wo+w contrast Patient weight: 165 lbs. IV contrast: ProHance, 15 ml, per protocol. Multiple T1 and T2-weighted MR sequence images of the brain were obtained in the sagittal axial and coronal planes pre- and post administration of intravenous contrast per departmental protocol. FINDINGS: INTRACRANIAL FINDINGS: Persistent tiny branch of the left AICA looping into the proximal left IAC, similar to prior MRI from July 2011. Postcontrast series demonstrates no focal enhancing lesion. There are no cerebellopontine angle masses or cysts. There is no abnormal enhancement of the 8th nerve complex or labyrinth. High resolution axial T2 images through the labyrinth demonstrate no fibrous or osseous obliteration of labyrinthine structures. There are no abnormal enhancing posterior fossa vascular structures. There is no evidence of an aberrant carotid artery or a vascular middle ear or jugular foramen mas No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, space-occupying lesion, or mass effect. Mild bilateral periventricular and scattered punctate subcortical/deep cerebral white matter T2/FLAIR hyperintensities, likely chronic microangiopathic changes. 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. Left greater than right maxillary sinus moderate to severe mucosal thickening. Mild bilateral anterior ethmoid sinus and left frontal sinus mucosal thickening. Partial left mastoid effusion. The paranasal sinuses and right mastoid air cells are otherwise clear. Both orbits are unremarkable. Note is made of significant synovial enhancement about the left TMJ CONCLUSION: 1. Persistent tiny branch of the left AICA looping into the proximal left IAC, similar to prior MRI from July 2011. No definite displacement of the left C7 cranial nerve VIII nerve root complex. 2. No additional intracranial abnormality or pathologic enhancement to explain patient's dizziness and left nystagmus. 3. Partial left mastoid effusion. 4. Significant left TMJ synovitis likely on degenerative basis. As the attending 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: Persistent tiny branch of the left AICA looping into the proximal left IAC, similar to prior MRI from July 2011. Postcontrast series demonstrates no focal enhancing lesion. There are no cerebellopontine angle masses or cysts. There is no abnormal enhancement of the 8th nerve complex or labyrinth. High resolution axial T2 images through the labyrinth demonstrate no fibrous or osseous obliteration of labyrinthine structures. There are no abnormal enhancing posterior fossa vascular structures. There is no evidence of an aberrant carotid artery or a vascular middle ear or jugular foramen mas No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, space-occupying lesion, or mass effect. Mild bilateral periventricular and scattered punctate subcortical/deep cerebral white matter T2/FLAIR hyperintensities, likely chronic microangiopathic changes. 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. Left greater than right maxillary sinus moderate to severe mucosal thickening. Mild bilateral anterior ethmoid sinus and left frontal sinus mucosal thickening. Partial left mastoid effusion. The paranasal sinuses and right mastoid air cells are otherwise clear. Both orbits are unremarkable. Note is made of significant synovial enhancement about the left TMJ
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A CT perfusion study was performed during single pass of 50 cc contrast bolus. Axial images were acquired at 8 axial locations and time-attenuation curves generated from this dataset were utilized to calculate cerebral blood flow, mean transit time, time to peak, and cerebral blood volume maps as well as region of interest specific quantitative data. "Prognostic" color maps were also generated depicting areas of ischemia (voxel values for MTT > 1.4 times mirror image voxels on the contralateral "normal side") in the color green and areas predictive of infarction (CBV values 6.0s = 32 mL) without definite evidence of core infarct on perfusion.
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15,921 |
EXAM: MR Lumbar Spine wo contrast CLINICAL INFORMATION: Back pain with concern for spinal canal stenosis lumbar spine radiographs. COMPARISON: MR spine radiograph dated 11/17/2021. TECHNIQUE: MR Lumbar Spine wo contrast. FINDINGS: No suspicious marrow replacement. Discogenic endplate edema at L2-L3. No significant spondylolisthesis. Mild levoscoliosis centered at L3. The conus terminates at L1-L2. Apparent bunching of the cauda equina nerve roots at L1 and L2 secondary to severe canal stenosis at L2-3. T12-L1: No significant disc bulge, spinal canal, or foraminal narrowing. L1-L2: Minimal broad-based disc bulge most pronounced in the foraminal regions. No significant spinal canal narrowing. Associated bilateral facet arthropathy results in mild bilateral foraminal narrowing without nerve root compression. L2-L3: Moderate to severe broad-based disc bulge with associated ligamentum flavum hypertrophy resulting in severe spinal canal narrowing and clumping/compression of the cauda equina. Moderate bilateral left worse than right facet arthropathy results in moderate bilateral foraminal narrowing with abutment of the nerve roots posteriorly to the hypertrophied facets. L3-L4: Significant posterior projecting disc osteophyte complex with associated severe ligamentum flavum hypertrophy results in moderate to severe spinal canal narrowing at this level with clumping of the cauda equina. Associated right worse than left significant facet arthropathy results in severe bilateral neural foraminal narrowing with significant exiting right L3 nerve root compression and posterior abutment to the hypertrophied facets of the exiting left L3 nerve root. L4-L5: Significant broad-based disc bulge with only mild spinal canal narrowing and associated ligamentum flavum hypertrophy. Advanced facet arthropathy results in severe right and mild to moderate left neural foraminal narrowing with compression of the exiting right L4 nerve root. L5-S1: Significant broad-based disc bulge with mild associated ligamentum flavum hypertrophy. No significant spinal canal narrowing. Advanced bilateral facet arthropathy results in bilateral moderate neural foraminal narrowing with suspected compression of the exiting right L5 nerve root and abutment both superiorly and posteriorly of the exiting left L5 nerve root. No significant soft tissue abnormality. CONCLUSION: 1. Severely advanced lower lumbar spine degenerative change resulting in severe spinal canal stenosis at L2-L3 and L3-L4. 2. Associated severe neural foraminal narrowing without nerve root compression involving the exiting right L3 nerve root, exiting right L4 nerve root, and exiting right L5 nerve root. There is also multilevel abutment of exiting nerve roots to the posterior hypertrophied facets as described above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: No suspicious marrow replacement. Discogenic endplate edema at L2-L3. No significant spondylolisthesis. Mild levoscoliosis centered at L3. The conus terminates at L1-L2. Apparent bunching of the cauda equina nerve roots at L1 and L2 secondary to severe canal stenosis at L2-3. T12-L1: No significant disc bulge, spinal canal, or foraminal narrowing. L1-L2: Minimal broad-based disc bulge most pronounced in the foraminal regions. No significant spinal canal narrowing. Associated bilateral facet arthropathy results in mild bilateral foraminal narrowing without nerve root compression. L2-L3: Moderate to severe broad-based disc bulge with associated ligamentum flavum hypertrophy resulting in severe spinal canal narrowing and clumping/compression of the cauda equina. Moderate bilateral left worse than right facet arthropathy results in moderate bilateral foraminal narrowing with abutment of the nerve roots posteriorly to the hypertrophied facets. L3-L4: Significant posterior projecting disc osteophyte complex with associated severe ligamentum flavum hypertrophy results in moderate to severe spinal canal narrowing at this level with clumping of the cauda equina. Associated right worse than left significant facet arthropathy results in severe bilateral neural foraminal narrowing with significant exiting right L3 nerve root compression and posterior abutment to the hypertrophied facets of the exiting left L3 nerve root. L4-L5: Significant broad-based disc bulge with only mild spinal canal narrowing and associated ligamentum flavum hypertrophy. Advanced facet arthropathy results in severe right and mild to moderate left neural foraminal narrowing with compression of the exiting right L4 nerve root. L5-S1: Significant broad-based disc bulge with mild associated ligamentum flavum hypertrophy. No significant spinal canal narrowing. Advanced bilateral facet arthropathy results in bilateral moderate neural foraminal narrowing with suspected compression of the exiting right L5 nerve root and abutment both superiorly and posteriorly of the exiting left L5 nerve root. No significant soft tissue abnormality.
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FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Mildly suboptimal quality with incomplete evaluation of subsegmental pulmonary arteries due to motion artifact. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Scattered groundglass opacities, predominantly in the upper lobes. No pneumothorax or pleural effusion. Central airways are patent. Incidentally noted azygos lobe. HEART / OTHER VESSELS: Normal heart size. No pericardial effusion. Normal size pulmonary artery. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Partially imaged hypoattenuating lesions in the left upper pole, likely renal cysts. MUSCULOSKELETAL: No significant abnormality.
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15,922 |
EXAM: MR Lumbar Spine wo contrast CLINICAL INFORMATION: Left-sided sciatica. COMPARISON: MR lumbar spine dated 11/16/2018. TECHNIQUE: MR Lumbar Spine wo contrast. FINDINGS: No abnormal marrow replacement. No acute displaced fracture or compression deformity. No significant spondylolisthesis. The disc heights appear maintained throughout. Mild disc desiccation at L3-S1. The conus terminates at the inferior endplate of L2. T12-L1: No significant disc bulge, spinal canal, or foraminal narrowing. L1-L2: No significant disc bulge, spinal canal or foraminal narrowing. L2-L3: Mild bilateral facet arthropathy without significant spinal canal or foraminal narrowing. Mild facet arthropathy. L3-L4: Mild broad-based disc bulge without significant spinal canal or foraminal narrowing. Mild to moderate associated facet arthropathy. L4-L5: Broad disc bulge with ligamentum flavum thickening and significant advanced hypertrophic facet arthropathy resulting in moderate spinal canal narrowing. There is also dorsal epidural lipomatosis contributing to narrowing of the thecal sac at this level. No definitive cauda equina compression. Associated moderate bilateral facet arthropathy, left greater than right results in mild bilateral neural foraminal narrowing. L5 5 S1: Mild broad-based disc bulge lateralized to the left without significant spinal canal narrowing. There is slight left lateral recess narrowing and also mild left neural foraminal narrowing. Moderate right greater than left facet arthropathy results in mild bilateral neural foraminal narrowing. Slight interval worsening conspicuity of collecting system dilation involving the left kidney. No significant dilation is noted of the left proximal ureter. Asymmetric left renal atrophy is unchanged. Interval development of periaortic decreased T1 and T2 signal without significant luminal caliber change. Inferiorl aorta measures up to 3.0 cm in diameter. Redemonstrated ectatic dilation of the left common iliac artery. CONCLUSION: 1. Moderately advanced multilevel inferior lumbar spine facet arthropathy. Findings most pronounced at L4-L5 where there is moderate narrowing of the thecal sac. Dorsal epidural lipomatosis at this level also contributes to narrowing of the thecal sac There is also advanced facet arthropathy at L5-S1. There is mild bilateral neural foraminal narrowing at these levels. . 2. Incidentally noted ectatic aneurysmal dilatation of the infrarenal abdominal aorta has developed. 3. Slight interval worsening of the left renal pelviectasis without associated hydroureter. *****IMPORTANT INCIDENTAL IMAGING FINDINGS REPORTED***** As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report. Note: Important incidental findings were discussed with the provided clinical contact Dorothy Williams by Dr. Kuhlman at 1/28/2022 2:39 PM. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: No abnormal marrow replacement. No acute displaced fracture or compression deformity. No significant spondylolisthesis. The disc heights appear maintained throughout. Mild disc desiccation at L3-S1. The conus terminates at the inferior endplate of L2. T12-L1: No significant disc bulge, spinal canal, or foraminal narrowing. L1-L2: No significant disc bulge, spinal canal or foraminal narrowing. L2-L3: Mild bilateral facet arthropathy without significant spinal canal or foraminal narrowing. Mild facet arthropathy. L3-L4: Mild broad-based disc bulge without significant spinal canal or foraminal narrowing. Mild to moderate associated facet arthropathy. L4-L5: Broad disc bulge with ligamentum flavum thickening and significant advanced hypertrophic facet arthropathy resulting in moderate spinal canal narrowing. There is also dorsal epidural lipomatosis contributing to narrowing of the thecal sac at this level. No definitive cauda equina compression. Associated moderate bilateral facet arthropathy, left greater than right results in mild bilateral neural foraminal narrowing. L5 5 S1: Mild broad-based disc bulge lateralized to the left without significant spinal canal narrowing. There is slight left lateral recess narrowing and also mild left neural foraminal narrowing. Moderate right greater than left facet arthropathy results in mild bilateral neural foraminal narrowing. Slight interval worsening conspicuity of collecting system dilation involving the left kidney. No significant dilation is noted of the left proximal ureter. Asymmetric left renal atrophy is unchanged. Interval development of periaortic decreased T1 and T2 signal without significant luminal caliber change. Inferiorl aorta measures up to 3.0 cm in diameter. Redemonstrated ectatic dilation of the left common iliac artery.
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Findings: Overall unchanged appearance of focal parenchymal hemorrhage in the posterior right frontal lobe at the central precentral gyrus. No significant mass effect or midline shift. No new intracranial hemorrhage is identified. No acute infarct. Chronic lacunar infarct in the right basal ganglia. Bilateral globes and optic nerves are intact. Bilateral pseudophakia. The retrobulbar soft tissues have a normal appearance. Unchanged small right parietal scalp hematoma. No acute calvarial fracture. The visualized paranasal sinuses mastoid air cells are clear.
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15,923 |
EXAM: MULTIPARAMETRIC MRI OF THE PROSTATE W AND WO IV CONTRAST CLINICAL INDICATION: prostate cancer, C61 Malignant neoplasm of prostate 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: 195 lbs. IV contrast: ProHance, 18 ml, per protocol. IV contrast injection rate: 2.50 ml per sec. COMPARISON: None. FINDINGS: STRUCTURED REPORT: MRI Prostate PROSTATE: Measurement: 3.1 x 3.7 x 4.3 cm; estimated volume: 26 cc Focal lesion(s): Lesion # 1 (index lesion): - Key image: image 16; series 5 - Size: 21 x 8 mm - Location: right; mid; posterolateral peripheral zone with suspected involvement of the PZ-CG junction. - T2WI: 5 ; DWI: 4; DCE (early and focal enhancement): positive - PI-RADS v2.1 score: 5 - Very high (clinically significant cancer is highly likely to be present) - Likelihood of extraprostatic extension: 4 - Likely; contacts prostatic capsule greater than 1 cm with mild contour irregularity. - Likelihood of seminal vesicle invasion: 2 - Unlikely Diffuse prostate abnormalities: Diffusely striated appearance of the peripheral zone on T2WI with abnormal contrast kinetics may reflect prostatitis Other prostate findings: Additional regions of T2 hypointensity and diffusion restriction throughout the central gland favor BPH nodules. VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. BLADDER: Within normal limits. OTHER PELVIC FINDINGS: Noninflamed sigmoid colon diverticulosis. 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. Lesion within the right mid posterior lateral peripheral zone is high suspicion for clinically significant prostate cancer (PIRADS 5) with findings suspicious for extraprostatic extension. 2. No pathologically enlarged lymph nodes or additional evidence of metastatic disease throughout the imaged pelvis. As the attending 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: 3.1 x 3.7 x 4.3 cm; estimated volume: 26 cc Focal lesion(s): Lesion # 1 (index lesion): - Key image: image 16; series 5 - Size: 21 x 8 mm - Location: right; mid; posterolateral peripheral zone with suspected involvement of the PZ-CG junction. - T2WI: 5 ; DWI: 4; DCE (early and focal enhancement): positive - PI-RADS v2.1 score: 5 - Very high (clinically significant cancer is highly likely to be present) - Likelihood of extraprostatic extension: 4 - Likely; contacts prostatic capsule greater than 1 cm with mild contour irregularity. - Likelihood of seminal vesicle invasion: 2 - Unlikely Diffuse prostate abnormalities: Diffusely striated appearance of the peripheral zone on T2WI with abnormal contrast kinetics may reflect prostatitis Other prostate findings: Additional regions of T2 hypointensity and diffusion restriction throughout the central gland favor BPH nodules. VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. BLADDER: Within normal limits. OTHER PELVIC FINDINGS: Noninflamed sigmoid colon diverticulosis. 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: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. MASTOIDS: Clear. SOFT TISSUE: No significant abnormality. MAXILLOFACIAL: No maxillofacial or mandibular fracture. Numerous periapical lucencies and dental caries. Small midline parietal scalp hematoma.
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15,924 |
MR Brain wo+w contrast 1/28/2022 9:35 AM Clinical Information: Evaluation for asymmetric hearing loss. Comparison: CT dated 1/28/2022 Technique: Multiplanar MR imaging was performed with and without contrast as per department protocol. Findings: No mass lesion is seen within the internal auditory canals. Cochlea and semicircular canals appear normal in morphology and signal. There is a round 13 x 11 mm heterogeneously mostly signal void lesion located in the right posterior parietal lobe which is almost calcified on CT images, suggesting a vascular malformation like cavernoma. There is also localized FLAIR hyper signal intensity around the lesion, likely suggesting mild peripheral edema. After contrast injection, scattered patchy areas of enhancement is seen in central and peripheral parts of the lesion. There are scattered areas of FLAIR hyper signal intensity in both centrum semiovale most prominent in right side, suggesting microangiopathic changes. No intracranial mass effect, edema, hemorrhage, hydrocephalus, or evidence of acute infarction is seen. The visualized paranasal sinuses and mastoid air cells are clear. No acute osseous or soft tissue abnormality. Impression: 1. No abnormality identified involving the internal auditory canals. 2. Stable right parietal lobe vascular lesion most in keeping with a cavernoma. As the attending 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 mass lesion is seen within the internal auditory canals. Cochlea and semicircular canals appear normal in morphology and signal. There is a round 13 x 11 mm heterogeneously mostly signal void lesion located in the right posterior parietal lobe which is almost calcified on CT images, suggesting a vascular malformation like cavernoma. There is also localized FLAIR hyper signal intensity around the lesion, likely suggesting mild peripheral edema. After contrast injection, scattered patchy areas of enhancement is seen in central and peripheral parts of the lesion. There are scattered areas of FLAIR hyper signal intensity in both centrum semiovale most prominent in right side, suggesting microangiopathic changes. No intracranial mass effect, edema, hemorrhage, hydrocephalus, or evidence of acute infarction is seen. 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 CAP Trauma LOWER NECK: Soft tissue emphysema tracking along the lateral lower left neck. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube distal tip projects 3 cm superior to the carina. Bilateral chest tubes in place with the right chest tube tip terminating along the anterior medial right lung at the margin of the anterior mediastinum and the left chest tube terminating at the left lung apex with hemorrhagic consolidation along the tube courses in the left upper lobe.. Trace residual anterior pneumothoraces, bilaterally. Few scattered small lung contusions and small lung laceration in the peripheral left lung underlying the displaced left fifth rib fracture. HEART / VESSELS: Right IJ line courses superiorly within the IJ vein with tip. Coronary artery calcifications. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Scattered foci of chest wall emphysema, bilaterally. Large soft tissue laceration traumatic soft tissue defect along the anterior left upper arm/left axilla with retained hyperattenuating traumatic fragments/foreign bodies associated at the soft tissue defect.. ABDOMEN and PELVIS: LIVER: Cirrhotic, mildly enlarged, and and diffusely heterogenous. No acute injury BILIARY TRACT: Normal. GALLBLADDER: Distended but otherwise normal PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Multifocal regions of hypoattenuation within the right kidney with majority showing mild contour deformity/indentation of the overlying cortex. Nonobstructing right renal stone. No associated perinephric stranding or fluid. LYMPH NODES: None enlarged21212 STOMACH / SMALL BOWEL: Esophagogastric tube distal tip terminates in the distal gastric body. Small bowel is normal in caliber. COLON / APPENDIX: The appendix and colon are normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Left inferior approach arterial line. Scattered vascular calcifications. URINARY BLADDER: Collapsed around a Foley balloon. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing inguinal hernias. MUSCULOSKELETAL: Comminuted left scapular fracture involving the scapular body and extending into the scapular spine. With soft tissue gas and surrounding hematoma. Comminuted left medial clavicle fracture. Multiple left-sided rib fractures including the first through sixth ribs, segmentally at 1-4. 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. Mild multilevel discogenic degenerative change at the thoracal lumbar junction and lower lumbar spine. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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15,925 |
EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: PANCREATIC CYST, K86.2 Cyst of pancreas COMPARISON: None. TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 120 lbs. IV contrast: ProHance, 11 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: T2 hyperintense cyst within the uncinate process measures 1.4 x 1.0 cm on T2 axial image 10, series 301. The cyst is unilocular without internal septations and demonstrates no postcontrast enhancement. There is no upstream ductal dilatation and the remainder of the pancreas appears 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: Simple cyst within the uncinate process of the pancreas without suspicious features. Findings are most compatible with a simple retention cyst or intraductal papillary mucinous neoplasm, although no communication to the main pancreatic duct is identified. Recommend follow-up with MR and MRCP in two years, unless clinically indicated sooner. As the attending 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: No abnormality. PANCREAS: T2 hyperintense cyst within the uncinate process measures 1.4 x 1.0 cm on T2 axial image 10, series 301. The cyst is unilocular without internal septations and demonstrates no postcontrast enhancement. There is no upstream ductal dilatation and the remainder of the pancreas appears 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: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Soft tissue emphysema tracking along the lateral lower left neck. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube distal tip projects 3 cm superior to the carina. Bilateral chest tubes in place with the right chest tube tip terminating along the anterior medial right lung at the margin of the anterior mediastinum and the left chest tube terminating at the left lung apex with hemorrhagic consolidation along the tube courses in the left upper lobe.. Trace residual anterior pneumothoraces, bilaterally. Few scattered small lung contusions and small lung laceration in the peripheral left lung underlying the displaced left fifth rib fracture. HEART / VESSELS: Right IJ line courses superiorly within the IJ vein with tip. Coronary artery calcifications. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Scattered foci of chest wall emphysema, bilaterally. Large soft tissue laceration traumatic soft tissue defect along the anterior left upper arm/left axilla with retained hyperattenuating traumatic fragments/foreign bodies associated at the soft tissue defect.. ABDOMEN and PELVIS: LIVER: Cirrhotic, mildly enlarged, and and diffusely heterogenous. No acute injury BILIARY TRACT: Normal. GALLBLADDER: Distended but otherwise normal PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Multifocal regions of hypoattenuation within the right kidney with majority showing mild contour deformity/indentation of the overlying cortex. Nonobstructing right renal stone. No associated perinephric stranding or fluid. LYMPH NODES: None enlarged21212 STOMACH / SMALL BOWEL: Esophagogastric tube distal tip terminates in the distal gastric body. Small bowel is normal in caliber. COLON / APPENDIX: The appendix and colon are normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Left inferior approach arterial line. Scattered vascular calcifications. URINARY BLADDER: Collapsed around a Foley balloon. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing inguinal hernias. MUSCULOSKELETAL: Comminuted left scapular fracture involving the scapular body and extending into the scapular spine. With soft tissue gas and surrounding hematoma. Comminuted left medial clavicle fracture. Multiple left-sided rib fractures including the first through sixth ribs, segmentally at 1-4. 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. Mild multilevel discogenic degenerative change at the thoracal lumbar junction and lower lumbar spine. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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15,926 |
EXAM: MR Knee Left wo contrast CLINICAL INFORMATION: Left knee injury, open wound anterior knee, pain, erythema and swelling COMPARISON: None. TECHNIQUE: MR Knee Left wo contrast STRUCTURED REPORT: MRI Knee 1/2/2020 FINDINGS: BONES:No fracture, marrow replacement, or aggressive osseous lesion. Tricompartmental osteophyte formation. ARTICULATIONS: Effusion:None. Patellofemoral compartment:Severe chondromalacia patella with full-thickness cartilage loss along the lateral patellar facet and lateral trochlea with associated subchondral marrow edema. Medial compartment:Chondromalacia with thinning of the central weightbearing femoral and tibial articular cartilage. Lateral compartment:No cartilage defect. MENISCI: Medial meniscus:Small vertical undersurface tear in the posterior horn of the medial meniscus.. Lateral meniscus:Intact. LIGAMENTS: Cruciate ligaments:Intact. Medial collateral ligament:Intact. Lateral collateral ligament:Intact. Posterolateral corner structures:Intact. EXTENSOR MECHANISM:The distal quadriceps and patellar tendons are intact. Moderate diffuse soft tissue edema. Laceration along the anterior knee with underlying large prepatellar/infrapatellar edema/hemorrhage. CONCLUSION: 1. No acute internal derangement. 2. Laceration along the anterior knee with underlying large prepatellar/infrapatellar edema/hemorrhage. 3. Small vertical undersurface tear in the posterior horn of the medial meniscus 4. Advanced tricompartmental osteoarthritis with cartilage loss is greatest in the patellofemoral articulation. As the attending 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. Tricompartmental osteophyte formation. ARTICULATIONS: Effusion:None. Patellofemoral compartment:Severe chondromalacia patella with full-thickness cartilage loss along the lateral patellar facet and lateral trochlea with associated subchondral marrow edema. Medial compartment:Chondromalacia with thinning of the central weightbearing femoral and tibial articular cartilage. Lateral compartment:No cartilage defect. MENISCI: Medial meniscus:Small vertical undersurface tear in the posterior horn of the medial meniscus.. Lateral meniscus:Intact. LIGAMENTS: Cruciate ligaments:Intact. Medial collateral ligament:Intact. Lateral collateral ligament:Intact. Posterolateral corner structures:Intact. EXTENSOR MECHANISM:The distal quadriceps and patellar tendons are intact. Moderate diffuse soft tissue edema. Laceration along the anterior knee with underlying large prepatellar/infrapatellar edema/hemorrhage.
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FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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15,927 |
MR Cervical Spine wo contrast, MR Thoracic Spine wo contrast Clinical Information:Per chart review, 75-year-old female with symptoms of back stiffness and balance issues concerning for thoracic versus cervical myelopathy. Comparison: CT 7/21/2021 and MR 1/22/2020. Technique: Multiplanar multisequence MRI of the cervical spine was performed without contrast. Findings: Mild straightening of the normal cervical lordosis, similar to prior. Congenital fusion of C6 and C7. Mild anterolisthesis of C3 on C4. Mild retrolisthesis of C4 on C5 and C5 on C6, unchanged. No acute fracture. No marrow signal abnormalities. No cord signal abnormalities. Prevertebral soft tissues are normal. Anterior and posterior ligamentous complexes are intact. C2-C3: No significant disc protrusion without significant canal or foraminal stenosis. C3-C4: Mild posterior disc osteophyte complex and anterolisthesis of C3 on C4 resulting in mild narrowing of the spinal canal without cord compression. Right greater than left moderate facet arthropathy and uncovertebral hypertrophy resulting in severe right and mild left foraminal narrowing, greater on the right. Modic type III degenerative changes of the posterior aspect of the inferior C3 endplate and superior C4 endplate. C4-C5: Significant loss of disc height and moderate retrolisthesis of C4 on C5 resulting in moderate canal narrowing with abutment of the cord without cord signal changes, similar to prior. Bulky uncovertebral hypertrophy bilaterally without significant facet hypertrophy resulting in moderate foraminal narrowing bilaterally. Modic type III endplate changes at the inferior endplate of C4 and superior endplate of C5. C5-C6: Significant loss of disc height and moderate retrolisthesis of C5 on C6 resulting in moderate canal narrowing with abutment of the cord without cord signal changes, similar to prior bulky uncovertebral hypertrophy bilaterally without significant associated hypertrophy resulting in moderate foraminal narrowing bilaterally. Modic type III changes at inferior endplate of C5 and superior endplate of C6. C6/C7-T1: No significant disc bulge. No significant spinal canal or foraminal narrowing. T1-T2: No significant disc bulge. No significant spinal canal or foraminal narrowing. T2-T3: No significant disc bulge. Mild thickening of the posterior longitudinal ligament. No significant spinal canal or foraminal narrowing. T3-T4: Well-circumscribed hemangioma within the vertebral body of T3. No significant disc bulge. No significant spinal canal or foraminal narrowing. T4-T5: Thickening of the posterior longitudinal ligament (sagittal series 23, image 11) with mild disc bulge resulting in narrowing of the spinal canal without cord compression. No significant foraminal narrowing. T6-T7: No significant disc bulge. No significant spinal canal or foraminal narrowing. T7-T8: No significant disc bulge. No significant spinal canal or foraminal narrowing. T9-T10: No significant disc bulge. No significant spinal canal or foraminal narrowing. T10-T11: No significant disc bulge. No significant spinal canal or foraminal narrowing. T11-T12: No significant disc bulge. Mild thickening of the posterior longitudinal ligament. No significant spinal canal or foraminal narrowing. T12-L1: No significant disc bulge. No significant spinal canal or foraminal narrowing. There is no abnormal signal within the thoracic spinal cord. Conus medullaris terminates at the L1 level. OTHER: Posterior spinal fusion hardware in the lumbar spine spanning L2-S1 there are multilevel laminectomies. There is mild retrolisthesis of L2 on L3 and mild anterolisthesis of L3-4. Hyperlordotic curvature of the lumbar spine. Cauda equina not well evaluated secondary to lack of axial images. CONCLUSION: 1. No abnormal cord signal changes in visualized spine. 2. Multilevel moderate degenerative changes of the cervical spine most prominent at C4-C6 with moderate canal narrowing and abutment of the cord at C4-C6 without cord signal changes. 3. Severe neural foraminal narrowing on the right at C3-C4, correlate clinically for right C4 radiculopathy. Moderate bilateral neural foraminal narrowing at C4-C5 and C5-C6. 4. Focal thickening of the posterior longitudinal ligament at T4-T5 resulting in mild canal narrowing. 5. Incompletely evaluated posterior spinal fusion hardware and multilevel laminectomies of the lumbar spine with hyperlordosis and chronic listheses. As the attending 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: Mild straightening of the normal cervical lordosis, similar to prior. Congenital fusion of C6 and C7. Mild anterolisthesis of C3 on C4. Mild retrolisthesis of C4 on C5 and C5 on C6, unchanged. No acute fracture. No marrow signal abnormalities. No cord signal abnormalities. Prevertebral soft tissues are normal. Anterior and posterior ligamentous complexes are intact. C2-C3: No significant disc protrusion without significant canal or foraminal stenosis. C3-C4: Mild posterior disc osteophyte complex and anterolisthesis of C3 on C4 resulting in mild narrowing of the spinal canal without cord compression. Right greater than left moderate facet arthropathy and uncovertebral hypertrophy resulting in severe right and mild left foraminal narrowing, greater on the right. Modic type III degenerative changes of the posterior aspect of the inferior C3 endplate and superior C4 endplate. C4-C5: Significant loss of disc height and moderate retrolisthesis of C4 on C5 resulting in moderate canal narrowing with abutment of the cord without cord signal changes, similar to prior. Bulky uncovertebral hypertrophy bilaterally without significant facet hypertrophy resulting in moderate foraminal narrowing bilaterally. Modic type III endplate changes at the inferior endplate of C4 and superior endplate of C5. C5-C6: Significant loss of disc height and moderate retrolisthesis of C5 on C6 resulting in moderate canal narrowing with abutment of the cord without cord signal changes, similar to prior bulky uncovertebral hypertrophy bilaterally without significant associated hypertrophy resulting in moderate foraminal narrowing bilaterally. Modic type III changes at inferior endplate of C5 and superior endplate of C6. C6/C7-T1: No significant disc bulge. No significant spinal canal or foraminal narrowing. T1-T2: No significant disc bulge. No significant spinal canal or foraminal narrowing. T2-T3: No significant disc bulge. Mild thickening of the posterior longitudinal ligament. No significant spinal canal or foraminal narrowing. T3-T4: Well-circumscribed hemangioma within the vertebral body of T3. No significant disc bulge. No significant spinal canal or foraminal narrowing. T4-T5: Thickening of the posterior longitudinal ligament (sagittal series 23, image 11) with mild disc bulge resulting in narrowing of the spinal canal without cord compression. No significant foraminal narrowing. T6-T7: No significant disc bulge. No significant spinal canal or foraminal narrowing. T7-T8: No significant disc bulge. No significant spinal canal or foraminal narrowing. T9-T10: No significant disc bulge. No significant spinal canal or foraminal narrowing. T10-T11: No significant disc bulge. No significant spinal canal or foraminal narrowing. T11-T12: No significant disc bulge. Mild thickening of the posterior longitudinal ligament. No significant spinal canal or foraminal narrowing. T12-L1: No significant disc bulge. No significant spinal canal or foraminal narrowing. There is no abnormal signal within the thoracic spinal cord. Conus medullaris terminates at the L1 level. OTHER: Posterior spinal fusion hardware in the lumbar spine spanning L2-S1 there are multilevel laminectomies. There is mild retrolisthesis of L2 on L3 and mild anterolisthesis of L3-4. Hyperlordotic curvature of the lumbar spine. Cauda equina not well evaluated secondary to lack of axial images.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Soft tissue emphysema tracking along the lateral lower left neck. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube distal tip projects 3 cm superior to the carina. Bilateral chest tubes in place with the right chest tube tip terminating along the anterior medial right lung at the margin of the anterior mediastinum and the left chest tube terminating at the left lung apex with hemorrhagic consolidation along the tube courses in the left upper lobe.. Trace residual anterior pneumothoraces, bilaterally. Few scattered small lung contusions and small lung laceration in the peripheral left lung underlying the displaced left fifth rib fracture. HEART / VESSELS: Right IJ line courses superiorly within the IJ vein with tip. Coronary artery calcifications. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Scattered foci of chest wall emphysema, bilaterally. Large soft tissue laceration traumatic soft tissue defect along the anterior left upper arm/left axilla with retained hyperattenuating traumatic fragments/foreign bodies associated at the soft tissue defect.. ABDOMEN and PELVIS: LIVER: Cirrhotic, mildly enlarged, and and diffusely heterogenous. No acute injury BILIARY TRACT: Normal. GALLBLADDER: Distended but otherwise normal PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Multifocal regions of hypoattenuation within the right kidney with majority showing mild contour deformity/indentation of the overlying cortex. Nonobstructing right renal stone. No associated perinephric stranding or fluid. LYMPH NODES: None enlarged21212 STOMACH / SMALL BOWEL: Esophagogastric tube distal tip terminates in the distal gastric body. Small bowel is normal in caliber. COLON / APPENDIX: The appendix and colon are normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Left inferior approach arterial line. Scattered vascular calcifications. URINARY BLADDER: Collapsed around a Foley balloon. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing inguinal hernias. MUSCULOSKELETAL: Comminuted left scapular fracture involving the scapular body and extending into the scapular spine. With soft tissue gas and surrounding hematoma. Comminuted left medial clavicle fracture. Multiple left-sided rib fractures including the first through sixth ribs, segmentally at 1-4. 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. Mild multilevel discogenic degenerative change at the thoracal lumbar junction and lower lumbar spine. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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15,928 |
MR Cervical Spine wo contrast, MR Thoracic Spine wo contrast Clinical Information:Per chart review, 75-year-old female with symptoms of back stiffness and balance issues concerning for thoracic versus cervical myelopathy. Comparison: CT 7/21/2021 and MR 1/22/2020. Technique: Multiplanar multisequence MRI of the cervical spine was performed without contrast. Findings: Mild straightening of the normal cervical lordosis, similar to prior. Congenital fusion of C6 and C7. Mild anterolisthesis of C3 on C4. Mild retrolisthesis of C4 on C5 and C5 on C6, unchanged. No acute fracture. No marrow signal abnormalities. No cord signal abnormalities. Prevertebral soft tissues are normal. Anterior and posterior ligamentous complexes are intact. C2-C3: No significant disc protrusion without significant canal or foraminal stenosis. C3-C4: Mild posterior disc osteophyte complex and anterolisthesis of C3 on C4 resulting in mild narrowing of the spinal canal without cord compression. Right greater than left moderate facet arthropathy and uncovertebral hypertrophy resulting in severe right and mild left foraminal narrowing, greater on the right. Modic type III degenerative changes of the posterior aspect of the inferior C3 endplate and superior C4 endplate. C4-C5: Significant loss of disc height and moderate retrolisthesis of C4 on C5 resulting in moderate canal narrowing with abutment of the cord without cord signal changes, similar to prior. Bulky uncovertebral hypertrophy bilaterally without significant facet hypertrophy resulting in moderate foraminal narrowing bilaterally. Modic type III endplate changes at the inferior endplate of C4 and superior endplate of C5. C5-C6: Significant loss of disc height and moderate retrolisthesis of C5 on C6 resulting in moderate canal narrowing with abutment of the cord without cord signal changes, similar to prior bulky uncovertebral hypertrophy bilaterally without significant associated hypertrophy resulting in moderate foraminal narrowing bilaterally. Modic type III changes at inferior endplate of C5 and superior endplate of C6. C6/C7-T1: No significant disc bulge. No significant spinal canal or foraminal narrowing. T1-T2: No significant disc bulge. No significant spinal canal or foraminal narrowing. T2-T3: No significant disc bulge. Mild thickening of the posterior longitudinal ligament. No significant spinal canal or foraminal narrowing. T3-T4: Well-circumscribed hemangioma within the vertebral body of T3. No significant disc bulge. No significant spinal canal or foraminal narrowing. T4-T5: Thickening of the posterior longitudinal ligament (sagittal series 23, image 11) with mild disc bulge resulting in narrowing of the spinal canal without cord compression. No significant foraminal narrowing. T6-T7: No significant disc bulge. No significant spinal canal or foraminal narrowing. T7-T8: No significant disc bulge. No significant spinal canal or foraminal narrowing. T9-T10: No significant disc bulge. No significant spinal canal or foraminal narrowing. T10-T11: No significant disc bulge. No significant spinal canal or foraminal narrowing. T11-T12: No significant disc bulge. Mild thickening of the posterior longitudinal ligament. No significant spinal canal or foraminal narrowing. T12-L1: No significant disc bulge. No significant spinal canal or foraminal narrowing. There is no abnormal signal within the thoracic spinal cord. Conus medullaris terminates at the L1 level. OTHER: Posterior spinal fusion hardware in the lumbar spine spanning L2-S1 there are multilevel laminectomies. There is mild retrolisthesis of L2 on L3 and mild anterolisthesis of L3-4. Hyperlordotic curvature of the lumbar spine. Cauda equina not well evaluated secondary to lack of axial images. CONCLUSION: 1. No abnormal cord signal changes in visualized spine. 2. Multilevel moderate degenerative changes of the cervical spine most prominent at C4-C6 with moderate canal narrowing and abutment of the cord at C4-C6 without cord signal changes. 3. Severe neural foraminal narrowing on the right at C3-C4, correlate clinically for right C4 radiculopathy. Moderate bilateral neural foraminal narrowing at C4-C5 and C5-C6. 4. Focal thickening of the posterior longitudinal ligament at T4-T5 resulting in mild canal narrowing. 5. Incompletely evaluated posterior spinal fusion hardware and multilevel laminectomies of the lumbar spine with hyperlordosis and chronic listheses. As the attending 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: Mild straightening of the normal cervical lordosis, similar to prior. Congenital fusion of C6 and C7. Mild anterolisthesis of C3 on C4. Mild retrolisthesis of C4 on C5 and C5 on C6, unchanged. No acute fracture. No marrow signal abnormalities. No cord signal abnormalities. Prevertebral soft tissues are normal. Anterior and posterior ligamentous complexes are intact. C2-C3: No significant disc protrusion without significant canal or foraminal stenosis. C3-C4: Mild posterior disc osteophyte complex and anterolisthesis of C3 on C4 resulting in mild narrowing of the spinal canal without cord compression. Right greater than left moderate facet arthropathy and uncovertebral hypertrophy resulting in severe right and mild left foraminal narrowing, greater on the right. Modic type III degenerative changes of the posterior aspect of the inferior C3 endplate and superior C4 endplate. C4-C5: Significant loss of disc height and moderate retrolisthesis of C4 on C5 resulting in moderate canal narrowing with abutment of the cord without cord signal changes, similar to prior. Bulky uncovertebral hypertrophy bilaterally without significant facet hypertrophy resulting in moderate foraminal narrowing bilaterally. Modic type III endplate changes at the inferior endplate of C4 and superior endplate of C5. C5-C6: Significant loss of disc height and moderate retrolisthesis of C5 on C6 resulting in moderate canal narrowing with abutment of the cord without cord signal changes, similar to prior bulky uncovertebral hypertrophy bilaterally without significant associated hypertrophy resulting in moderate foraminal narrowing bilaterally. Modic type III changes at inferior endplate of C5 and superior endplate of C6. C6/C7-T1: No significant disc bulge. No significant spinal canal or foraminal narrowing. T1-T2: No significant disc bulge. No significant spinal canal or foraminal narrowing. T2-T3: No significant disc bulge. Mild thickening of the posterior longitudinal ligament. No significant spinal canal or foraminal narrowing. T3-T4: Well-circumscribed hemangioma within the vertebral body of T3. No significant disc bulge. No significant spinal canal or foraminal narrowing. T4-T5: Thickening of the posterior longitudinal ligament (sagittal series 23, image 11) with mild disc bulge resulting in narrowing of the spinal canal without cord compression. No significant foraminal narrowing. T6-T7: No significant disc bulge. No significant spinal canal or foraminal narrowing. T7-T8: No significant disc bulge. No significant spinal canal or foraminal narrowing. T9-T10: No significant disc bulge. No significant spinal canal or foraminal narrowing. T10-T11: No significant disc bulge. No significant spinal canal or foraminal narrowing. T11-T12: No significant disc bulge. Mild thickening of the posterior longitudinal ligament. No significant spinal canal or foraminal narrowing. T12-L1: No significant disc bulge. No significant spinal canal or foraminal narrowing. There is no abnormal signal within the thoracic spinal cord. Conus medullaris terminates at the L1 level. OTHER: Posterior spinal fusion hardware in the lumbar spine spanning L2-S1 there are multilevel laminectomies. There is mild retrolisthesis of L2 on L3 and mild anterolisthesis of L3-4. Hyperlordotic curvature of the lumbar spine. Cauda equina not well evaluated secondary to lack of axial images.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Soft tissue emphysema tracking along the lateral lower left neck. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube distal tip projects 3 cm superior to the carina. Bilateral chest tubes in place with the right chest tube tip terminating along the anterior medial right lung at the margin of the anterior mediastinum and the left chest tube terminating at the left lung apex with hemorrhagic consolidation along the tube courses in the left upper lobe.. Trace residual anterior pneumothoraces, bilaterally. Few scattered small lung contusions and small lung laceration in the peripheral left lung underlying the displaced left fifth rib fracture. HEART / VESSELS: Right IJ line courses superiorly within the IJ vein with tip. Coronary artery calcifications. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Scattered foci of chest wall emphysema, bilaterally. Large soft tissue laceration traumatic soft tissue defect along the anterior left upper arm/left axilla with retained hyperattenuating traumatic fragments/foreign bodies associated at the soft tissue defect.. ABDOMEN and PELVIS: LIVER: Cirrhotic, mildly enlarged, and and diffusely heterogenous. No acute injury BILIARY TRACT: Normal. GALLBLADDER: Distended but otherwise normal PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Multifocal regions of hypoattenuation within the right kidney with majority showing mild contour deformity/indentation of the overlying cortex. Nonobstructing right renal stone. No associated perinephric stranding or fluid. LYMPH NODES: None enlarged21212 STOMACH / SMALL BOWEL: Esophagogastric tube distal tip terminates in the distal gastric body. Small bowel is normal in caliber. COLON / APPENDIX: The appendix and colon are normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Left inferior approach arterial line. Scattered vascular calcifications. URINARY BLADDER: Collapsed around a Foley balloon. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing inguinal hernias. MUSCULOSKELETAL: Comminuted left scapular fracture involving the scapular body and extending into the scapular spine. With soft tissue gas and surrounding hematoma. Comminuted left medial clavicle fracture. Multiple left-sided rib fractures including the first through sixth ribs, segmentally at 1-4. 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. Mild multilevel discogenic degenerative change at the thoracal lumbar junction and lower lumbar spine. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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15,929 |
EXAM:MR Shoulder Right wo contrast CLINICAL INFORMATION:Right shoulder pain COMPARISON: Radiographs dated 11/18/2021.. TECHNIQUE:Multiplanar multisequence images were obtained through the shoulder. Findings: There is extensive high-grade tearing of the supraspinatus tendon extending from the insertion to the myotendinous junction. The articular surface fibers are more torn and show mild retraction; however, the tear is probably full thickness in the critical zone. There is mild tendinosis of infraspinatus and subscapularis. Teres minor is unremarkable. There is slight increased fluid in the subacromial/subdeltoid bursa. There is a moderate size glenohumeral joint effusion with prominent synovium. There is moderate to severe glenohumeral degenerative change with extensive humeral head and glenoid articular cartilage loss. There is degenerative signal circumferentially throughout the labrum, but no discrete focal labral tear is seen. The long head biceps tendon is intact and properly positioned within the bicipital groove. There is an old healed fracture deformity of the lateral clavicle. There are moderate hypertrophic degenerative changes of the AC joint. The type II acromion shows no abnormal downsloping. Impression: 1. Extensive high-grade tearing of the supraspinatus tendon. The tear is probably focally full thickness in the critical zone. 2. Moderate to severe glenohumeral degenerative cartilage loss. Joint effusion with synovitis. 3. Moderate hypertrophic AC joint degenerative changes.
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Findings: There is extensive high-grade tearing of the supraspinatus tendon extending from the insertion to the myotendinous junction. The articular surface fibers are more torn and show mild retraction; however, the tear is probably full thickness in the critical zone. There is mild tendinosis of infraspinatus and subscapularis. Teres minor is unremarkable. There is slight increased fluid in the subacromial/subdeltoid bursa. There is a moderate size glenohumeral joint effusion with prominent synovium. There is moderate to severe glenohumeral degenerative change with extensive humeral head and glenoid articular cartilage loss. There is degenerative signal circumferentially throughout the labrum, but no discrete focal labral tear is seen. The long head biceps tendon is intact and properly positioned within the bicipital groove. There is an old healed fracture deformity of the lateral clavicle. There are moderate hypertrophic degenerative changes of the AC joint. The type II acromion shows no abnormal downsloping.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. MASTOIDS: Clear. SOFT TISSUE: No significant abnormality. MAXILLOFACIAL: No maxillofacial or mandibular fracture. Numerous periapical lucencies and dental caries. Small midline parietal scalp hematoma.
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15,930 |
EXAM: MR Abdomen wo+w contrast, MR Cholangiopancreatography MRCP CLINICAL INFORMATION: Dilated common bile duct; abnormal liver serum enzymes. History of autoimmune hepatitis per electronic medical record. On 12/28/2021 the patient's alkaline phosphatase and T bili were within normal limits. COMPARISON: Abdominal sonogram 12/14/2021 TECHNIQUE: MR Abdomen wo+w contrast, MR Cholangiopancreatography MRCP Patient weight: 200 lbs. IV contrast: ProHance, 10 ml, per protocol. IV contrast injection rate: 1 ml per sec. FINDINGS: STRUCTURED REPORT: MR HCC Screening IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: The liver is normal in size and morphology. No overt morphologic changes of cirrhosis. Mild diffuse loss of hepatic parenchymal signal, suggesting hepatic steatosis. LIVER LESIONS: No suspicious hepatic lesions. 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: Mild central intrahepatic biliary ductal dilation. No upstream dilation. The common bile duct is mildly dilated measuring up to 0.9 cm, but tapers to normal caliber at the pancreatic head. No filling defects or choledocholithiasis. Unremarkable appearance of the remnant cystic duct. GALLBLADDER: Absent. LYMPH NODES: None enlarged. SPLEEN: Normal size and appearance. PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Normal. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: Normal caliber of the abdominal aorta and IVC. BODY WALL: Susceptibility artifact from median sternotomy wires. MUSCULOSKELETAL: Mild S-shaped scoliosis of the thoracolumbar spine with degenerative changes and no destructive osseous lesion. CONCLUSION: 1. Mild central intrahepatic and extrahepatic biliary ductal dilation with normal tapering at the pancreatic head favors sequela of prior cholecystectomy. 2. No overt morphologic changes of cirrhosis. No suspicious hepatic lesion. 3. Additional incidental findings, as detailed.
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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: The liver is normal in size and morphology. No overt morphologic changes of cirrhosis. Mild diffuse loss of hepatic parenchymal signal, suggesting hepatic steatosis. LIVER LESIONS: No suspicious hepatic lesions. 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: Mild central intrahepatic biliary ductal dilation. No upstream dilation. The common bile duct is mildly dilated measuring up to 0.9 cm, but tapers to normal caliber at the pancreatic head. No filling defects or choledocholithiasis. Unremarkable appearance of the remnant cystic duct. GALLBLADDER: Absent. LYMPH NODES: None enlarged. SPLEEN: Normal size and appearance. PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Normal. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: Normal caliber of the abdominal aorta and IVC. BODY WALL: Susceptibility artifact from median sternotomy wires. MUSCULOSKELETAL: Mild S-shaped scoliosis of the thoracolumbar spine with degenerative changes and no destructive osseous lesion.
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Findings: CT C-spine: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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15,931 |
EXAM: MR Abdomen wo+w contrast, MR Cholangiopancreatography MRCP CLINICAL INFORMATION: Dilated common bile duct; abnormal liver serum enzymes. History of autoimmune hepatitis per electronic medical record. On 12/28/2021 the patient's alkaline phosphatase and T bili were within normal limits. COMPARISON: Abdominal sonogram 12/14/2021 TECHNIQUE: MR Abdomen wo+w contrast, MR Cholangiopancreatography MRCP Patient weight: 200 lbs. IV contrast: ProHance, 10 ml, per protocol. IV contrast injection rate: 1 ml per sec. FINDINGS: STRUCTURED REPORT: MR HCC Screening IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: The liver is normal in size and morphology. No overt morphologic changes of cirrhosis. Mild diffuse loss of hepatic parenchymal signal, suggesting hepatic steatosis. LIVER LESIONS: No suspicious hepatic lesions. 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: Mild central intrahepatic biliary ductal dilation. No upstream dilation. The common bile duct is mildly dilated measuring up to 0.9 cm, but tapers to normal caliber at the pancreatic head. No filling defects or choledocholithiasis. Unremarkable appearance of the remnant cystic duct. GALLBLADDER: Absent. LYMPH NODES: None enlarged. SPLEEN: Normal size and appearance. PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Normal. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: Normal caliber of the abdominal aorta and IVC. BODY WALL: Susceptibility artifact from median sternotomy wires. MUSCULOSKELETAL: Mild S-shaped scoliosis of the thoracolumbar spine with degenerative changes and no destructive osseous lesion. CONCLUSION: 1. Mild central intrahepatic and extrahepatic biliary ductal dilation with normal tapering at the pancreatic head favors sequela of prior cholecystectomy. 2. No overt morphologic changes of cirrhosis. No suspicious hepatic lesion. 3. Additional incidental findings, as detailed.
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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: The liver is normal in size and morphology. No overt morphologic changes of cirrhosis. Mild diffuse loss of hepatic parenchymal signal, suggesting hepatic steatosis. LIVER LESIONS: No suspicious hepatic lesions. 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: Mild central intrahepatic biliary ductal dilation. No upstream dilation. The common bile duct is mildly dilated measuring up to 0.9 cm, but tapers to normal caliber at the pancreatic head. No filling defects or choledocholithiasis. Unremarkable appearance of the remnant cystic duct. GALLBLADDER: Absent. LYMPH NODES: None enlarged. SPLEEN: Normal size and appearance. PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Normal. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: Normal caliber of the abdominal aorta and IVC. BODY WALL: Susceptibility artifact from median sternotomy wires. MUSCULOSKELETAL: Mild S-shaped scoliosis of the thoracolumbar spine with degenerative changes and no destructive osseous lesion.
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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 small left lower pole renal cyst. Otherwise normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No free fluid or free air. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No acute abnormality. Left ovarian dominant follicle. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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15,932 |
Thoracic MRI with and without contrast - Clinical indication: Mid-back pain, M54.2 Cervicalgia, V89.2XXA Person injured in unspecified motor-vehicle accident, traffic, initial encounter, S13.4XXA Sprain of ligaments of cervical spine, initial encounter, M54.9 Dorsalgia, unspecified. - Technique: Multiple T1 and T2 weighted MR sequence images of the thoracic spine were obtained in the axial and sagittal plane without and with the use of intravenous contrast per departmental thoracic spine protocol. - Comparison: No previous similar studies are presented for comparison.. - Findings: There is mild anterior wedging of the T1 vertebral body without definite marrow edema, likely chronic in nature. Remaining vertebral bodies are within normal limits. There are small Schmorl's nodes in the lower thoracic spine vertebral endplates. Bone marrow shows normal signal intensity on all pulse sequences. There is mild degenerative changes in the mid and lower thoracic spine without significant central canal or neural foraminal narrowing, predominantly at T6-7, T7-8 and T9-10. There is no significant neural foraminal narrowing. Thoracic spinal cord is within normal limits. There is no abnormal intramedullary signal. - Impression: No acute pathology is identified in the thoracic spine. No significant central canal or neural foraminal narrowing is identified in the thoracic spine. Thoracic spinal cord is within normal limits. -
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Findings: There is mild anterior wedging of the T1 vertebral body without definite marrow edema, likely chronic in nature. Remaining vertebral bodies are within normal limits. There are small Schmorl's nodes in the lower thoracic spine vertebral endplates. Bone marrow shows normal signal intensity on all pulse sequences. There is mild degenerative changes in the mid and lower thoracic spine without significant central canal or neural foraminal narrowing, predominantly at T6-7, T7-8 and T9-10. There is no significant neural foraminal narrowing. Thoracic spinal cord is within normal limits. There is no abnormal intramedullary signal. -
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FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Bilateral emphysema with hyperexpanded lungs and scattered subsegmental atelectasis and/or scarring. No pneumothorax or pleural effusion. HEART / OTHER VESSELS: Coronary artery vascular calcifications. MEDIASTINUM / ESOPHAGUS: Moderately sized hiatal hernia. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: No acute abnormality MUSCULOSKELETAL: Mild multilevel discogenic degenerative change.
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15,933 |
MR Breast Diagnostic Bil wo+w contrast CLINICAL INFORMATION: hx breast ca and dense breasts, C50.411 Malignant neoplasm of upper-outer quadrant of right female breast, Z92.21 Personal history of antineoplastic chemotherapy, Z92.3 Personal history of irradiation, Z98.890 Other specified postprocedural states. TECHNIQUE: T1 axial, FSE T2 fat sat axial, pre and post contrast vibrant sequence with 3D reconstructions and time intensity curves. Delayed post contrast axials. A dedicated 8 channel breast imaging coil was utilized. Patient weight: 183 lbs. IV contrast: ProHance, 17 ml, per protocol. IV contrast injection rate: 1.60 ml per sec. COMPARISON: Prior studies including most recent breast diagnostic imaging from 2021 and most recent prior breast MRI from 2014 FINDINGS: All measurements provided in the format AP, TV, CC dimensions Breast tissue is heterogeneous fibroglandular tissue. Postcontrast administration there is minimal background enhancement. RIGHT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. Postsurgical changes from lumpectomy LEFT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. BILATERAL Internal mammary nodes are normal. Axillary lymph nodes are normal. EXTRAMAMMARY: T2 hyperintense liver lesion on series 5 image 17 not definitively seen on prior exams. Otherwise unremarkable IMPRESSION: RIGHT BREAST: No MRI evidence of malignancy.: BI-RADS 2: Benign LEFT BREAST: No MRI evidence of malignancy.: BI-RADS 1: Negative Overall BI-RADS assessment: BI-RADS 2: Benign T2 hyperintense liver lesion may represent a benign cyst but is not definitively seen on priors. In this patient with a history of breast cancer, dedicated liver imaging (CT or MRI) recommended Patient is due for mammography in July 2022 and breast MRI in one year
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FINDINGS: All measurements provided in the format AP, TV, CC dimensions Breast tissue is heterogeneous fibroglandular tissue. Postcontrast administration there is minimal background enhancement. RIGHT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. Postsurgical changes from lumpectomy LEFT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. BILATERAL Internal mammary nodes are normal. Axillary lymph nodes are normal. EXTRAMAMMARY: T2 hyperintense liver lesion on series 5 image 17 not definitively seen on prior exams. Otherwise unremarkable
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FINDINGS: Exam is limited due to streak artifact and motion. BRAIN PARENCHYMA: Multiple rounded lesions within the cerebellum with surrounding vasogenic edema including edema extending into the right middle cerebellar peduncle. There is partial effacement of the fourth ventricle. Right median cerebellum lesion measures 2.6 x 2.4 cm (image 123, series #201) and right inferior cerebellar lesion measuring 1.7 x 1.6 cm (image 27, series #201). . Mild diffuse parenchymal volume loss. Periventricular white matter hypoattenuation consistent with chronic microangiopathic changes. No midline shift. EXTRA-AXIAL SPACES: No extra-axial collections. Basal cisterns are patent. SKULL AND SKULL BASE: No aggressive osseous lesions. No acute fracture. Bilateral mastoid air cells are clear. VENTRICULAR SYSTEM: Complete effacement of the median aperture and partial effacement of the fourth ventricle as above. Moderate enlargement of the lateral and third ventricles. ORBITS: Bilateral pseudophakia. SINUSES: Paranasal sinuses are clear. VESSELS: Normal noncontrast appearance of the vessels.
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15,934 |
MR Cervical Spine wo contrast 1/28/2022 11:05 AM Clinical Information: Neck pain, acute, no red flags, M54.2 Cervicalgia, V89.2XXA Person injured in unspecified motor-vehicle accident, traffic, initial encounter, S13.4XXA Sprain of ligaments of cervical spine, initial encounter Comparison: CT cervical spine from 11/6/2021 Technique: T2 sagittal and axial fast spin spin echo, T1 sagittal spin echo, sagittal STIR, axial T2* gradient echo. Findings: There is mild anterolisthesis of C4 on C5 and C7 on T1. There is mild retrolisthesis of C5 on C6. Vertebral body heights are preserved. There are no suspicious bone marrow signal abnormalities. The cranial vertebral junction appears unremarkable. No definite cord signal abnormality is identified. Degenerative findings are discussed on a level by level basis: C2-3: Mild diffuse disc bulge and ligamentum flavum thickening, resulting in minimal indentation of the posterior thecal sac without significant cord compression. There is no significant neural foraminal narrowing. C3-4: Moderate diffuse disc bulge and posterior osteophyte, resulting in mild indentation of the anterior thecal sac without significant cord compression. There is mild thickening of ligamentum flavum and bilateral facet joint DJD. There is mild uncovertebral joint hypertrophy, resulting in moderate bilateral neural foraminal narrowing. C4-5: Mild diffuse disc bulge and ligamentum flavum thickening and advanced left and moderate right facet joint DJD, resulting in moderate left neural foraminal stenosis. There is no significant central canal narrowing. C5-6: Moderate disc osteophyte complex, resulting in mild indentation of the thecal sac without touching the spinal cord. There is moderate bilateral facet joint DJD and uncovertebral joint hypertrophy, resulting in severe right and moderate left neural foramen stenosis. There is possible indentation of the exiting right C6 nerve root. C6-7: Mild posterior disc bulge without touching the spinal cord. There is no significant neural foraminal narrowing. C7-T1: Mild diffuse disc bulge without significant central canal or neural foraminal narrowing. Impression: Multilevel moderate degenerative changes of the cervical spine, predominantly at C5-6 without definite cord compression as described above. There is severe right neural foramen stenosis at C5-6 with possible indentation of the exiting C6 nerve root. Spinal cord is within normal limits. See comment for individual levels.
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Findings: There is mild anterolisthesis of C4 on C5 and C7 on T1. There is mild retrolisthesis of C5 on C6. Vertebral body heights are preserved. There are no suspicious bone marrow signal abnormalities. The cranial vertebral junction appears unremarkable. No definite cord signal abnormality is identified. Degenerative findings are discussed on a level by level basis: C2-3: Mild diffuse disc bulge and ligamentum flavum thickening, resulting in minimal indentation of the posterior thecal sac without significant cord compression. There is no significant neural foraminal narrowing. C3-4: Moderate diffuse disc bulge and posterior osteophyte, resulting in mild indentation of the anterior thecal sac without significant cord compression. There is mild thickening of ligamentum flavum and bilateral facet joint DJD. There is mild uncovertebral joint hypertrophy, resulting in moderate bilateral neural foraminal narrowing. C4-5: Mild diffuse disc bulge and ligamentum flavum thickening and advanced left and moderate right facet joint DJD, resulting in moderate left neural foraminal stenosis. There is no significant central canal narrowing. C5-6: Moderate disc osteophyte complex, resulting in mild indentation of the thecal sac without touching the spinal cord. There is moderate bilateral facet joint DJD and uncovertebral joint hypertrophy, resulting in severe right and moderate left neural foramen stenosis. There is possible indentation of the exiting right C6 nerve root. C6-7: Mild posterior disc bulge without touching the spinal cord. There is no significant neural foraminal narrowing. C7-T1: Mild diffuse disc bulge without significant central canal or neural foraminal narrowing.
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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: Subsegmental atelectatic changes in the lingula and bilateral lower lobes. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Heart size is normal. No pericardial effusion. Coronary artery stent is noted. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Normal for technique. ADRENALS: Normal. KIDNEYS: Normal noncontrast appearance. Bilateral renal cysts. Punctate nonobstructing bilateral renal calculi. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No significant abnormality in the colon. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild aortoiliac calcific atherosclerosis. Dolichoectasia of the left common, external, and internal iliac arteries with long segment borderline aneurysmal dilatation of the left common iliac artery, measuring 1.9 cm in diameter (coronal image 95). Focal fusiform aneurysmal dilatation of the proximal left internal iliac artery, measuring up to 2.5 cm in diameter (coronal image 76). URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Asymmetric subcutaneous edema along the right flank, right groin, and proximal right thigh. Marked asymmetric fatty atrophy of the right thigh musculature with relative sparing of the sartorius, pectineus, and adductor longus. Evaluation of the right groin is mildly limited by streak artifact from right hip arthroplasty hardware, without organized or drainable fluid collection identified. Small fat-containing bilateral inguinal hernias. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. Multilevel degenerative changes in the visualized thoracolumbar spine. Right hip bipolar arthroplasty hardware is in expected position without evidence of hardware failure or complication.
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15,935 |
RADIOLOGIC EXAM: MR Brain wo+w contrast CLINICAL INFORMATION: Meningioma, Spec Inst: follow up meningioma sp resection, surveillance. Per chart review, history of left posterior fossa meningioma with associated hydrocephalus status post craniotomy tumor resection on 11/18/2019 followed by VP shunt placement on 11/29/2019. COMPARISON: MRI brain dated 1/29/2021, 1/31/2020. TECHNIQUE: MR Brain wo+w contrast Patient weight: 205 lbs. IV contrast: ProHance, 20 ml, per protocol. Multiple T1 and T2-weighted MR sequence images of the brain were obtained in the sagittal axial and coronal planes pre- and post administration of intravenous contrast per departmental protocol. FINDINGS: The study is moderately degraded by artifact secondary to ventriculostomy shunt catheter apparatus. INTRACRANIAL FINDINGS: Stable postsurgical changes from prior left suboccipital craniotomy resection with chronic left cerebellar hemisphere encephalomalacia/gliosis, chronic blood products in the resection bed, and small epidural hygroma. Interval decrease in trace right occipital horn susceptibility artifact, likely residual blood products. Interval development of diffuse smooth pachymeningeal thickening/enhancement. No focal nodular or masslike enhancement. No acute intraparenchymal infarct, hemorrhage, edema, or hydrocephalus within limitations of the exam. Stable position of right frontal approach ventriculostomy shunt catheter terminating in the anterior right lateral ventricle body. Multifocal bilateral periventricular and scattered punctate subcortical/deep cerebral white matter T2/FLAIR hyperintensities, similar to prior, likely chronic microangiopathic changes. 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 bilateral anterior ethmoid sinus mucosal thickening. The paranasal sinuses and mastoid air cells are otherwise clear. Both orbits are unremarkable. CONCLUSION: 1. New diffuse smooth pachymeningeal thickening/enhancement, which could reflect intracranial hypotension. Otherwise stable shunted ventricles with unchanged position of right frontal shunt catheter. 2. Stable left posterior fossa postsurgical changes without focal nodular or masslike enhancement to suggest enlarging residual or recurrent tumor. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: The study is moderately degraded by artifact secondary to ventriculostomy shunt catheter apparatus. INTRACRANIAL FINDINGS: Stable postsurgical changes from prior left suboccipital craniotomy resection with chronic left cerebellar hemisphere encephalomalacia/gliosis, chronic blood products in the resection bed, and small epidural hygroma. Interval decrease in trace right occipital horn susceptibility artifact, likely residual blood products. Interval development of diffuse smooth pachymeningeal thickening/enhancement. No focal nodular or masslike enhancement. No acute intraparenchymal infarct, hemorrhage, edema, or hydrocephalus within limitations of the exam. Stable position of right frontal approach ventriculostomy shunt catheter terminating in the anterior right lateral ventricle body. Multifocal bilateral periventricular and scattered punctate subcortical/deep cerebral white matter T2/FLAIR hyperintensities, similar to prior, likely chronic microangiopathic changes. 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 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: There is no evidence of acute intracranial hemorrhage, infarction, brain edema, mass effect or hydrocephalus. The visualized paranasal sinuses, mastoid air cells and middle ear cavities are clear. Both orbits appear normal.
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15,936 |
MR Brain wo+w contrast 1/28/2022 10:22 AM Clinical Information: glomus, D44.7 Neoplasm of uncertain behavior of aortic body and other paraganglia Spec Inst: history of right glomus tympanicum Comparison: MRI brain of 1/8/2020 Technique: Diffusion weighted series, T1 sagittal and axial spin echo, T2 axial fast spin echo, axial FLAIR, postcontrast T1 axial, coronal, and sagittal. Patient weight: 132 lbs. IV contrast: ProHance, 10 ml, per protocol. IV contrast injection rate: 0.50 ml per sec. Findings: Again seen is asymmetric enhancement involving the right EAC and tegmen tympani. There is abnormal enhancement in the region of the right mastoid and middle ear cavity, also extending into the eustachian tube. No abnormal enhancement is seen within the IAC. There is a right mastoid effusion. There is no appreciable enhancement of the adjacent right inferior temporal lobe. Overall, the appearance is similar to the prior MRI of 2020. There are scattered T2 FLAIR hyperintensities within the deep and periventricular white matter, consistent with chronic microangiopathic changes. No acute infarct, hemorrhage, intracranial mass, or hydrocephalus. There are bilateral maxillary mucous retention cyst and mucosal thickening of the left ethmoid sinuses. Remaining paranasal sinuses and orbits are unremarkable. Left mastoid air cells are clear. Conclusion: Stable appearance of abnormal enhancement involving the right EAC, tegmen tympani, and middle ear cavity with associated mastoid effusion.
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Findings: Again seen is asymmetric enhancement involving the right EAC and tegmen tympani. There is abnormal enhancement in the region of the right mastoid and middle ear cavity, also extending into the eustachian tube. No abnormal enhancement is seen within the IAC. There is a right mastoid effusion. There is no appreciable enhancement of the adjacent right inferior temporal lobe. Overall, the appearance is similar to the prior MRI of 2020. There are scattered T2 FLAIR hyperintensities within the deep and periventricular white matter, consistent with chronic microangiopathic changes. No acute infarct, hemorrhage, intracranial mass, or hydrocephalus. There are bilateral maxillary mucous retention cyst and mucosal thickening of the left ethmoid sinuses. Remaining paranasal sinuses and orbits are unremarkable. Left mastoid air cells are clear.
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FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The trachea and central airways are patent. A moderate left and small right pleural effusions are noted with mild loculation at superior aspect of the right. Scattered bilateral atelectasis. There is a small nodular opacity within the right midlung which is obscured due to motion on image 122, series 201. Otherwise, no definite pulmonary nodule is seen. Right lobectomy changes are noted. HEART / VESSELS: Scattered vascular and coronary calcifications. The heart is mildly enlarged. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Multiple enlarged centrally necrotic metastatic mediastinal and hilar lymph nodes are noted most pronounced in the posterior mediastinum and left hilum. The largest of these nodal complexes within the subcarinal region and measures 3.3 x 1.6 cm on axial series 201 image 120. A second large nodal complex in the left hilum measures 2.1 x 1.5 cm on axial series 201 image 121. CHEST WALL: There is asymmetrical thickening and nodularity seen within the left breast which is associated with probable small clips. ABDOMEN and PELVIS: LIVER: Multiple subcentimeter hypoattenuating lesions within the liver may represent cysts, however in the setting of metastatic disease metastasis is also a consideration. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Bilateral nodularity and thickening involving the adrenal glands. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Focal colonic wall thickening involving the cecum. Mild wall thickening involving the rectum with associated perirectal fat stranding and a small amount of edema. PERITONEUM / MESENTERY: Trace stranding adjacent to the cecum. RETROPERITONEUM: Perirectal stranding and edema. VESSELS: Scattered vascular calcifications. The left and right hepatic arteries arise independently from the celiac trunk. Two right renal arteries. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is present. No adnexal mass. BODY WALL: Scattered body wall edema. MUSCULOSKELETAL: Internal fixation hardware involving the proximal left femur. Associated heterotopic ossification is noted posteriorly. Associated small fluid tract is noted extending laterally from this heterotopic ossification out of the field-of-view. Multifocal lytic regions of destruction involving the bilateral ribs including the base of the right third rib (axial series 201 image 37) in the distal left 10th rib (axial series 201 image 249). Other similar-appearing lytic lesions are noted throughout the osseous structures including the posterior right inferior pubic ramus, anterior left iliac bone, anterior/inferior T12 vertebral body, anterior T10 vertebral body, multilevel discogenic degenerative change.
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15,937 |
MR Breast Screening wo+w contrast CLINICAL INFORMATION: hx silicone implant recon, C50.919 Malignant neoplasm of unspecified site of unspecified female breast, Z90.11 Acquired absence of right breast and nipple, Z92.29 Personal history of other drug therapy Spec Inst: pt said she can tolerate contrast dye if she takes Benadryl beforehand. TECHNIQUE: T1 axial, FSE T2 fat sat axial, pre and post contrast vibrant sequence with 3D reconstructions and time intensity curves. Delayed post contrast sagittal. A dedicated 8 channel breast imaging coil was utilized. Patient weight: 180 lbs. IV contrast: ProHance, 17 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: Prior studies including most recent breast MRI from 2014 FINDINGS: All measurements provided in the format AP, TV, CC dimensions Breast tissue is scattered fibroglandular tissue. Postcontrast administration there is minimal background enhancement. RIGHT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. Postsurgical changes from mastectomy and implant reconstruction. Study not performed for implant evaluation LEFT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. BILATERAL Internal mammary nodes are normal. Axillary lymph nodes are normal. EXTRAMAMMARY: There is no suspicious abnormality in the visualized lung fields. Visualized upper abdomen unremarkable. Marrow signal is normal. IMPRESSION: RIGHT BREAST: No MRI evidence of malignancy. BI-RADS 2: Benign LEFT BREAST: No MRI evidence of malignancy. BI-RADS 2: Benign Overall BI-RADS assessment: BI-RADS 2: Benign
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FINDINGS: All measurements provided in the format AP, TV, CC dimensions Breast tissue is scattered fibroglandular tissue. Postcontrast administration there is minimal background enhancement. RIGHT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. Postsurgical changes from mastectomy and implant reconstruction. Study not performed for implant evaluation LEFT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. BILATERAL Internal mammary nodes are normal. Axillary lymph nodes are normal. EXTRAMAMMARY: There is no suspicious abnormality in the visualized lung fields. Visualized upper abdomen unremarkable. Marrow signal is normal.
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FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The trachea and central airways are patent. A moderate left and small right pleural effusions are noted with mild loculation at superior aspect of the right. Scattered bilateral atelectasis. There is a small nodular opacity within the right midlung which is obscured due to motion on image 122, series 201. Otherwise, no definite pulmonary nodule is seen. Right lobectomy changes are noted. HEART / VESSELS: Scattered vascular and coronary calcifications. The heart is mildly enlarged. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Multiple enlarged centrally necrotic metastatic mediastinal and hilar lymph nodes are noted most pronounced in the posterior mediastinum and left hilum. The largest of these nodal complexes within the subcarinal region and measures 3.3 x 1.6 cm on axial series 201 image 120. A second large nodal complex in the left hilum measures 2.1 x 1.5 cm on axial series 201 image 121. CHEST WALL: There is asymmetrical thickening and nodularity seen within the left breast which is associated with probable small clips. ABDOMEN and PELVIS: LIVER: Multiple subcentimeter hypoattenuating lesions within the liver may represent cysts, however in the setting of metastatic disease metastasis is also a consideration. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Bilateral nodularity and thickening involving the adrenal glands. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Focal colonic wall thickening involving the cecum. Mild wall thickening involving the rectum with associated perirectal fat stranding and a small amount of edema. PERITONEUM / MESENTERY: Trace stranding adjacent to the cecum. RETROPERITONEUM: Perirectal stranding and edema. VESSELS: Scattered vascular calcifications. The left and right hepatic arteries arise independently from the celiac trunk. Two right renal arteries. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is present. No adnexal mass. BODY WALL: Scattered body wall edema. MUSCULOSKELETAL: Internal fixation hardware involving the proximal left femur. Associated heterotopic ossification is noted posteriorly. Associated small fluid tract is noted extending laterally from this heterotopic ossification out of the field-of-view. Multifocal lytic regions of destruction involving the bilateral ribs including the base of the right third rib (axial series 201 image 37) in the distal left 10th rib (axial series 201 image 249). Other similar-appearing lytic lesions are noted throughout the osseous structures including the posterior right inferior pubic ramus, anterior left iliac bone, anterior/inferior T12 vertebral body, anterior T10 vertebral body, multilevel discogenic degenerative change.
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15,938 |
EXAM: MR Pelvis wo contrast CLINICAL INFORMATION: dynamic MRI with defecogram - evacuation cine phase to ro defecatory dyssynergia, K59.04 Chronic idiopathic constipation, K59.02 Outlet dysfunction constipation COMPARISON: None. TECHNIQUE: MR Pelvis wo contrast FINDINGS: STRUCTURED REPORT: MRI Dynamic Pelvis LOWER ABDOMEN: BOWEL: No abnormality. PERITONEUM: Normal. OTHER: No other abnormality. PELVIS: ANATOMIC EVALUATION: Surgical changes: Not applicable. Levators: Lateral bowing of the bilateral levator ani complex with at least partial disruption of the left anterior attachment to the pubic bone (image 20, series 601 and image 1, series 501). While the anterior attachment is incompletely imaged on the coronal series, there is greater than 50% muscle fiber loss at the left anterior insertion. DYNAMIC EVALUATION: - H line (pubic symphysis to posterior anorectal junction; normal 1 cm below pubococcygeal line): -- Rest: 1.5 cm above PCL line. -- Defecation / Maximal Strain: 3.5 cm above PCL line. - Urethral hypermobility (abnormal if > 30 degree rotation from rest): Present. MIDDLE COMPARTMENT: - Vaginal apex/cervix (abnormal if >1 cm below pubococcygeal line) -- Rest: 2 cm above PCL line. -- Defecation / Maximal Strain: 5 cm below PCL line. - Peritoneocele: Absent. - Enterocele: Absent. POSTERIOR COMPARTMENT: - Rectocele (abnormal if >2 cm beyond anterior rectal wall): Present. - Rectocele size: 5 cm. - Anorectal plate junction angle (normal 108-127 degrees at rest; should increase 15-20 degrees with evacuation; should decrease 15-20 degrees with Kegel) -- Rest: 139 degrees -- Defecation / Maximal Strain: 135 degrees - Rectal intussusception: Present. -- Dept of rectal intussusception: Mucosal. -- Location of intussusception prolapse: Lower rectum. - Sigmoidocele: Absent. VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is surgically absent. No adnexal masses. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Tricompartmental laxity most severe within the anterior compartment where there is a large cystocele and significant urethral hypermobility. Cystocele exerts mass effect on the rectum, resulting in posterior displacement. Unidentified artifact adjacent to the urethral sphincter may be related to bulking agent, clinical correlation recommended. 2. Moderate rectocele with significant perineal descent and mucosal intussusception within the lower rectum. Small amount of retained contrast within the lower rectum. Loss of normal anorectal angle. 3. Widening of the levator hiatus with at least partial disruption of the left anterior attachment of the left levator ani complex on the pubic bone. As the attending 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 Dynamic Pelvis LOWER ABDOMEN: BOWEL: No abnormality. PERITONEUM: Normal. OTHER: No other abnormality. PELVIS: ANATOMIC EVALUATION: Surgical changes: Not applicable. Levators: Lateral bowing of the bilateral levator ani complex with at least partial disruption of the left anterior attachment to the pubic bone (image 20, series 601 and image 1, series 501). While the anterior attachment is incompletely imaged on the coronal series, there is greater than 50% muscle fiber loss at the left anterior insertion. DYNAMIC EVALUATION: - H line (pubic symphysis to posterior anorectal junction; normal 1 cm below pubococcygeal line): -- Rest: 1.5 cm above PCL line. -- Defecation / Maximal Strain: 3.5 cm above PCL line. - Urethral hypermobility (abnormal if > 30 degree rotation from rest): Present. MIDDLE COMPARTMENT: - Vaginal apex/cervix (abnormal if >1 cm below pubococcygeal line) -- Rest: 2 cm above PCL line. -- Defecation / Maximal Strain: 5 cm below PCL line. - Peritoneocele: Absent. - Enterocele: Absent. POSTERIOR COMPARTMENT: - Rectocele (abnormal if >2 cm beyond anterior rectal wall): Present. - Rectocele size: 5 cm. - Anorectal plate junction angle (normal 108-127 degrees at rest; should increase 15-20 degrees with evacuation; should decrease 15-20 degrees with Kegel) -- Rest: 139 degrees -- Defecation / Maximal Strain: 135 degrees - Rectal intussusception: Present. -- Dept of rectal intussusception: Mucosal. -- Location of intussusception prolapse: Lower rectum. - Sigmoidocele: Absent. VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is surgically absent. No adnexal masses. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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Findings: There are evolving hypodensities in the left occipital lobe, bilateral cerebellar hemispheres and brainstem corresponding to the known recent infarcts. Small faint infarcts in the right occipital lobe does not have a CT correlate. Is no significant superimposed hemorrhagic transformation. There is localized mass effect without midline shift. There is partial effacement of the fourth ventricle without obstructive hydrocephalus. There are areas of low attenuation in the periventricular and subcortical white matter, likely microangiopathic changes. There is partial patchy opacification of the left ethmoid air cells. Remaining paranasal sinuses and mastoid air cells are clear.
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15,939 |
EXAM: MR Knee Left wo contrast CLINICAL INFORMATION: Left knee instability COMPARISON: Radiographs dated 1/5/2022 TECHNIQUE: Multiplanar multisequence images were obtained through the knee Findings: There is moderate patellofemoral articular cartilage loss. Full-thickness cartilage defects along the lateral patellar facet associated with underlying subchondral cystic changes. There is mild diffuse degenerative cartilage loss in the medial tibiofemoral compartment. There is a trace joint effusion. A large popliteal cyst is present. The anterior and posterior cruciate ligaments are intact. There is moderate myxoid degenerative change of the cruciates. The lateral meniscus is borderline discoid with complex radial tear of the central free edge at the junction of the body and posterior horn. There is extensive complex tearing of the body and posterior horn of the medial meniscus with a horizontal component extending centrally almost to the tibial insertion. The quadriceps and patellar tendons are intact. The medial collateral ligament is unremarkable. There is chronic appearing thickening of the lateral patellar retinaculum. The iliotibial band and posterior lateral corner structures are unremarkable. Impression: 1. Extensive complex degenerative tearing of the body and posterior horn of the medial meniscus. 2. Complex radial tear of the lateral meniscus at the junction of the body and posterior horn. 3. Moderate patellofemoral articular cartilage loss with several focal full-thickness defects. 4. Large popliteal cyst
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Findings: There is moderate patellofemoral articular cartilage loss. Full-thickness cartilage defects along the lateral patellar facet associated with underlying subchondral cystic changes. There is mild diffuse degenerative cartilage loss in the medial tibiofemoral compartment. There is a trace joint effusion. A large popliteal cyst is present. The anterior and posterior cruciate ligaments are intact. There is moderate myxoid degenerative change of the cruciates. The lateral meniscus is borderline discoid with complex radial tear of the central free edge at the junction of the body and posterior horn. There is extensive complex tearing of the body and posterior horn of the medial meniscus with a horizontal component extending centrally almost to the tibial insertion. The quadriceps and patellar tendons are intact. The medial collateral ligament is unremarkable. There is chronic appearing thickening of the lateral patellar retinaculum. The iliotibial band and posterior lateral corner structures are unremarkable.
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FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Mild-to-moderate suboptimal quality with incomplete evaluation of segmental and subsegmental pulmonary arteries, particularly in the upper lobes. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: No definite pulmonary thromboembolism is identified although evaluation of the segmental and subsegmental pulmonary arteries is limited, particularly in the upper lobes given respiratory motion. LUNGS / AIRWAYS / PLEURA: Large right pleural effusion is redemonstrated with associated ventriculopleural shunt catheter right base. Small left pleural effusion. Associated atelectasis is noted. Scattered mosaic increased attenuation throughout both lungs with basilar predominance. The right lower lobe shows mild bronchial wall thickening and subtle intermittent mucus plugging. HEART / OTHER VESSELS: The heart size is normal. Mild pericardial thickening/trace pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Partially visualized ventriculoperitoneal shunt catheter with associated ascites. MUSCULOSKELETAL: No significant abnormality.
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15,940 |
EXAM: CV MR Cardiac w contrast PATIENT DATA Date of Study: 1/28/2022 11:03 AM Referring MD: Erin Petrie Height: 172 cm. Patient weight: 104 kg. BSA: 2.22910 Heart Rate: 56 bpm. EGFR 60. The patient's creatinine was 0.9 on 01/28/22. 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: VT, evaluate for scar History: 73 year old woman with past medical history of prior myocardial infarction, CABG, HTN, HLD, presenting with monomorphic VT COMPARISON: TECHNIQUE: CV MR Cardiac w contrast FINDINGS: IMAGING DATA Imaging System: GE 1.5T Overall Image Quality: Good Patient unable to stay awake to follow breathing instructions. CARDIAC MORPHOLOGY AND VENTRICULAR FUNCTION 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: Inpatient ECG gated: yes MEASUREMENTS: in millimeters Left Atrium: 46 LV End Diastolic Dimension: 55 LV End Systolic Dimension: 44 LV Posterior Wall: 10 Right Atrium 45 RV End Diastolic Dimension: 39 Interventricular Septum: 16 Left Ventricle (short axis): Volumes in mL, index in mL per square meter End Diastolic Volume: 146 ED index: 68 End Systolic Volume: 95 ES index: 44 Stroke Volume: 51 SV index: 24 Ejection Fraction: 35% Morphology: The left ventricle is normal in size by volume. The systolic function is moderate to severely reduced with regional wall motion abnormalities as noted. There is aneurysmal dilatation of the basal inferior and inferoseptal walls There is akinesis of the mid inferior and mid lateral wall with preserved distal segments. There is normal anterior, apical, distal anterolateral wall motion. There is decreased resting first pass perfusion in the inferior and inferolateral walls on first pass gadolinium enhancement. There is late gadolinium enhancement of the thinned out basal inferior septum and inferior wall. Right Ventricle (short axis): Volumes in mL, index in mL per square meter End Diastolic Volume: 95 ED index: 44 End Systolic Volume: 50 ES index: 23 Stroke Volume: 45 SV index: 21 Ejection Fraction: 47.4% Morphology: The right ventricle is normal in size and function. Atria: The right atria is normal in size. The left atria is enlarged. The atrial septum is aneurysmal. LAVI= 93/2.16 = 43ml/m2 Pericardium: The pericardium is normal. There is no pericardial effusion noted. Pleural: no pleural effusion noted Regional Abnormalities: Normal unless otherwise specified VALVULAR MORPHOLOGY Valve: Mitral: Visually mild regurgitation. No obvious stenosis. Aortic: No significant stenosis or regurgitation. Tricuspid: No significant stenosis or regurgitation. Pulmonary: Not well visualized Vessel dimensions: (In mm normal range dimensions mm) Main Pulmonary Artery 28 Aortic Root 34 Aortic Arch 24 [18-37] Right Pulmonary Artery 22 Ascending Aorta 33 [19-37] Left Pulmonary Artery 22 Inferior Vena Cava 26 Descending Aorta 24 [16-29] INCIDENTAL FINDINGS: Sternotomy wires present with minimal suseptibility artifact present There is a lesion in the left breast approximately 1x0.9cm in size which is hypointense on double IR sequence CONCLUSION: 1. There is moderate to severely reduced left ventricular function with thinning and aneurysmal dilatation in the basal inferior and inferoseptal segments. There is decreased first pass perfusion to these regions suggesting ischemia. 2. There is late gadolinium enhancement suggesting scar and nonviability of the basal segments of the inferoseptal and inferior wall, all other segments are viable. This is secondary to RCA occlusion. 3. There is normal right ventricular size and function 4. There is a small left breast lesion as described above, consider further evaluation with ultrasound. Cardiac MRI Technologist: Cathy Gunn As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: IMAGING DATA Imaging System: GE 1.5T Overall Image Quality: Good Patient unable to stay awake to follow breathing instructions. CARDIAC MORPHOLOGY AND VENTRICULAR FUNCTION 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: Inpatient ECG gated: yes MEASUREMENTS: in millimeters Left Atrium: 46 LV End Diastolic Dimension: 55 LV End Systolic Dimension: 44 LV Posterior Wall: 10 Right Atrium 45 RV End Diastolic Dimension: 39 Interventricular Septum: 16 Left Ventricle (short axis): Volumes in mL, index in mL per square meter End Diastolic Volume: 146 ED index: 68 End Systolic Volume: 95 ES index: 44 Stroke Volume: 51 SV index: 24 Ejection Fraction: 35% Morphology: The left ventricle is normal in size by volume. The systolic function is moderate to severely reduced with regional wall motion abnormalities as noted. There is aneurysmal dilatation of the basal inferior and inferoseptal walls There is akinesis of the mid inferior and mid lateral wall with preserved distal segments. There is normal anterior, apical, distal anterolateral wall motion. There is decreased resting first pass perfusion in the inferior and inferolateral walls on first pass gadolinium enhancement. There is late gadolinium enhancement of the thinned out basal inferior septum and inferior wall. Right Ventricle (short axis): Volumes in mL, index in mL per square meter End Diastolic Volume: 95 ED index: 44 End Systolic Volume: 50 ES index: 23 Stroke Volume: 45 SV index: 21 Ejection Fraction: 47.4% Morphology: The right ventricle is normal in size and function. Atria: The right atria is normal in size. The left atria is enlarged. The atrial septum is aneurysmal. LAVI= 93/2.16 = 43ml/m2 Pericardium: The pericardium is normal. There is no pericardial effusion noted. Pleural: no pleural effusion noted Regional Abnormalities: Normal unless otherwise specified VALVULAR MORPHOLOGY Valve: Mitral: Visually mild regurgitation. No obvious stenosis. Aortic: No significant stenosis or regurgitation. Tricuspid: No significant stenosis or regurgitation. Pulmonary: Not well visualized Vessel dimensions: (In mm normal range dimensions mm) Main Pulmonary Artery 28 Aortic Root 34 Aortic Arch 24 [18-37] Right Pulmonary Artery 22 Ascending Aorta 33 [19-37] Left Pulmonary Artery 22 Inferior Vena Cava 26 Descending Aorta 24 [16-29] INCIDENTAL FINDINGS: Sternotomy wires present with minimal suseptibility artifact present There is a lesion in the left breast approximately 1x0.9cm in size which is hypointense on double IR sequence
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FINDINGS: STRUCTURED REPORT: CTA Upper Extremity FINDINGS: VASCULATURE: AORTIC ARCH: No significant abnormality as visualized. PROXIMAL ASPECT OF ARCH VESSELS: No significant abnormality as visualized. LEFT SUBCLAVIAN ARTERY: No significant abnormality. LEFT AXILLARY ARTERY: No significant abnormality. LEFT BRACHIAL ARTERY: Mild diffuse irregular narrowing of the mid brachial artery, which may represent low-grade injury or vasospasm. LEFT RADIAL ARTERY: No significant abnormality. LEFT ULNAR ARTERY: No significant abnormality. LEFT HAND ARTERIES: No significant abnormality. OTHER VASCULATURE: No significant abnormality. No active extravasation or pseudoaneurysm identified. PARTIALLY IMAGED HEAD AND NECK: No abnormality. PARTIALLY IMAGED CHEST: Left chest tube projects over the left apex. Small left residual pneumothorax. Scattered left upper lobe consolidation, predominantly surrounding the chest tube and likely pulmonary contusions. Please see separately reported CT chest for complete intrathoracic findings. SUPERFICIAL SOFT TISSUES: Retained radiopaque fragments and soft tissue gas as described below. MUSCULOSKELETAL: No fracture identified in the left humerus, radius, ulna, or hand. Multiple retained radiopaque fragments are present within the left axilla soft tissues, biceps, and anterior deltoid muscles. Soft tissue gas is present in the posterior neck/chest wall and left axilla/proximal arm soft tissues associated with the retained radiopaque fragments. Comminuted displaced proximal one third left clavicle fracture. Comminuted scapular body fracture. Comminuted, displaced fractures of the left first through fifth ribs. Minimally displaced fracture of the left sixth rib.
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15,941 |
MR Brain wo+w contrast 1/28/2022 9:48 AM Clinical Information: Brain mass or lesion, Z87.898 Personal history of other specified conditions Spec Inst: History of brain mass since childhood. Comparison: Technique: Diffusion weighted series, T1 sagittal and axial spin echo, T2 axial fast spin echo, axial FLAIR, postcontrast T1 axial, coronal, and sagittal. Patient weight: 161 lbs. IV contrast: ProHance, 15 ml, per protocol. IV contrast injection rate: 1 ml per sec. Findings: There is a rounded structure in the right choroidal fissure which follows CSF intensity on all sequences, most in keeping with a choroid fissure cyst. No brain mass is seen. The brain is normal in signal intensity and morphology. There is no hydrocephalus, intracranial hemorrhage, acute infarct, or mass effect. No extra-axial fluid collections. Conclusion: Incidental right choroid fissure cyst.
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Findings: There is a rounded structure in the right choroidal fissure which follows CSF intensity on all sequences, most in keeping with a choroid fissure cyst. No brain mass is seen. The brain is normal in signal intensity and morphology. There is no hydrocephalus, intracranial hemorrhage, acute infarct, or mass effect. No extra-axial fluid collections.
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Findings: There is subtle hypoattenuation in the left frontal lobe including the frontal operculum. There is no evidence of acute hemorrhage or hydrocephalus. There is diffuse cerebral volume loss with slightly more pronounced ventricular prominence, however likely also on an ex vacuo basis. Mild chronic microangiopathic changes. Chronic lacunar infarcts are noted in the right pons. The visualized paranasal sinuses and mastoid air cells are clear. There is no acute osseous abnormality.
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15,942 |
EXAM: MR Facial Bones wo+w contrast CLINICAL INFORMATION: Female patient 49 years with oral cancer surveillance, C06.9 Malignant neoplasm of mouth, unspecified Spec Inst: Surveillance . History of ameloblastoma carcinoma of the left maxilla status post left maxillary debulking and radiation therapy TECHNIQUE: Axial DWI, axial T1, axial STIR, sagittal T1, coronal T1, coronal STIR of the maxillofacial bones were obtained without intravenous gadolinium. In addition multiplanar T1-weighted images were obtained after the intravenous demonstration of gadolinium. Technique: Patient weight: 190 lbs. IV contrast: ProHance, 18 ml, per protocol. COMPARISON: MRI dated 3/8/2021 FINDINGS: Partial left maxillectomy changes with flap reconstruction are again noted there is soft tissue thickening along the lateral margin of the previous left maxillary sinus without interval change. The left inferior turbinate has also been resected. There is mild loss of normal fat within the left pterygopalatine fossa without interval change. There is mild patchy opacification of the left ethmoid air cells and also left sphenoid sinus without interval change. The remaining paranasal sinuses are clear. The orbits appear within normal limits. There is irregular enhancement along the superior aspect of the prior left maxillary sinus and also mild irregular enhancement laterally without interval change. These may simply represent postsurgical granulation tissue. There are no new abnormal areas of enhancement There are surgical clips within the left neck related to lymph node dissection. There is no fluid collection or abnormal enhancement within the visualized neck. There is no acute abnormality within the visualized brain. CONCLUSION: 01. Stable postsurgical changes related to partial left maxillectomy. There is stable mild patchy enhancement along the margins of the surgical bed without interval change. No new nodular enhancement to suggest tumor recurrence. 02. Stable left neck postsurgical changes. No lymphadenopathy identified using size criteria.
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FINDINGS: Partial left maxillectomy changes with flap reconstruction are again noted there is soft tissue thickening along the lateral margin of the previous left maxillary sinus without interval change. The left inferior turbinate has also been resected. There is mild loss of normal fat within the left pterygopalatine fossa without interval change. There is mild patchy opacification of the left ethmoid air cells and also left sphenoid sinus without interval change. The remaining paranasal sinuses are clear. The orbits appear within normal limits. There is irregular enhancement along the superior aspect of the prior left maxillary sinus and also mild irregular enhancement laterally without interval change. These may simply represent postsurgical granulation tissue. There are no new abnormal areas of enhancement There are surgical clips within the left neck related to lymph node dissection. There is no fluid collection or abnormal enhancement within the visualized neck. There is no acute abnormality within the visualized brain.
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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: Surgically absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Symmetric contrast enhancement. Hypoattenuating lesion in the upper pole of left kidney is too small to characterize, but is statistically likely a cyst. No radiopaque nephrolithiasis. Right pelviectasis without frank hydronephrosis. No left hydronephrosis. No hydroureter. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Small hiatal hernia. No significant abnormality in the remainder the stomach or small bowel. COLON / APPENDIX: Diverticulosis. The appendix is normal. PERITONEUM / MESENTERY: No free intraperitoneal fluid. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Myomatous uterus. No significant adnexal abnormality. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. Mild multilevel discogenic degenerative changes in the visualized thoracolumbar spine.
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15,943 |
MR Lumbar Spine wo+w contrast 1/28/2022 10:25 AM Clinical Information: Metastatic spine tumor suspected, symptomatic, C50.919 Malignant neoplasm of unspecified site of unspecified female breast, C79.31 Secondary malignant neoplasm of brain, C79.51 Secondary malignant neoplasm of bone Comparison: Bone scan of 1/5/2022 Technique: T1 sagittal and axial spin echo, sagittal STIR, T2 sagittal and axial fast spin echo, post contrast sagittal and axial T1. Patient weight: 180 lbs. IV contrast: ProHance, 17 ml, per protocol. Findings: Vertebral body height and alignment are within normal limits. There is diffuse loss of the normal marrow signal on T1 and T2-weighted images consistent with a replacement process. Postcontrast images demonstrate diffuse vertebral marrow enhancement and heterogeneity. Conus terminates at T12-L1. Cauda equina nerve roots are normal in course and caliber without abnormal intracanalicular enhancement. There is no focal high-grade spinal canal stenosis. Conclusion: Diffuse lumbar and sacral marrow enhancement most in keeping with metastatic involvement. There is no significant height loss or retropulsion into the spinal canal. Spinal canal is normal in caliber without abnormal intracanalicular enhancement.
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Findings: Vertebral body height and alignment are within normal limits. There is diffuse loss of the normal marrow signal on T1 and T2-weighted images consistent with a replacement process. Postcontrast images demonstrate diffuse vertebral marrow enhancement and heterogeneity. Conus terminates at T12-L1. Cauda equina nerve roots are normal in course and caliber without abnormal intracanalicular enhancement. There is no focal high-grade spinal canal stenosis.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Mild age-appropriate diffuse parenchymal volume loss. Encephalomalacia in left temporal lobe. Periventricular white matter hypoattenuation consistent with chronic microangiopathic changes. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. VENTRICULAR SYSTEM: Mild ex vacuo dilatation. ORBITS: Bilateral pseudophakia. SINUSES: Mild mucosal thickening of the bilateral ethmoid air cells. VESSELS: Normal noncontrast appearance of the vessels.
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15,944 |
EXAM: MR Bone Pelvis wo+w contrast CLINICAL INFORMATION: Metastatic spine tumor suspected, symptomatic, C79.51 Secondary malignant neoplasm of bone, C79.31 Secondary malignant neoplasm of brain, C50.919 Malignant neoplasm of unspecified site of unspecified female breast COMPARISON: MR lumbar spine 1/28/2022, nuclear medicine bone scan 1/5/2022, CT abdomen pelvis 1/3/2022 TECHNIQUE: MR Bone Pelvis wo+w contrast Patient weight: 180 lbs. IV contrast: ProHance, 17 ml, per protocol. STRUCTURED REPORT: MRI HIP/BONE PELVIS v1/2/2020 FINDINGS: BONES: Visualized bones of the lower lumbar spine, pelvis, and proximal femurs demonstrate heterogeneously decreased T1 marrow signal and heterogeneously increased signal on fluid sensitive sequences. There is also heterogeneous enhancement on the postcontrast sequences with overall findings highly concerning for diffuse osseous metastases. No pathologic fractures identified. HIP JOINTS: Alignment: Normal. Effusion: None. Labrum: Normal for non-arthrographic technique. Cartilage: Normal. Capsule and ligaments:Normal. MUSCLES/TENDON: Periosteal/muscular edema along the right anterior proximal femur muscle may represent periosteal reaction associated with osseous metastatic disease versus low-grade vastus intermedius muscle strain. VESSELS:No significant disease. NERVES: Normal. INTRAPELVIC: No visceral or solid organ abnormality within the pelvis. No lymphadenopathy. No free fluid in the pelvis. CONCLUSION: 1. Diffuse lower lumbar, pelvic, and proximal femoral marrow enhancement consistent with diffuse osseous metastatic disease. No pathologic fracture is identified. 2. Periosteal/muscular edema along the right anterior proximal femur muscle may represent periosteal reaction associated with osseous metastatic disease versus low-grade vastus intermedius muscle strain. As the attending 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: Visualized bones of the lower lumbar spine, pelvis, and proximal femurs demonstrate heterogeneously decreased T1 marrow signal and heterogeneously increased signal on fluid sensitive sequences. There is also heterogeneous enhancement on the postcontrast sequences with overall findings highly concerning for diffuse osseous metastases. No pathologic fractures identified. HIP JOINTS: Alignment: Normal. Effusion: None. Labrum: Normal for non-arthrographic technique. Cartilage: Normal. Capsule and ligaments:Normal. MUSCLES/TENDON: Periosteal/muscular edema along the right anterior proximal femur muscle may represent periosteal reaction associated with osseous metastatic disease versus low-grade vastus intermedius muscle strain. VESSELS:No significant disease. NERVES: Normal. INTRAPELVIC: No visceral or solid organ abnormality within the pelvis. No lymphadenopathy. No free fluid in the pelvis.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Subsegmental atelectatic changes in the left lower lobe and lingula. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Heart size is normal. No pericardial effusion. Partially visualized calcific atherosclerotic stenosis in the coronary arteries. ABDOMEN and PELVIS: LIVER: Multiple scattered subcentimeter hypoattenuating lesions in both hepatic lobes, too small to characterize but statistically likely to represent cysts.. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. Otherwise, no significant abnormality. PANCREAS: Mild fatty atrophy. No focal parenchymal lesion or pancreatic ductal dilatation. SPLEEN: Normal. ADRENALS: No significant abnormality. KIDNEYS: Symmetric contrast enhancement. Bilateral renal cysts, the largest which in the left lower pole appears to have thin internal septations versus multiple adjacent cysts, measuring 7.8 x 6.8 cm (series 201, image 137). Additional hypoattenuating lesions in both kidneys are too small to characterize, but are statistically likely to represent cysts. Nonobstructing left nephrolithiasis. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Colonic diverticulosis. The appendix is normal. PERITONEUM / MESENTERY: No free intraperitoneal fluid. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: Mild aortoiliac calcific atherosclerosis. URINARY BLADDER: Evaluation is partially obscured by streak artifact from left hip arthroplasty hardware. Decompressed around a Foley catheter. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. Partially visualized left hip bipolar arthroplasty hardware. Mild multilevel degenerative changes in the visualized thoracolumbar spine.
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15,945 |
EXAM: MR Pelvis wo+w contrast CLINICAL INFORMATION: Perineal fluid collection with spontaneous drainage and clinical concern for anal canal involvement. COMPARISON: CT pelvis 1/25/2022 TECHNIQUE: MR Pelvis wo+w contrast Patient weight: 148 lbs. IV contrast: ProHance, 7 ml, per protocol. IV contrast injection rate: 1 ml per sec. FINDINGS: STRUCTURED REPORT: MRI Pelvis LOWER ABDOMEN: BOWEL: Sigmoid colon diverticula without inflammation. No findings to suggest bowel obstruction. PERITONEUM: Normal. OTHER: No other abnormality. PELVIS: VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Examination is not optimized for evaluation of prostate gland; however, the prostate gland appears normal in size. T2 hyperintense cysts partially imaged in the scrotum bilaterally. Small hydroceles bilaterally. BODY WALL: There is been interval resolution of previously seen fluid collections along the midline perineum. Foci of gas within these fluid collections without residual fluid. Very minimal surrounding inflammatory change. The most posterior collection abuts the external anal sphincter anteriorly (image 19, series 11); however, no findings to suggest perianal fistula. No new fluid collections. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Interval resolution of previously seen perineal fluid collections with interval appearance of locules of gas. No residual drainable fluid collection. Gas may be secondary to drainage of fluid collections; however, superimposed infection is possible. There is minimal surrounding inflammation and clinical correlation is suggested. No perianal fistula or involvement of the anal canal identified. 2. Well-circumscribed T2 hyperintense cysts partially imaged in the scrotum bilaterally favoring epididymal head cysts.
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FINDINGS: STRUCTURED REPORT: MRI Pelvis LOWER ABDOMEN: BOWEL: Sigmoid colon diverticula without inflammation. No findings to suggest bowel obstruction. PERITONEUM: Normal. OTHER: No other abnormality. PELVIS: VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Examination is not optimized for evaluation of prostate gland; however, the prostate gland appears normal in size. T2 hyperintense cysts partially imaged in the scrotum bilaterally. Small hydroceles bilaterally. BODY WALL: There is been interval resolution of previously seen fluid collections along the midline perineum. Foci of gas within these fluid collections without residual fluid. Very minimal surrounding inflammatory change. The most posterior collection abuts the external anal sphincter anteriorly (image 19, series 11); however, no findings to suggest perianal fistula. No new fluid collections. 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: Calcified granuloma in the right lower lobe. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Calcified granulomas. ADRENALS: Normal. KIDNEYS: Ileal conduit in the right lower quadrant. Right ureteral/conduit stent is coiled within the right renal pelvis and courses through the ileal conduit. Grossly unchanged degree of moderate right and mild left hydroureteronephrosis. Mild stranding and ureteral wall thickening of the proximal right ureter, which appears new from prior exam. Decreased right perinephric stranding. No renal calculi. LYMPH NODES: Shoddy para-aortic lymph nodes, unchanged. None enlarged by size criteria. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: End colostomy in the left lower quadrant. No significant abnormality of the rectal stump. PERITONEUM / MESENTERY: Unchanged mild presacral stranding. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Surgically absent. REPRODUCTIVE ORGANS: Prostatectomy. BODY WALL: Small fat-containing hernias associated with the colostomy and ileal conduit, unchanged. Severe atrophy of the right rectus muscles. MUSCULOSKELETAL: No aggressive osseous lesions.
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15,946 |
MR Brain wo+w contrast, MR Orbit wo+w contrast 1/28/2022 10:40 AM Clinical Information: optic nerve meningioma, D32.0 Benign neoplasm of cerebral meninges Comparison: MRI brain of 10/31/2013 Technique: Diffusion weighted series, T1 sagittal and axial spin echo, T2 axial fast spin echo, axial FLAIR, postcontrast T1 axial, coronal, and sagittal. Patient weight: 110 lbs. IV contrast: ProHance, 10 ml, per protocol. IV contrast injection rate: 1 ml per sec. (accession MR220003658), Patient weight: 110 lbs. IV contrast injection rate: 1 ml per sec. (accession MR220003659) Findings: Focal enhancing mass surrounding the right optic nerve in the retrobulbar component in the right orbit is again noted, stable in size and enhancement. The mass extends up to the orbital apex with possible extension into the right optic canal. There is no extension into the prechiasmatic segment of the intracranial optic nerve. There is atrophy of the chiasm or the right optic nerve. Other than the tumor, no other abnormality is noted in the orbit. No orbital or suprasellar masses are evident. There is no abnormal signal, mass or enhancement along the visual pathway. There is also no abnormal enhancement of the optic nerve/sheath complex. The brain appears normal. There is no acute or chronic infarction, demyelination, mass, hemorrhage or hydrocephalus. Conclusion: Stable right optic nerve meningioma.
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Findings: Focal enhancing mass surrounding the right optic nerve in the retrobulbar component in the right orbit is again noted, stable in size and enhancement. The mass extends up to the orbital apex with possible extension into the right optic canal. There is no extension into the prechiasmatic segment of the intracranial optic nerve. There is atrophy of the chiasm or the right optic nerve. Other than the tumor, no other abnormality is noted in the orbit. No orbital or suprasellar masses are evident. There is no abnormal signal, mass or enhancement along the visual pathway. There is also no abnormal enhancement of the optic nerve/sheath complex. The brain appears normal. There is no acute or chronic infarction, demyelination, mass, hemorrhage or hydrocephalus.
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FINDINGS: BONES/JOINTS: Interval insertion of two percutaneous pins through the highly comminuted fracture of the talar neck and dome with improved alignment of the major fracture fragments. The tip of one of the percutaneous pins extend slightly through the posterior medial aspect of the talar dome. There is improved, near-anatomic alignment of the posterior subtalar joint There is near-anatomic alignment of the tibiotalar joint with a few small fracture fragments present within the tibiotalar and talofibular joint spaces. There is a comminuted and displaced fracture of the medial malleolus at the level of the tibial plafond with approximately 0.9 cm of inferior medial displacement of the largest fracture fragment. Small nondisplaced avulsion fracture of the lateral malleolus. Similar appearance of the comminuted fracture of the anterior tibia extending into the tibiotalar joint. SOFT TISSUES: No large hematoma. Improved alignment of the peroneal tendons. Subcutaneous foci of gas throughout the posterior ankle. Diffuse dermal thickening and subcutaneous edema circumferentially around the ankle joint.
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15,947 |
MR Brain wo+w contrast, MR Orbit wo+w contrast 1/28/2022 10:40 AM Clinical Information: optic nerve meningioma, D32.0 Benign neoplasm of cerebral meninges Comparison: MRI brain of 10/31/2013 Technique: Diffusion weighted series, T1 sagittal and axial spin echo, T2 axial fast spin echo, axial FLAIR, postcontrast T1 axial, coronal, and sagittal. Patient weight: 110 lbs. IV contrast: ProHance, 10 ml, per protocol. IV contrast injection rate: 1 ml per sec. (accession MR220003658), Patient weight: 110 lbs. IV contrast injection rate: 1 ml per sec. (accession MR220003659) Findings: Focal enhancing mass surrounding the right optic nerve in the retrobulbar component in the right orbit is again noted, stable in size and enhancement. The mass extends up to the orbital apex with possible extension into the right optic canal. There is no extension into the prechiasmatic segment of the intracranial optic nerve. There is atrophy of the chiasm or the right optic nerve. Other than the tumor, no other abnormality is noted in the orbit. No orbital or suprasellar masses are evident. There is no abnormal signal, mass or enhancement along the visual pathway. There is also no abnormal enhancement of the optic nerve/sheath complex. The brain appears normal. There is no acute or chronic infarction, demyelination, mass, hemorrhage or hydrocephalus. Conclusion: Stable right optic nerve meningioma.
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Findings: Focal enhancing mass surrounding the right optic nerve in the retrobulbar component in the right orbit is again noted, stable in size and enhancement. The mass extends up to the orbital apex with possible extension into the right optic canal. There is no extension into the prechiasmatic segment of the intracranial optic nerve. There is atrophy of the chiasm or the right optic nerve. Other than the tumor, no other abnormality is noted in the orbit. No orbital or suprasellar masses are evident. There is no abnormal signal, mass or enhancement along the visual pathway. There is also no abnormal enhancement of the optic nerve/sheath complex. The brain appears normal. There is no acute or chronic infarction, demyelination, mass, hemorrhage or hydrocephalus.
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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: Noncalcified 4 mm nodule in the right middle lobe (series 201, image 9), unchanged since at least the 2018 exam. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Normal for technique. ADRENALS: Normal. KIDNEYS: Unchanged renal cysts. Otherwise normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Nondilated and without acute abnormality. COLON / APPENDIX: Noninflamed colonic diverticula. Normal appendix PERITONEUM / MESENTERY: No free intracranial fluid. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: Mild aortoiliac calcific atherosclerotic stenosis. URINARY BLADDER: Mildly distended but otherwise normal. REPRODUCTIVE ORGANS: Uterus is surgically absent. No significant adnexal abnormality. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: No aggressive osseous abnormality is identified.
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15,948 |
EXAM: MULTIPARAMETRIC MRI OF THE PROSTATE W AND WO IV CONTRAST CLINICAL INDICATION: History of PET imaging in September 2020, which demonstrated marked uptake in the left inferior aspect of the enlarged prostate gland. Patient's PSA was 75.8. Patient presents for further evaluation. 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: 175 lbs. IV contrast: ProHance, 16 ml, per protocol. IV contrast injection rate: 2.50 ml per sec. COMPARISON: None. FINDINGS: STRUCTURED REPORT: MRI Prostate PROSTATE: Measurement: 4.6 x 5.3 x 5.2 cm; estimated volume: 66 cc Focal lesion(s): Lesion # 1 (index lesion): - Key image: image 11; series 8 - Size: At least 37 x 50 mm - Location: Bilateral apical and mid central gland extending to the left greater than right transitional zone as well as the posterior peripheral zone in the mid prostate and base (DWI image 17, series 8). Lesion abuts the prostatic urethra in the mid gland. - T2WI: 5 ; DWI: 5; DCE (early and focal enhancement): positive - PI-RADS v2.1 score: 5 - Very high (clinically significant cancer is highly likely to be present) - Likelihood of extraprostatic extension: 5 - Highly likely extracapsular extension with irregular margins along the anterior apical to mid gland, as well as the posterior lateral mid to base. As above, lesion abuts the mid prostatic urethra. - Likelihood of seminal vesicle invasion: 4 - Likely Diffuse prostate abnormalities: Diffusely striated appearance of the peripheral zone on T2WI with abnormal contrast kinetics may reflect prostatitis Other prostate findings: The central gland is enlarged with findings of BPH. VESSELS: No significant abnormality. LYMPH NODES: Left pelvic sidewall lymph node measuring 1.7 x 1.0 cm (image 28, series 5). PERIRECTAL / PERIANAL REGION: Normal. BLADDER: Within normal limits. Bladder diverticula are present. OTHER PELVIC FINDINGS: None. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Heterogenous appearance of the bone marrow with enhancing lesion measuring up to 1.6 cm on axial image 50, series 12 involving the left superior pubic ramus. 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. Large area of restricted diffusion, T2 hypointensity, and early postcontrast enhancement is highly suspicious for clinically significant prostate cancer, as detailed above (PIRADS 5). Lesion involves the anterior gland and the apical and mid portions, with irregularity at the capsule highly concerning for extracapsular extension. The lesion also abuts the mid prostatic urethra, concerning for urethral lesion. Within the posterior peripheral zone on the left, the lesion extends to the base. 2. Heterogenous appearing bone marrow with enhancing lesion, as described, within the left pubic ramus, concerning for metastasis. Consider further evaluation with nuclear medicine bone scan, as clinically indicated. 3. Left pelvic sidewall lymphadenopathy, suspicious for nodal 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 Prostate PROSTATE: Measurement: 4.6 x 5.3 x 5.2 cm; estimated volume: 66 cc Focal lesion(s): Lesion # 1 (index lesion): - Key image: image 11; series 8 - Size: At least 37 x 50 mm - Location: Bilateral apical and mid central gland extending to the left greater than right transitional zone as well as the posterior peripheral zone in the mid prostate and base (DWI image 17, series 8). Lesion abuts the prostatic urethra in the mid gland. - T2WI: 5 ; DWI: 5; DCE (early and focal enhancement): positive - PI-RADS v2.1 score: 5 - Very high (clinically significant cancer is highly likely to be present) - Likelihood of extraprostatic extension: 5 - Highly likely extracapsular extension with irregular margins along the anterior apical to mid gland, as well as the posterior lateral mid to base. As above, lesion abuts the mid prostatic urethra. - Likelihood of seminal vesicle invasion: 4 - Likely Diffuse prostate abnormalities: Diffusely striated appearance of the peripheral zone on T2WI with abnormal contrast kinetics may reflect prostatitis Other prostate findings: The central gland is enlarged with findings of BPH. VESSELS: No significant abnormality. LYMPH NODES: Left pelvic sidewall lymph node measuring 1.7 x 1.0 cm (image 28, series 5). PERIRECTAL / PERIANAL REGION: Normal. BLADDER: Within normal limits. Bladder diverticula are present. OTHER PELVIC FINDINGS: None. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Heterogenous appearance of the bone marrow with enhancing lesion measuring up to 1.6 cm on axial image 50, series 12 involving the left superior pubic ramus. 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 Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Bilateral subsegmental atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Tiny benign-appearing fat-containing circumscribed lesion in the hepatic dome, new from prior exam.1 BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. Trace fluid in the gallbladder fossa, likely postsurgical. PANCREAS: Diffuse coarse calculations throughout the pancreas with associated mild pancreatic ductal dilatation, likely sequela of chronic pancreatitis. Severe atrophy of the pancreatic tail. Small fluid collection along the pancreatic body intimately associated with the stomach, decreased in size from prior exam likely sequela of remote pancreatitis SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Scattered subcentimeter hypoattenuating lesions, likely renal cysts. No hydronephrosis or renal calculi. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Moderately distended small bowel with suspected transition point in the right lower quadrant (image 135, series #201). There are mildly dilated, nondistended small bowel loops distal to this with additional mild focal narrowing of the small bowel in the right lower quadrant (image 203, series #201). No definite evidence of closed loop obstruction. COLON / APPENDIX: No abnormality. Appendix is not visualized. PERITONEUM / MESENTERY: Small amount of free intraperitoneal air, predominantly concentrated in the upper anterior abdomen. Peripherally enhancing gas containing fluid collection in the right lower quadrant measuring 5.6 x 5.2 x 11.7 cm (image 270, series #201 and image 93, series #204). There is also a peripherally enhancing fluid in the deep pelvis RETROPERITONEUM: Normal. VESSELS: Duplicated IVC. Moderate scattered atherosclerosis of the abdominal aorta and branch vessels. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is absent. No suspicious adnexal mass BODY WALL: Gas in the right upper quadrant subcutaneous soft tissues without associated fluid collection, likely postsurgical. Healed midline incision from remote laparotomy. MUSCULOSKELETAL: Mild multilevel discogenic degenerative change. No aggressive osseous lesions.
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15,949 |
MR Brain wo+w contrast 1/28/2022 10:15 AM Clinical Information: Evaluation for multiple sclerosis Comparison: MR brain dated 6/27/2017 Technique: Diffusion weighted series, sagittal T1, axial FLAIR, axial T2 FS, axial T1 postcontrast, and axial and coronal T1 FS postcontrast sequences were acquired of the brain. Patient weight: 140 lbs. IV contrast: ProHance, 13 ml, per protocol. Findings: There is a new tiny FLAIR hyperintense lesion located in the deep white matter of left temporal lobe medial to the sylvian fissure. There is interval progression of FLAIR hyper intense lesion located in deep white matter of right frontal lobe., Adjacent to frontal horn of right lateral ventricle. The other T2 FLAIR hyperintense lesions seem stable since MRI dated 2017. Evidence of diffuse cerebral volume loss is noted secondary to atrophic changes, which is slightly more prominent since prior study. Prominent perivascular spaces is noted around the bilateral basal ganglia. 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. No acute osseous or soft tissue abnormality. Impression: 1. A new tiny FLAIR hyperintense lesion adjacent to the left sylvian fissure, associated with interval progression of FLAIR hyperintense lesion located in the right frontal lobe. 2. No new enhancing lesion is noted. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: There is a new tiny FLAIR hyperintense lesion located in the deep white matter of left temporal lobe medial to the sylvian fissure. There is interval progression of FLAIR hyper intense lesion located in deep white matter of right frontal lobe., Adjacent to frontal horn of right lateral ventricle. The other T2 FLAIR hyperintense lesions seem stable since MRI dated 2017. Evidence of diffuse cerebral volume loss is noted secondary to atrophic changes, which is slightly more prominent since prior study. Prominent perivascular spaces is noted around the bilateral basal ganglia. 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. No acute osseous or soft tissue abnormality.
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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 caliber. LUNGS / AIRWAYS / PLEURA: Extensive mucous plugging within the distal trachea and right mainstem bronchus, with complete right lower lobe atelectasis and mild upper and middle lobe atelectasis. Subsegmental minimal atelectasis in the left lower lobe. Superimposed patchy groundglass airspace opacities bilaterally. Trace right pleural effusion. No pneumothorax. HEART / OTHER VESSELS: Heart is normal in size. No pericardial effusion. Mild mass effect on the right atrium secondary to complete right lower lobe atelectasis and elevation of the right hemidiaphragm. Thoracic aorta is normal in course and caliber. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None pathologically enlarged. CHEST WALL: Mild anasarca. UPPER ABDOMEN: Limited imaging through the upper abdomen is unremarkable. MUSCULOSKELETAL: Partially visualized severe levoscoliosis of the thoracolumbar spine. No destructive osseous lesions.
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15,950 |
MR Brain wo+w contrast 1/28/2022 10:59 AM Clinical Information: Brain metastases suspected, C32.1 Malignant neoplasm of supraglottis, R59.0 Localized enlarged lymph nodes Comparison: MRI brain of 7/18/2019 Technique: Diffusion weighted series, T1 sagittal and axial spin echo, T2 axial fast spin echo, axial FLAIR, postcontrast T1 axial, coronal, and sagittal. Patient weight: 132 lbs. IV contrast: ProHance, 12 ml, per protocol. IV contrast injection rate: 1 ml per sec. Findings: There is a focus of enhancement and restricted diffusion involving the left frontal bone (series 15, image 139; series 5, image 43). No parenchymal or leptomeningeal enhancement is identified. There is no intracranial mass lesion, acute hemorrhage, or infarct. Partial opacification of the right maxillary sinus. Mastoid air cells are clear. Conclusion: Enhancement involving the left frontal bone may represent osseous metastasis. No parenchymal enhancing lesions.
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Findings: There is a focus of enhancement and restricted diffusion involving the left frontal bone (series 15, image 139; series 5, image 43). No parenchymal or leptomeningeal enhancement is identified. There is no intracranial mass lesion, acute hemorrhage, or infarct. Partial opacification of the right maxillary sinus. Mastoid air cells are clear.
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FINDINGS: STRUCTURED REPORT: CT Chest SOFT TISSUE NECK: SOFT TISSUES: Extensive postsurgical changes of laryngopharyngectomy and soft tissue dissection. Postsurgical changes of tracheostomy. LYMPH NODES: No pathologic adenopathy by imaging size criteria. AERODIGESTIVE STRUCTURES: At the level of C5-C6 there is an anterior fistulous track extending from the esophagus to the cutaneous tissues, left lateral (axial series 201 image 236). On the CT chest portion of the exam contrast is noted extruding from the esophagus through a fistulous tract to the skin surface on axial series 201 image 3. PAROTID GLANDS/SUBMANDIBULAR GLANDS: Unremarkable. THYROID GLAND: Not visualized. VASCULAR STRUCTURES: No evidence of dissection, occlusion, or aneurysm. OSSEOUS STRUCTURES: No fracture, dislocation, or destructive lesion. Advanced discogenic degenerative change of the cervical spine. ORBITS: Unremarkable. PARANASAL SINUSES AND MASTOID AIR CELLS: Mucosal thickening/fluid within the right sphenoid sinus. PARTIALLY VISUALIZED INTRACRANIAL STRUCTURES: Unremarkable. CHEST: LUNGS / AIRWAYS / PLEURA: Mild inspissated secretions within the trachea. Apical pleural-parenchymal scarring. Tree-in-bud nodularity in the medial aspect of the right lung as well as in the right lower lobe posterior periphery. Scattered nodules are also noted at the periphery of the posterior left lung base. HEART / VESSELS: Coronary artery calcifications. The heart size is normal. MEDIASTINUM / ESOPHAGUS: Contrast is noted within the esophagus. No evidence of intrathoracic esophageal leak. LYMPH NODES: Calcified mediastinal/hilar lymph nodes. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Mildly patchy enhancement of the spleen. MUSCULOSKELETAL: No significant abnormality.
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15,951 |
EXAM: MR Knee Left wo contrast CLINICAL INFORMATION: Knee pain COMPARISON: Radiographs dated 1/4/2022 TECHNIQUE: Multiplanar multisequence images were obtained through the knee Findings: There is minimal degenerative cartilage change in the patellofemoral compartment. There is severe, near complete articular cartilage loss throughout the medial tibiofemoral and lateral tibiofemoral compartments. There are large degenerative marginal osteophytes. The tibia is mildly laterally subluxed relative to the femur. There is a moderate-sized joint effusion with changes of synovitis. A moderate-sized popliteal cyst is present. The anterior cruciate ligament is chronically completely torn proximally. The PCL is intact. There is complex maceration of the anterior horn and body of the medial meniscus with peripheral extrusion of the meniscal body. There is a radial tear of the anterior horn and body of the lateral meniscus with moderate peripheral meniscal extrusion. The quadriceps and patellar tendons are intact. The medial collateral ligament, patellar retinaculum, iliotibial band, and posterior lateral corner structures are unremarkable. Impression: 1. Severe degenerative cartilage loss in the medial and lateral tibiofemoral compartments. 2. Extensive, complex degenerative tearing of the medial and lateral menisci. 3. Moderate knee joint effusion with synovitis. 4. Chronic complete proximal ACL tear. 5. Moderate-sized popliteal cyst.
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Findings: There is minimal degenerative cartilage change in the patellofemoral compartment. There is severe, near complete articular cartilage loss throughout the medial tibiofemoral and lateral tibiofemoral compartments. There are large degenerative marginal osteophytes. The tibia is mildly laterally subluxed relative to the femur. There is a moderate-sized joint effusion with changes of synovitis. A moderate-sized popliteal cyst is present. The anterior cruciate ligament is chronically completely torn proximally. The PCL is intact. There is complex maceration of the anterior horn and body of the medial meniscus with peripheral extrusion of the meniscal body. There is a radial tear of the anterior horn and body of the lateral meniscus with moderate peripheral meniscal extrusion. The quadriceps and patellar tendons are intact. The medial collateral ligament, patellar retinaculum, iliotibial band, and posterior lateral corner structures are unremarkable.
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FINDINGS: STRUCTURED REPORT: CT Chest SOFT TISSUE NECK: SOFT TISSUES: Extensive postsurgical changes of laryngopharyngectomy and soft tissue dissection. Postsurgical changes of tracheostomy. LYMPH NODES: No pathologic adenopathy by imaging size criteria. AERODIGESTIVE STRUCTURES: At the level of C5-C6 there is an anterior fistulous track extending from the esophagus to the cutaneous tissues, left lateral (axial series 201 image 236). On the CT chest portion of the exam contrast is noted extruding from the esophagus through a fistulous tract to the skin surface on axial series 201 image 3. PAROTID GLANDS/SUBMANDIBULAR GLANDS: Unremarkable. THYROID GLAND: Not visualized. VASCULAR STRUCTURES: No evidence of dissection, occlusion, or aneurysm. OSSEOUS STRUCTURES: No fracture, dislocation, or destructive lesion. Advanced discogenic degenerative change of the cervical spine. ORBITS: Unremarkable. PARANASAL SINUSES AND MASTOID AIR CELLS: Mucosal thickening/fluid within the right sphenoid sinus. PARTIALLY VISUALIZED INTRACRANIAL STRUCTURES: Unremarkable. CHEST: LUNGS / AIRWAYS / PLEURA: Mild inspissated secretions within the trachea. Apical pleural-parenchymal scarring. Tree-in-bud nodularity in the medial aspect of the right lung as well as in the right lower lobe posterior periphery. Scattered nodules are also noted at the periphery of the posterior left lung base. HEART / VESSELS: Coronary artery calcifications. The heart size is normal. MEDIASTINUM / ESOPHAGUS: Contrast is noted within the esophagus. No evidence of intrathoracic esophageal leak. LYMPH NODES: Calcified mediastinal/hilar lymph nodes. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Mildly patchy enhancement of the spleen. MUSCULOSKELETAL: No significant abnormality.
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15,952 |
MR Breast Screening wo+w contrast CLINICAL INFORMATION: FCBD, FH of breast cancer, LT risk >50%, Z80.3 Family history of malignant neoplasm of breast, N60.19 Diffuse cystic mastopathy of unspecified breast Spec Inst: Leeds. TECHNIQUE: T1 axial, FSE T2 fat sat axial, pre and post contrast vibrant sequence with 3D reconstructions. Fast scan. A dedicated 8 channel breast imaging coil was utilized. Patient weight: 173 lbs. IV contrast: ProHance, 16 ml, per protocol. IV contrast injection rate: 1.80 ml per sec. COMPARISON: Prior studies including most recent breast MRI dated 2020 FINDINGS: All measurements provided in the format AP, TV, CC dimensions Breast tissue is extreme fibroglandular tissue. Postcontrast administration there is moderate background enhancement. RIGHT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. LEFT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. BILATERAL Internal mammary and axillary nodes are unremarkable. EXTRAMAMMARY: There is no suspicious abnormality in the visualized lung fields. Visualized upper abdomen unremarkable. Marrow signal is normal. IMPRESSION: RIGHT BREAST: No MRI evidence of malignancy. BI-RADS 2: Benign LEFT BREAST: No MRI evidence of malignancy. BI-RADS 2: Benign Overall BI-RADS assessment: BI-RADS 2: Benign
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FINDINGS: All measurements provided in the format AP, TV, CC dimensions Breast tissue is extreme fibroglandular tissue. Postcontrast administration there is moderate background enhancement. RIGHT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. LEFT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. BILATERAL Internal mammary and axillary nodes are unremarkable. EXTRAMAMMARY: There is no suspicious abnormality in the visualized lung fields. Visualized upper abdomen unremarkable. Marrow signal is normal.
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Findings: In the interim, there has been placement of a right frontal approach EVD catheter terminating in the right lateral ventricle against the septum pellucidum. Redemonstration of small hemorrhages in the splenium of corpus callosum on the right and right thalamus as well as intraventricular hemorrhage. Small volume subarachnoid hemorrhage along right frontal sulci and questionable punctate hemorrhages in the left frontal gray-white matter junction. No obstructive hydrocephalus. There are scattered foci of gas in the interhemispheric region and right frontal convexity likely from recent procedure. Stable appearance of large left scalp hematoma.
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15,953 |
RADIOLOGIC EXAM: MR Brain wo+w contrast CLINICAL INFORMATION: Chronic tremors, new numbness, tingling, visual hallucinations. Per chart review, evaluated in Movement Disorders Clinic due to concern for Huntington's disease. COMPARISON: None available. TECHNIQUE: MR Brain wo+w contrast Patient weight: 132 lbs. IV contrast: ProHance, 12 ml, per protocol. Multiple T1 and T2-weighted MR sequence images of the brain were obtained in the sagittal axial and coronal planes pre- and post administration of intravenous contrast per departmental protocol. FINDINGS: The study is mildly degraded secondary to motion artifact. 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. The deep gray matter structures appear within normal limits. 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. The paranasal sinuses and mastoid air cells are clear. Both orbits are unremarkable. CONCLUSION: 1. Mildly degraded study secondary to motion artifact. 2. No acute intracranial process or pathologic enhancement within limitations of the exam. Specifically, no findings to explain patient's symptomatology. As the attending 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 study is mildly degraded secondary to motion artifact. 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. The deep gray matter structures appear within normal limits. 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. The paranasal sinuses and mastoid air cells are clear. Both orbits are unremarkable.
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FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Normal. HEART / VESSELS: Coronary calcifications. The heart size is normal. There is mild prominence of the aortic root/ascending aorta measuring up to 4 cm. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Redemonstrated hypoattenuating lesion within the posterior aspect of the right hepatic lobe shows nodular discontinuous peripheral enhancement. More superiorly a similar appearing hypoattenuating lesion is noted although given this single phase exam in the size of this lesion definitive diagnosis of hemangioma cannot be made. The other previously described lesion in the anterior left hepatic lobe is hypoattenuating and measures 1.3 x 0.8 cm on axial series 2 image 187 does not show classic features of hemangioma. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: 3 mm nonobstructing interpolar renal calculus of the right kidney. Single punctate nonobstructing calculus in the left kidney. Otherwise the kidneys are normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix and colon are normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is present. No adnexal mass. BODY WALL: Fat-containing umbilical hernia. MUSCULOSKELETAL: Mild multilevel discogenic degenerative change.
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15,954 |
DATE/TIME: 1/28/2022 11:47 AM EXAM: MR Chest MSK wo+w contrast CLINICAL STATEMENT: " left shoulder possible pleomorphic dermal sarcoma, C44.90 Unspecified malignant neoplasm of skin, unspecified Spec Inst: eval for surgical planningextent of disease" COMPARISON: None. TECHNIQUE: Multiplanar T1 and T2 weighted sequences of the left chest wall were obtained prior to and following intravenous administration of gadolinium. Patient weight: 112 lbs. IV contrast: ProHance, 10 ml, per protocol. FINDINGS: Vitamin E capsules placed on the skin surface of the left upper back and left supraclavicular fossa fossa indicate the area of clinical concern. Deep and lateral to the vitamin E capsules, there is a large irregular plaque-like mass primarily centered within the subcutaneous soft tissues of the left upper back/posterior shoulder mass with irregular nodular areas of extension into the left axilla as well as into the posterior left deltoid muscle and left pectoralis minor. The mass also closely abuts and likely involves the trapezius, infraspinatus, and teres major muscles. The mass is difficult to accurately measure due to its shape, but the largest component of the mass centered within the subcutaneous soft tissues of the along the posterior left shoulder measures approximately 2.3 x 10.5 x 11.9 cm (AP x TV x CC; series 13 image 12, series 18 image 23). The mass is isointense to slightly hyperintense relative to muscle on T1-weighted images and is increased in signal on fluid sensitive sequences. On postcontrast images, there is homogenous enhancement throughout the mass. Spiculated nodular components of the mass extend into the left axilla highly concerning for nodal metastatic disease with multiple satellite axillary nodes located around the larger spiculated masses. Multiple enhancing nodules, likely metastatic lymph nodes, surround the left axillary neurovascular bundle. In the superior lateral aspect of the humeral head, there is an area of heterogeneous marrow signal which is isointense to fat on all pulse sequences and and likely represents focal fat. Spiculated enhancing left upper lobe nodule measuring 1.0 x 1.0 cm highly concerning for pulmonary metastasis (series 13 image 18). Additional smaller enhancing nodules appear to be present throughout the left lung, but are suboptimally evaluated on MR. IMPRESSION: 1. Large irregular enhancing mass centered within the left posterior shoulder/left upper back subcutaneous soft tissues with extension into the left axilla as described above highly concerning for dermal sarcoma. Correlate with pathology results. 2. There is intramuscular involvement of the left deltoid and pectoralis minor muscles as well as extension of the mass along the muscular fascia of the trapezius, infraspinatus, and teres major muscles. 3. Spiculated nodular components of the mass extend into the left axilla highly concerning for nodal metastatic disease with multiple satellite axillary nodes located around the larger spiculated masses. Multiple enhancing nodules, likely metastatic lymph nodes, also surround the left axillary neurovascular bundle. 4. Spiculated enhancing left upper lobe nodule measuring 1.0 x 1.0 cm, highly concerning for pulmonary metastasis. Additional smaller enhancing nodules appear to be present throughout the left lung, but are suboptimally evaluated on MR. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report. Upon further review, an additional irregular enhancing mass is identified centered along the undersurface of the left trapezius muscle measuring approximately 1.6 x 1.0 cm in axial dimensions (series 13 image 13), concerning for an additional metastatic focus. There is also a nearby enhancing posterior chest wall lymph node deep to the rhomboid. Additional findings discussed at the interdisciplinary sarcoma management conference on 2/7/2022. 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: Vitamin E capsules placed on the skin surface of the left upper back and left supraclavicular fossa fossa indicate the area of clinical concern. Deep and lateral to the vitamin E capsules, there is a large irregular plaque-like mass primarily centered within the subcutaneous soft tissues of the left upper back/posterior shoulder mass with irregular nodular areas of extension into the left axilla as well as into the posterior left deltoid muscle and left pectoralis minor. The mass also closely abuts and likely involves the trapezius, infraspinatus, and teres major muscles. The mass is difficult to accurately measure due to its shape, but the largest component of the mass centered within the subcutaneous soft tissues of the along the posterior left shoulder measures approximately 2.3 x 10.5 x 11.9 cm (AP x TV x CC; series 13 image 12, series 18 image 23). The mass is isointense to slightly hyperintense relative to muscle on T1-weighted images and is increased in signal on fluid sensitive sequences. On postcontrast images, there is homogenous enhancement throughout the mass. Spiculated nodular components of the mass extend into the left axilla highly concerning for nodal metastatic disease with multiple satellite axillary nodes located around the larger spiculated masses. Multiple enhancing nodules, likely metastatic lymph nodes, surround the left axillary neurovascular bundle. In the superior lateral aspect of the humeral head, there is an area of heterogeneous marrow signal which is isointense to fat on all pulse sequences and and likely represents focal fat. Spiculated enhancing left upper lobe nodule measuring 1.0 x 1.0 cm highly concerning for pulmonary metastasis (series 13 image 18). Additional smaller enhancing nodules appear to be present throughout the left lung, but are suboptimally evaluated on MR.
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FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Normal. HEART / VESSELS: Coronary calcifications. The heart size is normal. There is mild prominence of the aortic root/ascending aorta measuring up to 4 cm. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Redemonstrated hypoattenuating lesion within the posterior aspect of the right hepatic lobe shows nodular discontinuous peripheral enhancement. More superiorly a similar appearing hypoattenuating lesion is noted although given this single phase exam in the size of this lesion definitive diagnosis of hemangioma cannot be made. The other previously described lesion in the anterior left hepatic lobe is hypoattenuating and measures 1.3 x 0.8 cm on axial series 2 image 187 does not show classic features of hemangioma. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: 3 mm nonobstructing interpolar renal calculus of the right kidney. Single punctate nonobstructing calculus in the left kidney. Otherwise the kidneys are normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix and colon are normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is present. No adnexal mass. BODY WALL: Fat-containing umbilical hernia. MUSCULOSKELETAL: Mild multilevel discogenic degenerative change.
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15,955 |
MR Brain wo+w contrast 1/28/2022 11:04 AM Clinical Information: Dementia, vascular suspected, R41.89 Other symptoms and signs involving cognitive functions and awareness Spec Inst: 68 yo RH F wtih cognitive decline who shares has 80% stenosis on R carotid Comparison: CT head of 6/14/2018 Technique: Diffusion weighted series, T1 sagittal and axial spin echo, T2 axial fast spin echo, axial FLAIR, postcontrast T1 axial, coronal, and sagittal. Patient weight: 192 lbs. IV contrast: ProHance, 18 ml, per protocol. Findings: There is minimally asymmetric increased volume loss involving the left perisylvian region compared to the right. There is no hippocampal atrophy. No encephalomalacia or acute infarct. No parenchymal hemorrhage. There are few scattered periventricular and subcortical white matter T2/FLAIR hyperintensities reflecting mild chronic microvascular ischemic change. No extra-axial fluid collections. Conclusion: Subtle asymmetric left parasylvian volume loss relative to the right. No hippocampal atrophy or encephalomalacia.
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Findings: There is minimally asymmetric increased volume loss involving the left perisylvian region compared to the right. There is no hippocampal atrophy. No encephalomalacia or acute infarct. No parenchymal hemorrhage. There are few scattered periventricular and subcortical white matter T2/FLAIR hyperintensities reflecting mild chronic microvascular ischemic change. No extra-axial fluid collections.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Subsegmental atelectatic changes in the right lower lobe. DISTAL ESOPHAGUS: Small sliding-type hiatal hernia. HEART / VESSELS: Heart size is normal. No pericardial effusion. Moderate calcific atherosclerosis in the coronary arteries. ABDOMEN and PELVIS: LIVER: Diffuse hepatic steatosis. Unchanged lesion in the posterior right hepatic lobe measuring 8.5 x 6.0 cm (series 301, image 91), with discontinuous peripheral nodular enhancement, again consistent with hemangioma. No new hepatic lesion is identified. BILIARY TRACT: Normal for postcholecystectomy state. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Symmetric contrast enhancement. Right upper pole cyst. Multiple additional hypoattenuating lesions in both kidneys are too small to characterize, but are statistically likely to represent cysts. No radiopaque nephrolithiasis. No hydroureteronephrosis. Excreted contrast is noted in the bilateral renal collecting systems. LYMPH NODES: Unchanged prominent periportal lymph node measuring up to 12 mm in short axis. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis. The appendix is not definitely visualized. PERITONEUM / MESENTERY: No free intracranial fluid. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: Mild aortoiliac calcific atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is surgically absent. No significant adnexal abnormality. BODY WALL: Percutaneous pigtail drainage catheter terminates within the right upper quadrant ventral abdominal wall peripherally enhancing collection, with interval decrease in size of the collection, measuring 3.9 x 2.8 cm (series 301, image 110), previously measuring 7.7 x 4.3 cm (series 201, image 108). No new body wall collection. Small fat-containing periumbilical hernia. MUSCULOSKELETAL: No aggressive osseous abnormality is identified. Multilevel degenerative changes in the visualized thoracal lumbar spine.
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15,956 |
MR Cervical Spine wo contrast 1/28/2022 11:01 AM Clinical Information: Cervical radiculopathy status post prior cervical spine surgery. Comparison: Not available Technique: Axial and sagittal T1, axial and sagittal T2, and sagittal STIR sequences were acquired of the cervical spine without the use of intravenous contrast. Findings: The patient is status post anterior fusion of C6-C7 level. No abnormality of cervical spinal alignment. The bone marrow is of normal signal intensity. The visualized portions of the posterior fossa and craniocervical junction appear normal. The cervical spinal cord is unremarkable. Degenerative changes of the cervical spine are described on a level by level basis below: C2-C3: There is mild bilateral facet arthropathy associated with moderate flavum hypertrophy, without significant spinal canal or neural foraminal narrowing. C3-C4: There is mild disc bulge, with mild indentation on the anterior aspect of thecal sac, associated with mild facet and flavum hypertrophy, without significant spinal canal or neural foraminal narrowing. C4-C5: There is moderate disc bulge most prominent on right side with indentation of the anterior aspect of thecal sac, there is also bilateral moderate facet hypertrophy, causing mild spinal canal narrowing. Evidence of minimal anterolisthesis of C4 on C5 is noted. C5-C6: There is central disc protrusion, with flattening of the the anterior cord, causing mild spinal canal stenosis. There is mild bilateral facet joint arthropathy, without significant neural foraminal narrowing. C6-C7: There is mild bilateral facet joint arthropathy, without significant neural foraminal or spinal canal narrowing. C7-T1: There is moderate disc bulge causing indentation on the anterior aspect of the thecal sac. There is also moderate bilateral facet arthropathy, without significant canal stenosis or neural foraminal narrowing The visualized prevertebral and paravertebral soft tissues are unremarkable. Impression: 1. Postsurgical changes status post anterior fusion of C6-C7. 2. Moderate degenerative changes as multilevel disc desiccation and facet hypertrophy with mild spinal canal narrowing at C4-C5 C5-C6. 3. If there is concern for persistent radiculopathy, consider CT myelogram for further evaluation. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: The patient is status post anterior fusion of C6-C7 level. No abnormality of cervical spinal alignment. The bone marrow is of normal signal intensity. The visualized portions of the posterior fossa and craniocervical junction appear normal. The cervical spinal cord is unremarkable. Degenerative changes of the cervical spine are described on a level by level basis below: C2-C3: There is mild bilateral facet arthropathy associated with moderate flavum hypertrophy, without significant spinal canal or neural foraminal narrowing. C3-C4: There is mild disc bulge, with mild indentation on the anterior aspect of thecal sac, associated with mild facet and flavum hypertrophy, without significant spinal canal or neural foraminal narrowing. C4-C5: There is moderate disc bulge most prominent on right side with indentation of the anterior aspect of thecal sac, there is also bilateral moderate facet hypertrophy, causing mild spinal canal narrowing. Evidence of minimal anterolisthesis of C4 on C5 is noted. C5-C6: There is central disc protrusion, with flattening of the the anterior cord, causing mild spinal canal stenosis. There is mild bilateral facet joint arthropathy, without significant neural foraminal narrowing. C6-C7: There is mild bilateral facet joint arthropathy, without significant neural foraminal or spinal canal narrowing. C7-T1: There is moderate disc bulge causing indentation on the anterior aspect of the thecal sac. There is also moderate bilateral facet arthropathy, without significant canal stenosis or neural foraminal narrowing The visualized prevertebral and paravertebral soft tissues are unremarkable.
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FINDINGS: 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: Tiny hypoattenuating lesion in the right hepatic lobe is likely a cyst but technically indeterminate. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Two renal arteries, bilaterally. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is absent. Diffuse fatty mural infiltration. Mild sigmoid diverticulosis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Fat-containing umbilical hernia. MUSCULOSKELETAL: No significant abnormality.
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15,957 |
MR Cervical Spine wo contrast 1/28/2022 11:33 AM Clinical Information: neck pain, left arm pain, numbness Comparison: 10/1/2021 Technique: T2 sagittal and axial fast spin spin echo, T1 sagittal spin echo, sagittal STIR, axial T2* gradient echo. Findings: Redemonstration of the congenital superior vertical subluxation of the dens, resulting in mild basilar invagination. There is mild posterior subluxation of the occipital condyles in relation to the C1 lateral masses on either side. There is loss of cervical lordosis. Vertebral body heights are preserved. There are no suspicious bone marrow signal abnormalities. The cranial vertebral junction appears unremarkable. No definite cord signal abnormality is identified. Degenerative findings are discussed on a level by level basis: C2-3: Within normal limits. C3-4: Mild diffuse disc bulge without significant central canal stenosis. There is mild to moderate bilateral neural foraminal narrowing. C4-5: Moderate posterior disc bulge, resulting in mild indentation of the anterior thecal sac and abutting the spinal cord without significant compression. There is no significant neural foraminal narrowing. C5-6: Mild diffuse disc bulge and right paracentral disc protrusion without touching the spinal cord. There is no significant neural foraminal narrowing. C6-7, C7-T1: Within normal limits. Impression: 1. Redemonstration of the congenital vertical subluxation of the dens, resulting in mild basilar invagination. Stable bilateral posterior subluxation of the occipital condyles in relation to the C1 lateral masses. 2. Stable degenerative changes of the cervical spine, predominantly at C4-5 without significant cord compression. Stable mild to moderate neural foraminal narrowing at C3-4 level.
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Findings: Redemonstration of the congenital superior vertical subluxation of the dens, resulting in mild basilar invagination. There is mild posterior subluxation of the occipital condyles in relation to the C1 lateral masses on either side. There is loss of cervical lordosis. Vertebral body heights are preserved. There are no suspicious bone marrow signal abnormalities. The cranial vertebral junction appears unremarkable. No definite cord signal abnormality is identified. Degenerative findings are discussed on a level by level basis: C2-3: Within normal limits. C3-4: Mild diffuse disc bulge without significant central canal stenosis. There is mild to moderate bilateral neural foraminal narrowing. C4-5: Moderate posterior disc bulge, resulting in mild indentation of the anterior thecal sac and abutting the spinal cord without significant compression. There is no significant neural foraminal narrowing. C5-6: Mild diffuse disc bulge and right paracentral disc protrusion without touching the spinal cord. There is no significant neural foraminal narrowing. C6-7, C7-T1: Within normal limits.
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FINDINGS: TEMPORAL BONES: Redemonstration of lucent lesions in the left clivus/petrous apex which demonstrate mild expansion, corticated margins, and are opacified (image 109, series #201 and image 242, series #203). The bilateral EACs are patent. Tympanic membranes and inco-stapedial joints appear intact. No fluid or debris in the middle ear. Normal appearance of the inner ear structures. No evidence of semicircular canal dehiscence. Normal caliber of the internal auditory canal and vestibular aqueduct. FACIAL BONES: Normal. REMAINING VISUALIZED BONES: Normal. SINONASAL CAVITIES: Clear. VISUALIZED INTRACRANIAL STRUCTURES: Normal. Posterior fossa arachnoid cyst. ORBITAL CONTENTS: Normal.
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15,958 |
EXAM: MR Thoracic Spine wo contrast CLINICAL INFORMATION: Female patient 53 years with Mid-back pain ; Mid-back pain, compression fracture suspected, M54.9 Dorsalgia, unspecified, M81.0 Age-related osteoporosis without current pathological fracture TECHNIQUE: Sagittal T1, sagittal T2, sagittal STIR, axial T1 and axial T2-weighted images of the thoracic spine were obtained without intravenous gadolinium. COMPARISON: Radiographs dated 11/22/2021. FINDINGS: There is no loss of height of the thoracic vertebrae and no subluxation. There is mild rightward curvature of the thoracic spine, similar to recent radiographs. There is no focal T2 hyperintense lesion within the thoracic vertebrae. There is no prevertebral or abnormal paraspinal soft tissue swelling. Thoracic spinal cord demonstrates normal signal intensity and caliber. There is multilevel disc desiccation throughout the thoracic spine. There is a small small left paracentral disc protrusion at T11-T12 without significant spinal canal narrowing. There is also mild disc bulge at T9-T10 without spinal canal narrowing. There is no significant neural foraminal narrowing. Within the visualized cervical spine there is a small disc osteophyte complex at C5-C6 resulting in mild central canal narrowing. CONCLUSION: 01. No evidence of acute or remote compression fracture within the thoracic spine. There is very mild rightward curvature of the thoracic spine. 02. Mild degenerative changes within the inferior thoracic spine as described above. There is no significant spinal canal narrowing or neural foraminal narrowing.
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FINDINGS: There is no loss of height of the thoracic vertebrae and no subluxation. There is mild rightward curvature of the thoracic spine, similar to recent radiographs. There is no focal T2 hyperintense lesion within the thoracic vertebrae. There is no prevertebral or abnormal paraspinal soft tissue swelling. Thoracic spinal cord demonstrates normal signal intensity and caliber. There is multilevel disc desiccation throughout the thoracic spine. There is a small small left paracentral disc protrusion at T11-T12 without significant spinal canal narrowing. There is also mild disc bulge at T9-T10 without spinal canal narrowing. There is no significant neural foraminal narrowing. Within the visualized cervical spine there is a small disc osteophyte complex at C5-C6 resulting in mild central canal narrowing.
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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: Normal. KIDNEYS: Tiny nonobstructing renal calculus in the inferior pole of the right kidney measuring approximately 1 cm on axial series 2 image 142. The kidneys and ureters are otherwise unremarkable. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Intrauterine device is noted. BODY WALL: No significant abnormality. MUSCULOSKELETAL: L4 limbus vertebra. No acute fracture.
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15,959 |
MR Lumbar Spine wo contrast 1/28/2022 11:38 AM Clinical Information: Lumbar radiculopathy, > 6 wks, M54.50 Low back pain, unspecified, M54.16 Radiculopathy, lumbar region, R26.89 Other abnormalities of gait and mobility Comparison: Lumbar spine radiographs of 5/6/2021 Technique: T1 sagittal and axial spin echo, sagittal STIR, T2 sagittal and axial fast spin echo, post contrast sagittal and axial T1. Patient weight: 105 lbs. Findings: There is grade 1 anterolisthesis of L4 on L5 and grade 2 anterolisthesis of L5 on S1. There is no evidence of a suspicious marrow infiltrative process. Discogenic endplate edema is noted at L5-S1. Vertebral body heights are within normal limits. T12-L1: No central canal or neural foraminal stenosis. L1-L2: No central canal or neural foraminal stenosis. L2-L3: Right frontal lateral disc bulge. Mild redundancy of ligamentum flavum. Central canal and neural foramina are patent. L3-L4: Circumferential disc bulge without significant spinal stenosis. Partial effacement of the right subarticular recess. Mild facet hypertrophy. Mild left neural foraminal stenosis. L4-L5: Severe spinal stenosis secondary to disc bulge and facet hypertrophy. Subarticular recesses are effaced bilaterally. There is moderate to severe bilateral neural foraminal stenosis. A synovial cyst is noted on the left which is distant from the neural foramen. L5-S1: Moderate spinal stenosis secondary to disc bulge and facet hypertrophy. There is effacement of the bilateral subarticular recesses. Severe bilateral neural foraminal stenosis. Paraspinal soft tissues are unremarkable. Conclusion: Degenerative changes most pronounced at L4-5 and L5-S1 secondary to pars defects with resultant spondylolisthesis, severe spinal canal stenosis as well as impingement of the neural foramina and subarticular recesses as described in detail above.
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Findings: There is grade 1 anterolisthesis of L4 on L5 and grade 2 anterolisthesis of L5 on S1. There is no evidence of a suspicious marrow infiltrative process. Discogenic endplate edema is noted at L5-S1. Vertebral body heights are within normal limits. T12-L1: No central canal or neural foraminal stenosis. L1-L2: No central canal or neural foraminal stenosis. L2-L3: Right frontal lateral disc bulge. Mild redundancy of ligamentum flavum. Central canal and neural foramina are patent. L3-L4: Circumferential disc bulge without significant spinal stenosis. Partial effacement of the right subarticular recess. Mild facet hypertrophy. Mild left neural foraminal stenosis. L4-L5: Severe spinal stenosis secondary to disc bulge and facet hypertrophy. Subarticular recesses are effaced bilaterally. There is moderate to severe bilateral neural foraminal stenosis. A synovial cyst is noted on the left which is distant from the neural foramen. L5-S1: Moderate spinal stenosis secondary to disc bulge and facet hypertrophy. There is effacement of the bilateral subarticular recesses. Severe bilateral neural foraminal stenosis. Paraspinal soft tissues are unremarkable.
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FINDINGS: BRAIN PARENCHYMA: Large, lobulated sellar and suprasellar mass isodense to gray matter and measuring approximately 3.4 x 2.1 x 3.9 cm (image 149, series #201 and image 34, series #204). Mass results in significant sellar expansion and bony thinning/remodeling. There is erosion of the right sphenoid sinus posterior wall with extension into the bilateral, right greater than left, sphenoid sinuses and likely into the right posterior ethmoid air cells. Suspected mass effect on the optic chiasm. Mild splaying of the bilateral cavernous sinuses, however extension to the cavernous sinus/ICAs is poorly evaluated on this noncontrast exam. No evidence of associated hemorrhage or significant edema. No intraparenchymal hemorrhage. Gray-white matter differentiation is maintained. No evidence of acute infarction. EXTRA-AXIAL SPACES: No extra-axial collections. SKULL AND SKULL BASE: Small bilateral mastoid air cell effusions. No fracture. VENTRICULAR SYSTEM: Sellar/suprasellar mass results in moderate mass effect on the anterior third ventricle. No hydrocephalus.. ORBITS: Normal. SINUSES: Extension of the mass into the sphenoid sinuses and posterior ethmoid air cells as above. Mild mucosal thickening of the right maxillary sinus. Tiny mucus retention cyst in the left maxillary sinus. VESSELS: No significant abnormality.
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15,960 |
MR Brain wo+w contrast 1/28/2022 4:44 PM CLINICAL INFORMATION: Intractable epilepsy, G40.804 Other epilepsy, intractable, without status epilepticus Spec Inst: Intractable epilepsy - MRI guidance for and monitoring of parenchymal tissue ablation (LITT procedure) - Dr. Riley. COMPARISON: Prior MR brain 11/8/2021. TECHNIQUE: Multiplanar, multisequence MR images of the brain were obtained before and after the administration of intravenous contrast. Of note, images were also obtained before and after thermal ablation of an epileptic focus. MRI used for guidance. Patient weight: 333 lbs. IV contrast: ProHance, 10 ml, per protocol. FINDINGS: Metallic artifact is seen along the trajectory of the ablation probe which is inserted from the right posterior lateral approach, with the tip at the right hippocampus. There is expected restricted diffusion at the ablation probe tip on DWI, and addition to increased T2/FLAIR signal hyperintensity surrounding the ablation probe tip. There is no evidence of intracranial hemorrhage. Postcontrast images demonstrate peripheral enhancement surrounding the ablation bed. Again noted is gray matter heterotopia adjacent to the ependyma of the lateral roof of the left lateral ventricle and peritrigonal white matter. The ventricles are normal in size and there is no midline shift. The bilateral orbits are within normal limits. The paranasal sinuses appear clear. CONCLUSION: 1. Expected post ablation changes in the right hippocampus. 2. Unchanged gray matter heterotopia along the ependyma of the lateral lateral roof of the left lateral ventricle. As the attending 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: Metallic artifact is seen along the trajectory of the ablation probe which is inserted from the right posterior lateral approach, with the tip at the right hippocampus. There is expected restricted diffusion at the ablation probe tip on DWI, and addition to increased T2/FLAIR signal hyperintensity surrounding the ablation probe tip. There is no evidence of intracranial hemorrhage. Postcontrast images demonstrate peripheral enhancement surrounding the ablation bed. Again noted is gray matter heterotopia adjacent to the ependyma of the lateral roof of the left lateral ventricle and peritrigonal white matter. The ventricles are normal in size and there is no midline shift. The bilateral orbits are within normal limits. The paranasal sinuses appear clear.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. Stable subcentimeter noncalcified nodules along the right major fissure and within the left lower lobe DISTAL ESOPHAGUS/MEDIASTINUM: Small hiatal hernia. Enlarged subcarinal mediastinal lymph node complex measures 2.6 x 1.3 cm on axial series 601 image 4. HEART / VESSELS: Coronary vascular calcifications. ABDOMEN and PELVIS: LIVER: Postsurgical changes of liver transplant. No focal lesion. BILIARY TRACT: Redemonstrated pneumobilia and common bile duct stent, unchanged. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Splenomegaly. ADRENALS: Normal. KIDNEYS: Redemonstrated and unchanged nonobstructing right renal calculus measuring 3 mm. Another nonobstructing left renal calculus is noted measuring 5 mm, unchanged. Multiple dense left renal lesions most consistent with simple cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: The stomach is normal. The small bowel is nondilated. No intraluminal contrast extravasation to suggest small bowel bleed. COLON / APPENDIX: The appendix is normal. The colon is unremarkable aside from scattered diverticula. No intraluminal contrast extravasation to suggest GI bleed. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Accessory inferior right hepatic vein. Common hepatic artery is replaced to the SMA URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Fat-containing ventral hernia. Partially visualized dystrophic calcification in the left lower anterior chest wall. MUSCULOSKELETAL: Mild multilevel discogenic degenerative change.
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15,961 |
EXAM: MR Knee Left wo contrast CLINICAL INFORMATION: Knee injury, history of prior meniscal tear COMPARISON: None. TECHNIQUE: Multiplanar multisequence images were obtained through the knee STRUCTURED REPORT: MRI Knee 1/2/2020 Findings: Patellofemoral articular cartilage is well maintained. There is mild degenerative thinning of the medial tibiofemoral cartilage. A large joint effusion is present. There is no popliteal cyst. The anterior and posterior cruciate ligaments are intact. The lateral meniscus is normal. There is a large, predominantly radial tear of the body and posterior horn of the medial meniscus. The quadriceps and patellar tendons are intact. There is mild patellar tendinosis. There is fluid tracking along the intact medial collateral ligament. The patellar retinaculum, iliotibial band, and posterior lateral corner structures are unremarkable. Impression: 1. Grade 1 sprain of the MCL. 2. Complex radial tear of the body and posterior horn of the medial meniscus, likely chronic. 3. Mild patellar tendinosis.
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Findings: Patellofemoral articular cartilage is well maintained. There is mild degenerative thinning of the medial tibiofemoral cartilage. A large joint effusion is present. There is no popliteal cyst. The anterior and posterior cruciate ligaments are intact. The lateral meniscus is normal. There is a large, predominantly radial tear of the body and posterior horn of the medial meniscus. The quadriceps and patellar tendons are intact. There is mild patellar tendinosis. There is fluid tracking along the intact medial collateral ligament. The patellar retinaculum, iliotibial band, and posterior lateral corner structures are unremarkable.
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FINDINGS: Right frontal approach external ventricular drainage catheter tip now terminates in the medial aspect of the right lateral ventricle body. Stable decompressed ventricles. Small pneumocephalus along the right frontal convexity and falx. Stable small intraventricular hemorrhage layering in the occipital horns of lateral ventricles. Unchanged small intraparenchymal hemorrhage in the corpus callosum and right thalamus. Tiny hemorrhage along the left frontal gray-white matter junction which appears more discrete. Unchanged trace extra-axial hemorrhage in the bifrontal cortical sulci and adjacent to the corpus callosum. No significant mass effect or midline shift. Unchanged enlarged left frontoparietotemporal scalp hematoma. Normal appearance of the orbits. Tiny mucus retention cyst in the right maxillary sinus. Mastoid air cells are clear.
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15,962 |
MR Cervical Spine wo contrast 1/28/2022 11:38 AM Clinical Information: Spinal stenosis, C-spine, M54.2 Cervicalgia, M54.50 Low back pain, unspecified, R20.0 Anesthesia of skin, R26.89 Other abnormalities of gait and mobility, M54.16 Radiculopathy, lumbar region Comparison: Cervical spine radiographs of 1/27/2022 Technique: T2 sagittal and axial fast spin spin echo, T1 sagittal spin echo, sagittal STIR, axial T2* gradient echo. Patient weight: 105 lbs. Findings: There is no evidence of a suspicious marrow infiltrative process. Reversal of normal cervical lordosis secondary to trace degenerative anterolisthesis of C3 on C4, C4 on C5 and C7 on T1. Discogenic endplate changes are noted at C3-4 with marrow edema. There is perifacet edema bilaterally at C3-4 and on the right at C4-5. Vertebral body heights are within normal limits. Subtle T2 hyperintensity is noted within the spinal cord at the C4 vertebral body level indicative of edema or myelomalacia. C2-3: Spinal canal is patent. Mild left neural foraminal stenosis secondary to uncovertebral and facet joint degeneration. C3-4: Posteriorly oriented disc osteophyte complex, facet and uncovertebral joint degeneration contribute to severe spinal stenosis with flattening of the ventral spinal cord and effacement of the CSF. Moderate bilateral neural foraminal stenosis. C4-5: Mild stenosis secondary to posteriorly oriented disc osteophyte complex with partial effacement of the ventral CSF. Moderate to severe right neural foraminal stenosis secondary to severe facet degeneration. C5-6: Mild canal narrowing with partial effacement of the ventral CSF. Mild left and severe right neural foraminal stenosis secondary to facet and uncovertebral joint degeneration. C6-7: Severe intervertebral disc height loss with posteriorly directed disc osteophyte complex which indents the thecal sac and partially effaces the ventral CSF, resulting in mild central canal stenosis. Moderate to severe right neural foraminal stenosis secondary to uncovertebral facet joint degeneration. C7-T1: Central canal is patent. No high-grade neural foraminal narrowing. Conclusion: Multilevel degenerative changes most pronounced at C3-4 where there is severe spinal stenosis resulting in subtle cord signal change. Additional multilevel neural foraminal high-grade stenosis due to a combination of uncovertebral, facet and discogenic degeneration.
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Findings: There is no evidence of a suspicious marrow infiltrative process. Reversal of normal cervical lordosis secondary to trace degenerative anterolisthesis of C3 on C4, C4 on C5 and C7 on T1. Discogenic endplate changes are noted at C3-4 with marrow edema. There is perifacet edema bilaterally at C3-4 and on the right at C4-5. Vertebral body heights are within normal limits. Subtle T2 hyperintensity is noted within the spinal cord at the C4 vertebral body level indicative of edema or myelomalacia. C2-3: Spinal canal is patent. Mild left neural foraminal stenosis secondary to uncovertebral and facet joint degeneration. C3-4: Posteriorly oriented disc osteophyte complex, facet and uncovertebral joint degeneration contribute to severe spinal stenosis with flattening of the ventral spinal cord and effacement of the CSF. Moderate bilateral neural foraminal stenosis. C4-5: Mild stenosis secondary to posteriorly oriented disc osteophyte complex with partial effacement of the ventral CSF. Moderate to severe right neural foraminal stenosis secondary to severe facet degeneration. C5-6: Mild canal narrowing with partial effacement of the ventral CSF. Mild left and severe right neural foraminal stenosis secondary to facet and uncovertebral joint degeneration. C6-7: Severe intervertebral disc height loss with posteriorly directed disc osteophyte complex which indents the thecal sac and partially effaces the ventral CSF, resulting in mild central canal stenosis. Moderate to severe right neural foraminal stenosis secondary to uncovertebral facet joint degeneration. C7-T1: Central canal is patent. No high-grade neural foraminal narrowing.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: No focal consolidation, pleural effusion, or pneumothorax. Mild dependent atelectasis. DISTAL ESOPHAGUS: Small hiatal hernia. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: Mildly prominent mesenteric lymph nodes in the right lower quadrant. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is nondilated measuring 5 mm and there is no significant periappendiceal stranding. The colon is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Collapsed. REPRODUCTIVE ORGANS: Intrauterine device is noted and appropriately positioned. Likely right corpus luteal cyst. Multiple cysts are noted in the left ovary. BODY WALL: Fat-containing umbilical hernia. MUSCULOSKELETAL: Bilateral L5 pars defects. Mild multilevel discogenic degenerative change.
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15,963 |
EXAM: MR Neck Soft Tissue wo+w contrast CLINICAL INFORMATION: Skull base mass near the posterior aspect of C1 on the left. Of note, patient has a history of upper mediastinal schwannoma. COMPARISON: CT neck soft tissue dated 12/27/2021. TECHNIQUE: MR Neck Soft Tissue wo+w contrast. Patient weight: 186 lbs. IV contrast: ProHance, 17 ml, per protocol. IV contrast injection rate: 0.50 ml per sec. FINDINGS: Redemonstrated a homogeneously enhancing mass within the soft tissues adjacent to the left posterior arch of C1, measuring 2.4 x 1.5 cm on axial series 16 image 22 (previously 2.6 x 1.5 cm given differences in technique). This lesion shows slight heterogeneous increased T2 signal with T1 signal intensity slightly more intense than adjacent muscle. There is also increased signal on the STIR sequence. There is no definitive restricted diffusion associated with this lesion although the DWI intensity is elevated along with the ADC, suggesting T2 shine through. The superficial and deep neck soft tissues are otherwise unremarkable. The expected vascular flow voids and postcontrast vascular structures are unremarkable. No abnormal bone marrow signal. The lung apices are clear. CONCLUSION: Redemonstrated is a homogeneously enhancing T2 hyperintense circumscribed lesion within the left posterior paraspinal soft tissues adjacent to the posterior arch of C1. These findings are most suggestive of nerve sheath tumor, most likely schwannoma rather than metastasis. This lesion is significantly unchanged from the CT neck from July 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: Redemonstrated a homogeneously enhancing mass within the soft tissues adjacent to the left posterior arch of C1, measuring 2.4 x 1.5 cm on axial series 16 image 22 (previously 2.6 x 1.5 cm given differences in technique). This lesion shows slight heterogeneous increased T2 signal with T1 signal intensity slightly more intense than adjacent muscle. There is also increased signal on the STIR sequence. There is no definitive restricted diffusion associated with this lesion although the DWI intensity is elevated along with the ADC, suggesting T2 shine through. The superficial and deep neck soft tissues are otherwise unremarkable. The expected vascular flow voids and postcontrast vascular structures are unremarkable. No abnormal bone marrow signal. The lung apices are clear.
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Findings: Asymmetric enlargement of the right parotid gland which appears mildly edematous and hyperenhancing when compared to the contralateral side. No sialolith identified. There is unorganized fluid surrounding the right parotid gland. No focal fluid collection identified. Normal appearance of the lymphoid tissue in Waldeyer's ring. Normal appearance of the prevertebral soft tissues. Shoddy bilateral cervical lymph nodes, likely reactive. No discrete neck mass. The nasopharynx, oropharynx, larynx and hypopharynx are normal in appearance. Normal appearance of the epiglottis. The base of the tongue is unremarkable. Normal appearance of the bilateral submandibular glands and thyroid gland. Included portions of the brain and skull base appear normal. Normal appearance of the orbits. Paranasal sinuses are clear. Visualized lung apices are clear. No aggressive osseous lesions. No significant vascular abnormality.
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15,964 |
EXAM: MR Abdomen wo contrast CLINICAL INFORMATION: Myelofibrosis COMPARISON: 11/5/2021 TECHNIQUE: MR Abdomen wo contrast FINDINGS: STRUCTURED REPORT: MRI Abdomen Examination is limited by study protocol LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Hepatic parenchymal hypointensity on T2-weighted images suggests iron deposition. Small hepatic cyst. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Incidental pancreas divisum. SPLEEN: Redemonstration of splenomegaly, similar in appearance with small T2 hyperintense foci in the spleen. ADRENALS: Normal. KIDNEYS: Scattered small renal cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: Small T2 hyperintense focus in the anterior abdominal wall on the left series 301 image 8, unchanged. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Splenomegaly and similar findings to prior MR examination 11/5/2021. Spleen volumes will be dictated separately.
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FINDINGS: STRUCTURED REPORT: MRI Abdomen Examination is limited by study protocol LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Hepatic parenchymal hypointensity on T2-weighted images suggests iron deposition. Small hepatic cyst. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Incidental pancreas divisum. SPLEEN: Redemonstration of splenomegaly, similar in appearance with small T2 hyperintense foci in the spleen. ADRENALS: Normal. KIDNEYS: Scattered small renal cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: Small T2 hyperintense focus in the anterior abdominal wall on the left series 301 image 8, unchanged. 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. EXTRA-AXIAL SPACES: Normal. 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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15,965 |
Calculation of spleen volume was requested by the ordering provider and performed by a user at an independent workstation. The calculated splenic volume is as follows: Total splenic volume: 1120 mL Prior splenic volume (11/5/2021): 1118 mL Prior splenic volume (9/3/2021): 1152 mL Prior splenic volume (5/18/2021): 1028 mL
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The calculated splenic volume is as follows: Total splenic volume: 1120 mL Prior splenic volume (11/5/2021): 1118 mL Prior splenic volume (9/3/2021): 1152 mL Prior splenic volume (5/18/2021): 1028 mL
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Patchy perivascular nodular and peripheral groundglass opacities throughout the visualized portions of both lungs. Calcified granuloma in the left upper lobe. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Redemonstration of expected postsurgical changes from orthotopic liver transplant. No focal hepatic lesion is identified within the limitations of single phase technique. BILIARY TRACT: Unchanged wall enhancement and mild dilatation of the common bile duct, measuring up to 11 mm at the porta hepatis, with change in caliber at the biliary anastomosis. No radiopaque choledocholithiasis. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Enlarged. ADRENALS: Right adrenal gland is likely atrophic and not well-visualized. Left adrenal gland is KIDNEYS: Symmetric contrast enhancement. No radiopaque nephrolithiasis. No hydroureteronephrosis. LYMPH NODES: Unchanged prominent periportal lymph node measuring 1.2 cm in short axis, similar to prior examination. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No significant abnormality in the colon. The appendix is normal. PERITONEUM / MESENTERY: No free intraperitoneal fluid. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: Unchanged large perigastric and paraesophageal venous collaterals. Similar appearance of multiple distal splenic artery aneurysms, the largest which measures up to 11 mm (series 301, image 132), unchanged from prior examination. Scattered atherosclerotic calcifications in the infrarenal abdominal aorta. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Postsurgical changes to the ventral abdominal wall. MUSCULOSKELETAL: No aggressive osseous abnormalities identified. Multilevel degenerative changes in the visualized thoracolumbar spine. Chronic fracture deformity of the lateral right ninth rib. Chronic mild anterior wedging of the T11 vertebral body.
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15,966 |
MR Breast Diagnostic Bil wo+w contrast CLINICAL INFORMATION: short interval follow up right breast masses, N63.0 Unspecified lump in unspecified breast, R92.8 Other abnormal and inconclusive findings on diagnostic imaging of breast, Z80.3 Family history of malignant neoplasm of breast Spec Inst: prefers Gardendale. Note: patient also underwent gastric sleeve surgery TECHNIQUE: T1 axial, FSE T2 fat sat axial, pre and post contrast vibrant sequence with 3D reconstructions and time intensity curves. Delayed post contrast axials. A dedicated 8 channel breast imaging coil was utilized. Patient weight: 160 lbs. IV contrast: ProHance, 15 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: Prior studies including most recent breast MRI from 7/27/2021 FINDINGS: All measurements provided in the format AP, TV, CC dimensions Breast tissue is scattered fibroglandular tissue. Postcontrast administration there is mild background enhancement. Significant interval decrease in size of the breasts and interval variation in the background parenchymal enhancement likely secondary to gastric sleeve surgery RIGHT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. Site of right breast oval enhancing T2 hyperintense mass is decrease in size, currently measuring 3 x 3 mm and previously 3 x 8 mm. This is best seen on series 400 image 153. LEFT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. BILATERAL Several scattered bilateral foci are similar in appearance. None stands out from background. These do limit detection of small invasive cancers. Internal mammary nodes are normal. Axillary lymph nodes are normal. EXTRAMAMMARY: There is no suspicious abnormality in the visualized lung fields. Visualized upper abdomen unremarkable. Marrow signal is normal. IMPRESSION: RIGHT BREAST: No MRI evidence of malignancy.: BI-RADS 2: Benign LEFT BREAST: No MRI evidence of malignancy.: BI-RADS 1: Negative Overall BI-RADS assessment: BI-RADS 2: Benign Patient is due for mammography in November 2022 and breast MRI in one year
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FINDINGS: All measurements provided in the format AP, TV, CC dimensions Breast tissue is scattered fibroglandular tissue. Postcontrast administration there is mild background enhancement. Significant interval decrease in size of the breasts and interval variation in the background parenchymal enhancement likely secondary to gastric sleeve surgery RIGHT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. Site of right breast oval enhancing T2 hyperintense mass is decrease in size, currently measuring 3 x 3 mm and previously 3 x 8 mm. This is best seen on series 400 image 153. LEFT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. BILATERAL Several scattered bilateral foci are similar in appearance. None stands out from background. These do limit detection of small invasive cancers. Internal mammary nodes are normal. Axillary lymph nodes are normal. EXTRAMAMMARY: There is no suspicious abnormality in the visualized lung fields. Visualized upper abdomen unremarkable. Marrow signal is normal.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Persistent hyperdense contents within the posterior costophrenic angles, bilaterally. Small right lateral effusion with a subpulmonic component. Trace left subpulmonic effusion. Redemonstrated is chronic lung disease. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Coronary calcifications. Trace pericardial effusion. The heart size is normal. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Unremarkable aside from a small amount of stranding tracking along the common bile duct. GALLBLADDER: Interval insertion of a percutaneous cholecystostomy tube which is in appropriate position. Persistent mild stranding adjacent to the gallbladder, significantly improved when compared to prior. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Minimal thickening at the inferior aspect of the left adrenal gland. KIDNEYS: Mildly atrophic kidneys, symmetric and bilateral. Small left simple renal cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is normal. Extensive fecal material throughout the colon. Mild wall thickening extending from the distal sigmoid colon through the rectum with associated perirectal and retroperitoneal inflammatory stranding. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Mild stranding adjacent to the distal sigmoid colon. VESSELS: Scattered atherosclerotic disease. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Dystrophic calcifications in the prostate gland. No other abnormality. BODY WALL: Mild body wall edema. MUSCULOSKELETAL: Significant gluteal atrophy. Multiple chronic right rib deformities. Multilevel discogenic degenerative change. Anterior bridging osteophytes with maintenance of the disc spaces of the lower thoracic spine consistent with DISH.
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15,967 |
EXAM: MR Knee Left wo contrast CLINICAL INFORMATION: Knee pain, possible meniscal tear COMPARISON: Radiographs dated 9/2/2021 TECHNIQUE: Multiplanar multisequence images were obtained through the knee Findings: There is mild degenerative change of the patellofemoral cartilage, greatest along the medial femoral trochlea. There is severe, near complete articular cartilage loss throughout the medial tibiofemoral compartment. There is moderate cartilage loss in the lateral tibiofemoral compartment. A moderate size joint effusion is present. There is a small popliteal cyst. Fluid tracks from the inferior margin of the cyst distally along the pes anserine tendons. The ACL is attenuated with internally increased signal. There is myxoid degenerative change of the PCL. The lateral meniscus is normal. There is a full-thickness radial tear through the posterior central root of the medial meniscus. The quadriceps and patellar tendons are intact. There is mild patellar tendinosis. The medial collateral ligament, patellar retinaculum, iliotibial band, and posterior lateral corner structures are unremarkable. Impression: 1. Severe degenerative cartilage loss in the medial tibiofemoral compartment. 2. Full-thickness, unstable radial tear through the posterior central root of the medial meniscus. 3. Popliteal cyst with partial rupture. 4. Considerably attenuated ACL suggestive of a prior partial tear. Correlate clinically for evidence of ligamentous insufficiency.
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Findings: There is mild degenerative change of the patellofemoral cartilage, greatest along the medial femoral trochlea. There is severe, near complete articular cartilage loss throughout the medial tibiofemoral compartment. There is moderate cartilage loss in the lateral tibiofemoral compartment. A moderate size joint effusion is present. There is a small popliteal cyst. Fluid tracks from the inferior margin of the cyst distally along the pes anserine tendons. The ACL is attenuated with internally increased signal. There is myxoid degenerative change of the PCL. The lateral meniscus is normal. There is a full-thickness radial tear through the posterior central root of the medial meniscus. The quadriceps and patellar tendons are intact. There is mild patellar tendinosis. The medial collateral ligament, patellar retinaculum, iliotibial band, and posterior lateral corner structures are 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. Mild diffuse parenchymal volume loss. Corpus callosum is moderately hypoplastic/atrophic. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: Small right mastoid air cell effusion. VENTRICULAR SYSTEM: Unchanged mild hydrocephalus. ORBITS: Normal. SINUSES: Mild mucosal thickening of the bilateral maxillary and ethmoid sinuses. VESSELS: Normal noncontrast appearance of the vessels.
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15,968 |
MR Brain wo contrast, MR Angio Neck wo+w contrast, MR Angio Head wo contrast 1/28/2022 11:45 AM Clinical Information: Stroke, follow up, I66.9 Occlusion and stenosis of unspecified cerebral artery Comparison: CT head dated 8/27/2021. Technique: Axial DWI (b=1000 and 2000) with ADC maps, axial SWI with phase map, axial T2/FLAIR/T1, and post contrast axial and sagittal T1, 3-D multislab TOF MRA of the head and axial 2-D TOF MRA of the neck without contrast, and coronal thick slab CE-MRA of the neck Patient weight: 215 lbs. IV contrast: ProHance, 10 ml, per protocol. IV contrast injection rate: 2 ml per sec. Findings: Diffusion-weighted imaging reveals no evidence of acute lacunar infarction or vascular territory ischemia. No intracranial hemorrhage, mass or mass effect is identified. No underlying chronic microvascular ischemic disease burden is noted. Convexity subarachnoid spaces are prominently visualized as a result of cerebral cortical atrophy. The ventricles are symmetric and age-appropriate. Head MRA demonstrates no intracranial arterial occlusion or significant stenosis. Basilar artery and bilateral PCA show mild luminal irregularity. The right carotid siphon shows laterally oriented a wide neck aneurysm measuring 3 mm in width and 2 mm in height. Neck MRA demonstrates no flow limiting stenoses along the bilateral cervical ICA. Bilateral distal ICA, proximal ICA and right cervical vertebral artery show atherosclerotic luminal irregularity. A focal luminal stenosis is seen at the right V3-V4 junction. The left vertebral artery maintains normal caliber. The vertebral artery ostia are patent. Impression: 1. No evidence of acute cerebral infarction/ischemia. 2. No evidence of large vessel occlusion or stenosis. 3. Small wide neck aneurysm in the right carotid siphon.
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Findings: Diffusion-weighted imaging reveals no evidence of acute lacunar infarction or vascular territory ischemia. No intracranial hemorrhage, mass or mass effect is identified. No underlying chronic microvascular ischemic disease burden is noted. Convexity subarachnoid spaces are prominently visualized as a result of cerebral cortical atrophy. The ventricles are symmetric and age-appropriate. Head MRA demonstrates no intracranial arterial occlusion or significant stenosis. Basilar artery and bilateral PCA show mild luminal irregularity. The right carotid siphon shows laterally oriented a wide neck aneurysm measuring 3 mm in width and 2 mm in height. Neck MRA demonstrates no flow limiting stenoses along the bilateral cervical ICA. Bilateral distal ICA, proximal ICA and right cervical vertebral artery show atherosclerotic luminal irregularity. A focal luminal stenosis is seen at the right V3-V4 junction. The left vertebral artery maintains normal caliber. The vertebral artery ostia are patent.
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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. Tiny radiopaque fragment along the inferior left orbit. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. Small left frontal hematoma containing multiple radiopaque fragments. FACIAL BONES: No fracture. Bilateral pterygoid plates are intact. MANDIBLE: No fracture. Bilateral temporomandibular joints are intact. Scattered dental caries. SINONASAL CAVITIES: Small mucus retention cyst in the left maxillary sinus. Minimal mucosal thickening of the posterior left maxillary sinus.
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15,969 |
MR Brain wo contrast, MR Angio Neck wo+w contrast, MR Angio Head wo contrast 1/28/2022 11:45 AM Clinical Information: Stroke, follow up, I66.9 Occlusion and stenosis of unspecified cerebral artery Comparison: CT head dated 8/27/2021. Technique: Axial DWI (b=1000 and 2000) with ADC maps, axial SWI with phase map, axial T2/FLAIR/T1, and post contrast axial and sagittal T1, 3-D multislab TOF MRA of the head and axial 2-D TOF MRA of the neck without contrast, and coronal thick slab CE-MRA of the neck Patient weight: 215 lbs. IV contrast: ProHance, 10 ml, per protocol. IV contrast injection rate: 2 ml per sec. Findings: Diffusion-weighted imaging reveals no evidence of acute lacunar infarction or vascular territory ischemia. No intracranial hemorrhage, mass or mass effect is identified. No underlying chronic microvascular ischemic disease burden is noted. Convexity subarachnoid spaces are prominently visualized as a result of cerebral cortical atrophy. The ventricles are symmetric and age-appropriate. Head MRA demonstrates no intracranial arterial occlusion or significant stenosis. Basilar artery and bilateral PCA show mild luminal irregularity. The right carotid siphon shows laterally oriented a wide neck aneurysm measuring 3 mm in width and 2 mm in height. Neck MRA demonstrates no flow limiting stenoses along the bilateral cervical ICA. Bilateral distal ICA, proximal ICA and right cervical vertebral artery show atherosclerotic luminal irregularity. A focal luminal stenosis is seen at the right V3-V4 junction. The left vertebral artery maintains normal caliber. The vertebral artery ostia are patent. Impression: 1. No evidence of acute cerebral infarction/ischemia. 2. No evidence of large vessel occlusion or stenosis. 3. Small wide neck aneurysm in the right carotid siphon.
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Findings: Diffusion-weighted imaging reveals no evidence of acute lacunar infarction or vascular territory ischemia. No intracranial hemorrhage, mass or mass effect is identified. No underlying chronic microvascular ischemic disease burden is noted. Convexity subarachnoid spaces are prominently visualized as a result of cerebral cortical atrophy. The ventricles are symmetric and age-appropriate. Head MRA demonstrates no intracranial arterial occlusion or significant stenosis. Basilar artery and bilateral PCA show mild luminal irregularity. The right carotid siphon shows laterally oriented a wide neck aneurysm measuring 3 mm in width and 2 mm in height. Neck MRA demonstrates no flow limiting stenoses along the bilateral cervical ICA. Bilateral distal ICA, proximal ICA and right cervical vertebral artery show atherosclerotic luminal irregularity. A focal luminal stenosis is seen at the right V3-V4 junction. The left vertebral artery maintains normal caliber. The vertebral artery ostia are patent.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Right apical pleural-based hematoma adjacent to right 1st rib fracture. No focal consolidation, pleural effusion, or pneumothorax. Mild dependent atelectasis. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. DIAPHRAGM: Intact. LYMPH NODES: Scattered prominent mediastinal lymph nodes. CHEST WALL: No significant abnormality. Incidental left-sided sternalis muscle. ABDOMEN and PELVIS: LIVER: Hepatomegaly and hepatic steatosis. No acute traumatic injury BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix and colon are normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Small left inferior retroperitoneal hematoma along the posterior/inferior pelvic wall associated with pelvic and sacral fractures as described below. No active extravasation. VESSELS: Replaced right hepatic artery arising from the SMA. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is present. No adnexal mass. BODY WALL: Fat-containing umbilical hernia. There is a small amount of adjacent stranding. Small amount of hemorrhage/hematoma is noted within the soft tissues overlying the lateral left hip. MUSCULOSKELETAL: Multiple bilateral rib fractures involving the posterior first rib on the right and the first, second, third, and fifth ribs on the left. Comminuted left sacral fracture extending from the superior aspects to the S4 segment both zone one and zone two. Fractures extend into the left S1 and S2 neural foramen. Redemonstrated superior and inferior left pubic rami fractures with comminution extension to involve the pubic symphysis. The superior and lateral most aspect of the left superior pubic ramus fracture has minimal extension to involve the anterior/medial aspect of the right acetabulum (coronal series 503 image 54). THORACIC: VERTEBRA: Anterior compression fractures involving the superior endplates of T1 and T3. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No acute fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: Tiny minimally displaced fracture of the inferior left facet of L5 associated with the previously described sacral fractures. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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15,970 |
MR Brain wo contrast, MR Angio Neck wo+w contrast, MR Angio Head wo contrast 1/28/2022 11:45 AM Clinical Information: Stroke, follow up, I66.9 Occlusion and stenosis of unspecified cerebral artery Comparison: CT head dated 8/27/2021. Technique: Axial DWI (b=1000 and 2000) with ADC maps, axial SWI with phase map, axial T2/FLAIR/T1, and post contrast axial and sagittal T1, 3-D multislab TOF MRA of the head and axial 2-D TOF MRA of the neck without contrast, and coronal thick slab CE-MRA of the neck Patient weight: 215 lbs. IV contrast: ProHance, 10 ml, per protocol. IV contrast injection rate: 2 ml per sec. Findings: Diffusion-weighted imaging reveals no evidence of acute lacunar infarction or vascular territory ischemia. No intracranial hemorrhage, mass or mass effect is identified. No underlying chronic microvascular ischemic disease burden is noted. Convexity subarachnoid spaces are prominently visualized as a result of cerebral cortical atrophy. The ventricles are symmetric and age-appropriate. Head MRA demonstrates no intracranial arterial occlusion or significant stenosis. Basilar artery and bilateral PCA show mild luminal irregularity. The right carotid siphon shows laterally oriented a wide neck aneurysm measuring 3 mm in width and 2 mm in height. Neck MRA demonstrates no flow limiting stenoses along the bilateral cervical ICA. Bilateral distal ICA, proximal ICA and right cervical vertebral artery show atherosclerotic luminal irregularity. A focal luminal stenosis is seen at the right V3-V4 junction. The left vertebral artery maintains normal caliber. The vertebral artery ostia are patent. Impression: 1. No evidence of acute cerebral infarction/ischemia. 2. No evidence of large vessel occlusion or stenosis. 3. Small wide neck aneurysm in the right carotid siphon.
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Findings: Diffusion-weighted imaging reveals no evidence of acute lacunar infarction or vascular territory ischemia. No intracranial hemorrhage, mass or mass effect is identified. No underlying chronic microvascular ischemic disease burden is noted. Convexity subarachnoid spaces are prominently visualized as a result of cerebral cortical atrophy. The ventricles are symmetric and age-appropriate. Head MRA demonstrates no intracranial arterial occlusion or significant stenosis. Basilar artery and bilateral PCA show mild luminal irregularity. The right carotid siphon shows laterally oriented a wide neck aneurysm measuring 3 mm in width and 2 mm in height. Neck MRA demonstrates no flow limiting stenoses along the bilateral cervical ICA. Bilateral distal ICA, proximal ICA and right cervical vertebral artery show atherosclerotic luminal irregularity. A focal luminal stenosis is seen at the right V3-V4 junction. The left vertebral artery maintains normal caliber. The vertebral artery ostia are patent.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Right apical pleural-based hematoma adjacent to right 1st rib fracture. No focal consolidation, pleural effusion, or pneumothorax. Mild dependent atelectasis. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. DIAPHRAGM: Intact. LYMPH NODES: Scattered prominent mediastinal lymph nodes. CHEST WALL: No significant abnormality. Incidental left-sided sternalis muscle. ABDOMEN and PELVIS: LIVER: Hepatomegaly and hepatic steatosis. No acute traumatic injury BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix and colon are normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Small left inferior retroperitoneal hematoma along the posterior/inferior pelvic wall associated with pelvic and sacral fractures as described below. No active extravasation. VESSELS: Replaced right hepatic artery arising from the SMA. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is present. No adnexal mass. BODY WALL: Fat-containing umbilical hernia. There is a small amount of adjacent stranding. Small amount of hemorrhage/hematoma is noted within the soft tissues overlying the lateral left hip. MUSCULOSKELETAL: Multiple bilateral rib fractures involving the posterior first rib on the right and the first, second, third, and fifth ribs on the left. Comminuted left sacral fracture extending from the superior aspects to the S4 segment both zone one and zone two. Fractures extend into the left S1 and S2 neural foramen. Redemonstrated superior and inferior left pubic rami fractures with comminution extension to involve the pubic symphysis. The superior and lateral most aspect of the left superior pubic ramus fracture has minimal extension to involve the anterior/medial aspect of the right acetabulum (coronal series 503 image 54). THORACIC: VERTEBRA: Anterior compression fractures involving the superior endplates of T1 and T3. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No acute fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: Tiny minimally displaced fracture of the inferior left facet of L5 associated with the previously described sacral fractures. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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15,971 |
EXAM: MR Abdomen wo+w contrast, MR Cholangiopancreatography MRCP CLINICAL INFORMATION: Biliary dilation possible CBD stricture. COMPARISON: Prior MRI 4/6/2021 and CT 3/26/2021 TECHNIQUE: MR Abdomen wo+w contrast, MR Cholangiopancreatography MRCP Patient weight: 196 lbs. IV contrast: ProHance, 19 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: There may be mild hepatic steatosis. No arterially enhancing hepatic lesions. No areas of washout or T2 hyperintense lesion. BILIARY TRACT: Intrahepatic and extrahepatic biliary dilation, more in the left lobe. The common duct measures up to 1.8 cm. There is a small focus of narrowing in the distal common bile duct however the duct appears to be dilated to a similar degree beyond this point. No discrete filling defect. GALLBLADDER: Absent. PANCREAS: T2 hyperintense structure seen anterior to the common bile duct measures 1.9 x 1.2 cm on series 1005 image 32. There is questionable communication with the duct as seen on image 31 in this area. No internal enhancement within this is somewhat heterogeneous on the T2-weighted sequences. Unclear if this is arising from the pancreas or is simply adjacent to it. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Postsurgical changes in the stomach, possibly gastric bypass, better delineated on prior CT. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Intrahepatic and extra hepatic biliary dilation, more in the left lobe as described above with focal area of narrowing in the distal CBD however no definite filling defect is appreciated. 2. Complex cystic structure anterior to the distal common bile duct, unclear if arising from the pancreas or separate from it. There is a potential site of communication with the common bile duct although this is not definitive. This could reflect a cystic duct remnant or potentially choledochal cyst. A pancreatic IPMN is possible though when the CT from March 2021 is compared this favors that it is separate from the pancreas (and appeared to have calcification within it at that time).
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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: There may be mild hepatic steatosis. No arterially enhancing hepatic lesions. No areas of washout or T2 hyperintense lesion. BILIARY TRACT: Intrahepatic and extrahepatic biliary dilation, more in the left lobe. The common duct measures up to 1.8 cm. There is a small focus of narrowing in the distal common bile duct however the duct appears to be dilated to a similar degree beyond this point. No discrete filling defect. GALLBLADDER: Absent. PANCREAS: T2 hyperintense structure seen anterior to the common bile duct measures 1.9 x 1.2 cm on series 1005 image 32. There is questionable communication with the duct as seen on image 31 in this area. No internal enhancement within this is somewhat heterogeneous on the T2-weighted sequences. Unclear if this is arising from the pancreas or is simply adjacent to it. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Postsurgical changes in the stomach, possibly gastric bypass, better delineated on prior CT. 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: Mildly 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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15,972 |
EXAM: MR Abdomen wo+w contrast, MR Cholangiopancreatography MRCP CLINICAL INFORMATION: Biliary dilation possible CBD stricture. COMPARISON: Prior MRI 4/6/2021 and CT 3/26/2021 TECHNIQUE: MR Abdomen wo+w contrast, MR Cholangiopancreatography MRCP Patient weight: 196 lbs. IV contrast: ProHance, 19 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: There may be mild hepatic steatosis. No arterially enhancing hepatic lesions. No areas of washout or T2 hyperintense lesion. BILIARY TRACT: Intrahepatic and extrahepatic biliary dilation, more in the left lobe. The common duct measures up to 1.8 cm. There is a small focus of narrowing in the distal common bile duct however the duct appears to be dilated to a similar degree beyond this point. No discrete filling defect. GALLBLADDER: Absent. PANCREAS: T2 hyperintense structure seen anterior to the common bile duct measures 1.9 x 1.2 cm on series 1005 image 32. There is questionable communication with the duct as seen on image 31 in this area. No internal enhancement within this is somewhat heterogeneous on the T2-weighted sequences. Unclear if this is arising from the pancreas or is simply adjacent to it. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Postsurgical changes in the stomach, possibly gastric bypass, better delineated on prior CT. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Intrahepatic and extra hepatic biliary dilation, more in the left lobe as described above with focal area of narrowing in the distal CBD however no definite filling defect is appreciated. 2. Complex cystic structure anterior to the distal common bile duct, unclear if arising from the pancreas or separate from it. There is a potential site of communication with the common bile duct although this is not definitive. This could reflect a cystic duct remnant or potentially choledochal cyst. A pancreatic IPMN is possible though when the CT from March 2021 is compared this favors that it is separate from the pancreas (and appeared to have calcification within it at that time).
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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: There may be mild hepatic steatosis. No arterially enhancing hepatic lesions. No areas of washout or T2 hyperintense lesion. BILIARY TRACT: Intrahepatic and extrahepatic biliary dilation, more in the left lobe. The common duct measures up to 1.8 cm. There is a small focus of narrowing in the distal common bile duct however the duct appears to be dilated to a similar degree beyond this point. No discrete filling defect. GALLBLADDER: Absent. PANCREAS: T2 hyperintense structure seen anterior to the common bile duct measures 1.9 x 1.2 cm on series 1005 image 32. There is questionable communication with the duct as seen on image 31 in this area. No internal enhancement within this is somewhat heterogeneous on the T2-weighted sequences. Unclear if this is arising from the pancreas or is simply adjacent to it. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Postsurgical changes in the stomach, possibly gastric bypass, better delineated on prior CT. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Right apical pleural-based hematoma adjacent to right 1st rib fracture. No focal consolidation, pleural effusion, or pneumothorax. Mild dependent atelectasis. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. DIAPHRAGM: Intact. LYMPH NODES: Scattered prominent mediastinal lymph nodes. CHEST WALL: No significant abnormality. Incidental left-sided sternalis muscle. ABDOMEN and PELVIS: LIVER: Hepatomegaly and hepatic steatosis. No acute traumatic injury BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix and colon are normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Small left inferior retroperitoneal hematoma along the posterior/inferior pelvic wall associated with pelvic and sacral fractures as described below. No active extravasation. VESSELS: Replaced right hepatic artery arising from the SMA. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is present. No adnexal mass. BODY WALL: Fat-containing umbilical hernia. There is a small amount of adjacent stranding. Small amount of hemorrhage/hematoma is noted within the soft tissues overlying the lateral left hip. MUSCULOSKELETAL: Multiple bilateral rib fractures involving the posterior first rib on the right and the first, second, third, and fifth ribs on the left. Comminuted left sacral fracture extending from the superior aspects to the S4 segment both zone one and zone two. Fractures extend into the left S1 and S2 neural foramen. Redemonstrated superior and inferior left pubic rami fractures with comminution extension to involve the pubic symphysis. The superior and lateral most aspect of the left superior pubic ramus fracture has minimal extension to involve the anterior/medial aspect of the right acetabulum (coronal series 503 image 54). THORACIC: VERTEBRA: Anterior compression fractures involving the superior endplates of T1 and T3. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No acute fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: Tiny minimally displaced fracture of the inferior left facet of L5 associated with the previously described sacral fractures. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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15,973 |
Right foot MRI: Indication: Concern for osteomyelitis of the foot Technique: Multiplanar multisequence images were obtained through the foot both pre and post intravenous contrast administration. Technique: Patient weight: 180 lbs. IV contrast: ProHance, 17 ml, per protocol. Comparison: Radiographs dated 1/11/2022 Findings: There is a soft tissue ulceration overlying the fifth MTP joint. There is bone marrow edema and postcontrast enhancement in the fifth metatarsal head and proximal phalanx base. No defined soft tissue abscess is seen. There is edema in the fourth metatarsal head and proximal phalanx base, less pronounced than in the fifth toe. After contrast administration there is minimal enhancement in these regions. There is patchy edema throughout the calcaneus and all of the midfoot bones. No discrete fracture lucency is seen. There is no enhancement in these regions after contrast administration. Impression: 1. Osteomyelitis of the fifth metatarsal head and proximal phalanx base. 2. Edema and enhancement in the fourth metatarsal head and proximal phalanx base is considerably less pronounced than in the fifth toe. Finding may be reactive, but early osteomyelitis must be considered given its proximity to the fifth toe. 3. Patchy bone marrow edema throughout the hindfoot and midfoot bones is most suggestive of neuropathic related edema rather than infection.
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Findings: There is a soft tissue ulceration overlying the fifth MTP joint. There is bone marrow edema and postcontrast enhancement in the fifth metatarsal head and proximal phalanx base. No defined soft tissue abscess is seen. There is edema in the fourth metatarsal head and proximal phalanx base, less pronounced than in the fifth toe. After contrast administration there is minimal enhancement in these regions. There is patchy edema throughout the calcaneus and all of the midfoot bones. No discrete fracture lucency is seen. There is no enhancement in these regions after contrast administration.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Right apical pleural-based hematoma adjacent to right 1st rib fracture. No focal consolidation, pleural effusion, or pneumothorax. Mild dependent atelectasis. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. DIAPHRAGM: Intact. LYMPH NODES: Scattered prominent mediastinal lymph nodes. CHEST WALL: No significant abnormality. Incidental left-sided sternalis muscle. ABDOMEN and PELVIS: LIVER: Hepatomegaly and hepatic steatosis. No acute traumatic injury BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix and colon are normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Small left inferior retroperitoneal hematoma along the posterior/inferior pelvic wall associated with pelvic and sacral fractures as described below. No active extravasation. VESSELS: Replaced right hepatic artery arising from the SMA. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is present. No adnexal mass. BODY WALL: Fat-containing umbilical hernia. There is a small amount of adjacent stranding. Small amount of hemorrhage/hematoma is noted within the soft tissues overlying the lateral left hip. MUSCULOSKELETAL: Multiple bilateral rib fractures involving the posterior first rib on the right and the first, second, third, and fifth ribs on the left. Comminuted left sacral fracture extending from the superior aspects to the S4 segment both zone one and zone two. Fractures extend into the left S1 and S2 neural foramen. Redemonstrated superior and inferior left pubic rami fractures with comminution extension to involve the pubic symphysis. The superior and lateral most aspect of the left superior pubic ramus fracture has minimal extension to involve the anterior/medial aspect of the right acetabulum (coronal series 503 image 54). THORACIC: VERTEBRA: Anterior compression fractures involving the superior endplates of T1 and T3. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No acute fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: Tiny minimally displaced fracture of the inferior left facet of L5 associated with the previously described sacral fractures. PREVERTEBRAL SOFT TISSUES: Unremarkable.
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15,974 |
MR Brain wo+w contrast 1/28/2022 12:26 PM Clinical Information: Stroke, follow up ; Headache, intracranial hemorrhage suspected, I61.9 Nontraumatic intracerebral hemorrhage, unspecified Spec Inst: ICH fu Comparison: CT head dated 11/24/2021. Technique: Sagittal T1, axial T2, FLAIR, DWI with ADC map and SWI, postcontrast axial, coronal and sagittal T1. Patient weight: 167 lbs. IV contrast: ProHance, 8 ml, per protocol. Findings: Residual chronic hematoma in the right basal ganglia and corona radiata measures approximately 3.1 cm in AP, 1.4 cm in TR, and 2.4 cm in CC, which contains intra and extracellular methemoglobin contents outlined with hemosiderin staining. Previous perilesional edema has resolved. No underlying hemorrhagic etiology including an enhancing neoplasm or vascular malformation is identified. There is interval Wallerian degeneration along the right corticospinal tract with mild atrophy of the cerebral peduncle. The right lateral ventricle shows mild ex vacuo dilatation. The temporal horn of the left lateral ventricle also shows periependymal hemosiderin staining. There is no new intracranial hemorrhage or cerebral ischemia. Impression: 1. Residual chronic hematoma involving the right basal and coronal radiata. 2. No underlying enhancing tumor or vascular malformation identified. 3. Intraventricular hemosiderin staining in the temporal horn of the left lateral ventricle.
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Findings: Residual chronic hematoma in the right basal ganglia and corona radiata measures approximately 3.1 cm in AP, 1.4 cm in TR, and 2.4 cm in CC, which contains intra and extracellular methemoglobin contents outlined with hemosiderin staining. Previous perilesional edema has resolved. No underlying hemorrhagic etiology including an enhancing neoplasm or vascular malformation is identified. There is interval Wallerian degeneration along the right corticospinal tract with mild atrophy of the cerebral peduncle. The right lateral ventricle shows mild ex vacuo dilatation. The temporal horn of the left lateral ventricle also shows periependymal hemosiderin staining. There is no new intracranial hemorrhage or cerebral ischemia.
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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. Tiny radiopaque fragment along the inferior left orbit. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. Small left frontal hematoma containing multiple radiopaque fragments. FACIAL BONES: No fracture. Bilateral pterygoid plates are intact. MANDIBLE: No fracture. Bilateral temporomandibular joints are intact. Scattered dental caries. SINONASAL CAVITIES: Small mucus retention cyst in the left maxillary sinus. Minimal mucosal thickening of the posterior left maxillary sinus.
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15,975 |
EXAM: MR Enterography CLINICAL INFORMATION: Crohn s disease, K50.90 Crohn s disease, unspecified, without complications COMPARISON: MR enterography dated 3/24/2021 TECHNIQUE: MR Enterography Patient weight: 150 lbs. IV contrast: ProHance, 14 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: Dilated. SMALL BOWEL: Mural thickening, mucosal enhancement, and hypertrophy of adjacent fat involving the terminal ileum, spanning at least 6 cm (coronal T2 image 15, series 601, post contrast coronal image 44, series 902). Immediately distal to to this, there is significant focal, circumferential thickening measuring up to 1.6 cm in length resulting in significant narrowing of the lumen (coronal T2 image 18, series 601). There is severe upstream dilatation of the small bowel, with loops of small bowel in the anterior abdomen measuring up to 6.7 cm in diameter. PERITONEUM / MESENTERY: Normal. COLORECTAL: No abnormal bowel wall thickening or enhancement. APPENDIX: Normal. LIVER: Partially imaged portions are normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. SPLEEN: Partially imaged portions are normal. PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Significant focal thickening/narrowing within the distal ileum spanning a length of up to 1.6 cm with severe upstream dilatation, compatible with a stricture resulting in at least partial small bowel obstruction, probably worsened compared to prior. 2. Inflammation within the terminal ileum distal to this point is compatible with active Crohn's disease. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: 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: Dilated. SMALL BOWEL: Mural thickening, mucosal enhancement, and hypertrophy of adjacent fat involving the terminal ileum, spanning at least 6 cm (coronal T2 image 15, series 601, post contrast coronal image 44, series 902). Immediately distal to to this, there is significant focal, circumferential thickening measuring up to 1.6 cm in length resulting in significant narrowing of the lumen (coronal T2 image 18, series 601). There is severe upstream dilatation of the small bowel, with loops of small bowel in the anterior abdomen measuring up to 6.7 cm in diameter. PERITONEUM / MESENTERY: Normal. COLORECTAL: No abnormal bowel wall thickening or enhancement. APPENDIX: Normal. LIVER: Partially imaged portions are normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. SPLEEN: Partially imaged portions are normal. PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: Mildly 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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15,976 |
MR Breast Screening wo+w contrast CLINICAL INFORMATION: per radiology, D05.11 Intraductal carcinoma in situ of right breast. Patient has a history of right breast DCIS in January 2018 post lumpectomy and radiation TECHNIQUE: T1 axial, FSE T2 fat sat axial, pre and post contrast vibrant sequence with 3D reconstructions. Fast scan. A dedicated 8 channel breast imaging coil was utilized. Patient weight: 125 lbs. IV contrast: ProHance, 12 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: Prior studies with most recent MRI from 2020 FINDINGS: All measurements provided in the format AP, TV, CC dimensions Breast tissue is heterogeneous fibroglandular tissue. Postcontrast administration there is mild background enhancement. RIGHT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. Asymmetric background due to radiation in the right breast LEFT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. Numerous foci and nonmass enhancement similar to priors BILATERAL Internal mammary and axillary nodes unremarkable. EXTRAMAMMARY: There is no suspicious abnormality in the visualized lung fields. Visualized upper abdomen unremarkable. Marrow signal is normal. IMPRESSION: RIGHT BREAST: No MRI evidence of malignancy. BI-RADS 2: Benign LEFT BREAST: No MRI evidence of malignancy. BI-RADS 2: Benign Overall BI-RADS assessment: BI-RADS 2: Benign Patient will be due for mammography in September 2022 and breast MRI in one year
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FINDINGS: All measurements provided in the format AP, TV, CC dimensions Breast tissue is heterogeneous fibroglandular tissue. Postcontrast administration there is mild background enhancement. RIGHT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. Asymmetric background due to radiation in the right breast LEFT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. Numerous foci and nonmass enhancement similar to priors BILATERAL Internal mammary and axillary nodes unremarkable. EXTRAMAMMARY: There is no suspicious abnormality in the visualized lung fields. Visualized upper abdomen unremarkable. Marrow signal is normal.
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central tracheobronchial tree is patent. Mild central bronchial wall thickening. Mild upper lobe predominant centrilobular and paraseptal emphysematous changes. No focal consolidation, pleural effusion, or pneumothorax. HEART / VESSELS: Heart size is normal. Small pericardial effusion. Advanced calcific atherosclerosis in the coronary arteries. Dilatation of the main pulmonary artery, measuring 34 mm in diameter, suggestive of chronic pulmonary arterial hypertension. No central pulmonary embolus. The thoracic aorta is normal in caliber. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Left renal sinus cyst, incompletely visualized. Nodular thickening of the left adrenal gland without discrete lesion identified. Indeterminate attenuation right adrenal nodule measuring 1.8 x 1.4 cm (series 3, image 100). MUSCULOSKELETAL: No aggressive osseous abnormalities identified. Multilevel degenerative changes in the thoracic spine with flowing anterior osteophytosis, suggestive of DISH.
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15,977 |
MRI brain with and without Indication: Brain mass or lesion, G93.9 Disorder of brain, unspecified Spec Inst: stealth. please be sure to include T1 post gad stealth and flair stealth Comparison: 12/27/2021 Technique: Multiple T1 and T2-weighted MR sequence images of the brain were obtained in the sagittal axial and coronal planes pre-and post administration of intravenous contrast per departmental protocol . Patient weight: 156 lbs. IV contrast: ProHance, 15 ml, per protocol. Findings: Redemonstration of the T-2/flair hyperintense lesion involving the left frontal subcortical white matter with small areas of fluid signal intensity in the posterior aspect of the lesion with mild effacement of the adjacent sulci. It measures approximately 2.7 x 2.2 cm. Postcontrast images again focal nodular enhancement within the lesion. There is again T-2/hyperintense lesion involving the subcortical and cortical region of the right middle frontal gyrus, slightly increased in size compared to prior study. No definite contrast enhancement is identified. Remaining brain parenchyma and posterior fossa are within normal limits. There is no hydrocephalus. There is no increased susceptibility on SWI. Impression: 1. Slight interval enlargement of the T-2/flair hyperintense lesion involving the left frontal subcortical lesion involving the underlying white matter with associated focal nodular enhancement, consistent with enlarging tumor. 2. Slight interval decrease in size of subcortical lesion of the right middle frontal gyrus. No new lesion is identified.
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Findings: Redemonstration of the T-2/flair hyperintense lesion involving the left frontal subcortical white matter with small areas of fluid signal intensity in the posterior aspect of the lesion with mild effacement of the adjacent sulci. It measures approximately 2.7 x 2.2 cm. Postcontrast images again focal nodular enhancement within the lesion. There is again T-2/hyperintense lesion involving the subcortical and cortical region of the right middle frontal gyrus, slightly increased in size compared to prior study. No definite contrast enhancement is identified. Remaining brain parenchyma and posterior fossa are within normal limits. There is no hydrocephalus. There is no increased susceptibility on SWI.
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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: No focal consolidation, pleural effusion, or pneumothorax. Central airways are patent. HEART / OTHER VESSELS: Normal heart size. No pericardial effusion. Bovine arch. MEDIASTINUM / ESOPHAGUS: Mildly patulous esophagus. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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15,978 |
MR Cervical Spine wo contrast 1/28/2022 1:22 PM Clinical Information: Evaluation for cervical radiculopathy, status post multilevel laminoplasty. Comparison: Prior MRI from 5/10/2021 Technique: Axial and sagittal T1, axial and sagittal T2, and sagittal STIR sequences were acquired of the cervical spine without the use of intravenous contrast. Findings: The patient is status post multilevel laminoplasty with hardware in place with susceptibility artifacts, resulting in apparent indentation of the posterior lateral spinal cord at C3-4 and C4-5 on left side. There is loss of cervical lordosis with reversal of the curvature. There is interval development of abnormal signal involving the right pedicle, facet joint of the C5, resulting in severe narrowing of the right neural foramen. There is minimal prevertebral soft tissue edema anteriorly. The bone marrow is of normal signal intensity. The visualized portions of the posterior fossa and craniocervical junction appear normal. There is a scattered foci of T2 hyper signal intensity in the middle cervical cord likely foci of the myelomalacia. Degenerative changes of the cervical spine are described on a level by level basis below: C2-C3: There is right paracentral disc protrusion, with indentation on the anterior aspect of the thecal sac and moderate neural foraminal narrowing. C3-C4: There is mild disc bulge with posterior disc protrusion indenting the anterior thecal sac without cord compression. Status post left laminoplasty. There is no significant neural foraminal narrowing. C4-C5: There is central disc bulge with indentation on the anterior aspect of the thecal sac without significant spinal canal or neural foramina narrowing.There is anterior protrusion of laminoplasty hardware, with pressure effect and signal change on posterior aspect of the spinal cord. C5-C6: There is an abnormal signal involving the right pedicle, facet joint of the C5, resulting in severe narrowing of the right neural foramen. Minimal prevertebral soft tissue edema anterior to the C5 vertebral body. Left neural foramen and spinal canal is within normal limits. C6-C7: There is central disc bulge causing indentation of the anterior aspect of thecal sac without significant compression on the spinal cord, there is also bilateral facet arthropathy with mild left neural foraminal narrowing. And mild spinal canal stenosis. C7-T1: There is central disc protrusion with anterior indentation on the thecal sac, there is also bilateral facet arthropathy causing moderate bilateral neural foraminal narrowing. T1-T2: There is diffuse disc bulge with associated moderate facet arthropathy causing mild right neural foramina narrowing without significant spinal canal stenosis. The visualized prevertebral and paravertebral soft tissues are unremarkable. Impression: 1. The patient is status post decompressive laminectomy and multilevel laminoplasty with hardware in place with significant susceptibility artifacts as described above. There is no significant central canal stenosis. Stable focal spinal cord myelomalacia at C3-4 and C4-5 levels. 2. Interval development of abnormal signal involving the right pedicle and facet joint of the C5-6, resulting in severe right neural foramen stenosis. There is minimal increased prevertebral edema at this level. Recommended CT cervical spine to evaluate bone detail set this level. 3. Multinodular goiter with multifocal T2 hyperintense nodules. As the attending 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 is status post multilevel laminoplasty with hardware in place with susceptibility artifacts, resulting in apparent indentation of the posterior lateral spinal cord at C3-4 and C4-5 on left side. There is loss of cervical lordosis with reversal of the curvature. There is interval development of abnormal signal involving the right pedicle, facet joint of the C5, resulting in severe narrowing of the right neural foramen. There is minimal prevertebral soft tissue edema anteriorly. The bone marrow is of normal signal intensity. The visualized portions of the posterior fossa and craniocervical junction appear normal. There is a scattered foci of T2 hyper signal intensity in the middle cervical cord likely foci of the myelomalacia. Degenerative changes of the cervical spine are described on a level by level basis below: C2-C3: There is right paracentral disc protrusion, with indentation on the anterior aspect of the thecal sac and moderate neural foraminal narrowing. C3-C4: There is mild disc bulge with posterior disc protrusion indenting the anterior thecal sac without cord compression. Status post left laminoplasty. There is no significant neural foraminal narrowing. C4-C5: There is central disc bulge with indentation on the anterior aspect of the thecal sac without significant spinal canal or neural foramina narrowing.There is anterior protrusion of laminoplasty hardware, with pressure effect and signal change on posterior aspect of the spinal cord. C5-C6: There is an abnormal signal involving the right pedicle, facet joint of the C5, resulting in severe narrowing of the right neural foramen. Minimal prevertebral soft tissue edema anterior to the C5 vertebral body. Left neural foramen and spinal canal is within normal limits. C6-C7: There is central disc bulge causing indentation of the anterior aspect of thecal sac without significant compression on the spinal cord, there is also bilateral facet arthropathy with mild left neural foraminal narrowing. And mild spinal canal stenosis. C7-T1: There is central disc protrusion with anterior indentation on the thecal sac, there is also bilateral facet arthropathy causing moderate bilateral neural foraminal narrowing. T1-T2: There is diffuse disc bulge with associated moderate facet arthropathy causing mild right neural foramina narrowing without significant spinal canal stenosis. The visualized prevertebral and paravertebral soft tissues are unremarkable.
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FINDINGS: Inner table of the lateral right frontal bone, there is a mixed density hypoattenuating convexity with associated underlying osseous irregularity also involving the greater wing of the sphenoid. This lesion measures 2.9 x 1.1 cm on axial series 204 image 26. There is mild displacement of the right frontal lobe brain parenchyma likely lesion. No midline shift or definite edema. No intraparenchymal hemorrhage. The gray white matter differentiation is maintained. Pineal gland calcifications are noted. Partially empty sella. No extra axial collections. The ventricles are within normal size limits and there is no midline shift. No acute osseous abnormality. Partially visualized right maxillary sinus mucus retention cyst. The remaining paranasal sinuses, middle ears, and mastoid air cells are clear. The orbits are unremarkable. The visualized soft tissues are unremarkable. Lymph Nodes
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15,979 |
EXAM: MR Lumbar Spine wo contrast CLINICAL INFORMATION: Lumbar radiculopathy. COMPARISON: Lumbar spine radiograph dated 12/27/2021. TECHNIQUE: MR Lumbar Spine wo contrast. FINDINGS: No abnormal marrow replacement. No acute displaced fracture or compression deformity. Type I Modic endplate changes at L3-4 and L5-S1. Mild disc height loss and desiccation at L3-L4, L4-L5, and L5-S1. The conus terminates at the superior endplate of L2. T12-L1: No significant disc bulge, spinal canal, or foraminal narrowing. L1-L2: Minimal broad-based disc bulge most pronounced in the foraminal regions with mild associated facet arthropathy resulting in mild bilateral foraminal narrowing. No significant spinal canal narrowing. L2-L3: Mild broad-based disc without significant spinal canal narrowing. Associated mild to moderate facet arthropathy results in mild left and moderate right foraminal narrowing with abutment of the exiting right L2 nerve root anteriorly to the vertebral body/disc osteophyte complex. L3-L4: Posterior projecting disc osteophyte complex with associated moderate facet arthropathy and ligamentum flavum hypertrophy results in moderate spinal canal narrowing. There is moderate bilateral foraminal narrowing with abutment of the nerve roots to the adjacent disc bulge, bilaterally. L4-L5: Grade 1 anterolisthesis of L4 on L5 with associated mild broad-based disc bulge and advanced facet arthropathy results in mild to moderate spinal canal narrowing. This results in moderate bilateral foraminal narrowing without definitive appropriate compression. L5-S1: Mild broad-based disc bulge associated facet arthropathy. No significant spinal canal narrowing. Moderate bilateral foraminal narrowing without definitive neurocompression. No significant soft tissue abnormality. CONCLUSION: Moderate to severe discogenic degenerative changes of the lumbar spine with multilevel moderate spinal canal stenosis and moderate neuroforaminal narrowing at L3-4 and L4-5. Multiple nerve roots abut these degenerative changes without definitive nerve root compression. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: No abnormal marrow replacement. No acute displaced fracture or compression deformity. Type I Modic endplate changes at L3-4 and L5-S1. Mild disc height loss and desiccation at L3-L4, L4-L5, and L5-S1. The conus terminates at the superior endplate of L2. T12-L1: No significant disc bulge, spinal canal, or foraminal narrowing. L1-L2: Minimal broad-based disc bulge most pronounced in the foraminal regions with mild associated facet arthropathy resulting in mild bilateral foraminal narrowing. No significant spinal canal narrowing. L2-L3: Mild broad-based disc without significant spinal canal narrowing. Associated mild to moderate facet arthropathy results in mild left and moderate right foraminal narrowing with abutment of the exiting right L2 nerve root anteriorly to the vertebral body/disc osteophyte complex. L3-L4: Posterior projecting disc osteophyte complex with associated moderate facet arthropathy and ligamentum flavum hypertrophy results in moderate spinal canal narrowing. There is moderate bilateral foraminal narrowing with abutment of the nerve roots to the adjacent disc bulge, bilaterally. L4-L5: Grade 1 anterolisthesis of L4 on L5 with associated mild broad-based disc bulge and advanced facet arthropathy results in mild to moderate spinal canal narrowing. This results in moderate bilateral foraminal narrowing without definitive appropriate compression. L5-S1: Mild broad-based disc bulge associated facet arthropathy. No significant spinal canal narrowing. Moderate bilateral foraminal narrowing without definitive neurocompression. No significant soft tissue abnormality.
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FINDINGS: BONES/JOINTS: Comminuted and minimally displaced left zone one and zone two sacral alar fractures extending into the left L5-S1 facet joint and left S1-S3 neural foramen. Minimally displaced fracture of left L5 inferior articular facet. No evidence of fracture extension to the left SI joint. Bilateral SI joints are maintained with no evidence of diastasis. Minimally displaced fracture of the left pubic acetabular junction slightly extending into the anterior acetabulum. Minimally displaced fracture of the left pubic body extending to the symphysis pubis without significant pubic symphyseal diastasis. Minimally displaced fracture of the left inferior pubic ramus. SOFT TISSUES: Intramuscular hematoma involving the left piriformis muscle and small left retroperitoneal and pelvic sidewall hematomas. No evidence of active extravasation. Left hip soft tissue contusions.
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15,980 |
MR Brain wo+w contrast, MR Perfusion 1/28/2022 1:49 PM Clinical Information: TIA, I66.9 Occlusion and stenosis of unspecified cerebral artery Comparison: MRI of the brain dated 8/20/2021. Technique: Axial T2, 2D EPI PASL perfusion in 18 slices, 3D GRASE pCASL perfusion, and dynamic susceptibility contrast perfusion followed by sagittal 3D SPACE fatsat T1. Patient weight: 130 lbs. IV contrast: ProHance, 12 ml, per protocol. IV contrast injection rate: 4 ml per sec. (accession MR220003715), Patient weight: 132 lbs. IV contrast: ProHance, 6 ml, per protocol. IV contrast injection rate: 4 ml per sec. (accession MR220003706) Findings: The right intracranial ICA shows diffusely attenuated luminal caliber. Mildly engorged pial vessels of the right side brain indicate vasomotor reactivity to compensate reduced cerebral blood flow. Parametric mapping of the DSC perfusion exam was failed due to lack of IV contrast bolus. Both PASL and pCASL perfusion studies are poorly performed and their relCBF maps are unreliable. Impression: Nondiagnostic MR perfusion exams.
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Findings: The right intracranial ICA shows diffusely attenuated luminal caliber. Mildly engorged pial vessels of the right side brain indicate vasomotor reactivity to compensate reduced cerebral blood flow. Parametric mapping of the DSC perfusion exam was failed due to lack of IV contrast bolus. Both PASL and pCASL perfusion studies are poorly performed and their relCBF maps are unreliable.
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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: Subtle hazy groundglass opacities in the left lower lobe. Similar findings are present in the left lower lobe and lingula to a lesser degree. No pneumothorax or pleural effusion. Central airways are patent. Minimal upper lobe paraseptal emphysematous changes. HEART / OTHER VESSELS: Normal heart size. No pericardial effusion. Bovine arch. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous lesions. Mild multilevel discogenic degenerative change of the thoracic spine.
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15,981 |
MR Breast Screening wo+w contrast CLINICAL INFORMATION: High risk, R92.8 Other abnormal and inconclusive findings on diagnostic imaging of breast. TECHNIQUE: T1 axial, FSE T2 fat sat axial, pre and post contrast vibrant sequence with 3D reconstructions and time intensity curves. Delayed post contrast sagittal. A dedicated 8 channel breast imaging coil was utilized. Patient weight: 181 lbs. IV contrast: ProHance, 17 ml, per protocol. IV contrast injection rate: 1.80 ml per sec. COMPARISON: Prior studies including most recent diagnostic imaging from 2021 FINDINGS: All measurements provided in the format AP, TV, CC dimensions Breast tissue is heterogeneous fibroglandular tissue. Postcontrast administration there is minimal background enhancement. RIGHT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. LEFT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. Postbiopsy changes and duct ectasia with T1 hyperintense proteinaceous debris. No suspicious nonmass enhancement or mass at site of signal void (biopsy clip) BILATERAL Scattered bilateral foci are similar in appearance. None stands out from background. These do limit detection of small invasive cancers. Internal mammary nodes are normal. Axillary lymph nodes are normal. EXTRAMAMMARY: There is no suspicious abnormality in the visualized lung fields. Visualized upper abdomen unremarkable. Marrow signal is normal. IMPRESSION: RIGHT BREAST: No MRI evidence of malignancy. BI-RADS 2: Benign LEFT BREAST: No MRI evidence of malignancy. No suspicious enhancement at site of biopsied left breast papilloma. Clinical management recommended. BI-RADS 2: Benign Overall BI-RADS assessment: BI-RADS 2: Benign
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FINDINGS: All measurements provided in the format AP, TV, CC dimensions Breast tissue is heterogeneous fibroglandular tissue. Postcontrast administration there is minimal background enhancement. RIGHT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. LEFT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. Postbiopsy changes and duct ectasia with T1 hyperintense proteinaceous debris. No suspicious nonmass enhancement or mass at site of signal void (biopsy clip) BILATERAL Scattered bilateral foci are similar in appearance. None stands out from background. These do limit detection of small invasive cancers. Internal mammary nodes are normal. Axillary lymph nodes are normal. EXTRAMAMMARY: There is no suspicious abnormality in the visualized lung fields. Visualized upper abdomen unremarkable. Marrow signal is normal.
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FINDINGS: BONES/JOINTS: No acute fracture or malalignment. Redemonstrated trace suprapatellar effusion. No focal aggressive osseous lesion. Minimal degenerative change in the medial femorotibial compartment. SOFT TISSUES: No large hematoma or fluid collection. Minimal atherosclerotic calcification in the popliteal artery.
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15,982 |
RADIOLOGIC EXAM: MR Brain wo+w contrast, MR Orbit wo+w contrast CLINICAL INFORMATION: Headache, new or worsening, Short lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT), not intractable, Ocular pain, unspecified eye. Per chart review, evaluated in Movement Disorders Clinic to have action/posture tremor of bilateral hands and voice. History of stable tremor disorder since 2013, extensive family history of Parkinson's disease, double vision. COMPARISON: Dopamine transporter nuclear medicine study dated 11/7/2012. MRI brain dated 12/11/2009. TECHNIQUE: MR Brain wo+w contrast, MR Orbit wo+w contrast Patient weight: 195 lbs. IV contrast: ProHance, 18 ml, per protocol. Multiplanar, multisequence MRI of the brain and orbits was performed before and after the intravenous administration of contrast. FINDINGS: MRI Brain: INTRACRANIAL FINDINGS: The brain parenchyma appears normal without evidence for acute ischemia, hemorrhage, or mass lesion. The ventricles are normal in size. There is no abnormal extra-axial collection. There is no abnormal parenchymal or leptomeningeal enhancement. Mild, age-appropriate frontoparietal cerebral volume loss. Multifocal periventricular and scattered punctate subcortical/deep cerebral white matter T2/FLAIR hyperintensities, likely mild chronic microangiopathic changes. Bilateral basal ganglia susceptibility artifact, likely physiologic calcifications. Proportionate ex vacuo ventricular dilatation. 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 bilateral anterior ethmoid sinus mucosal thickening. The paranasal sinuses and mastoid air cells are otherwise clear. MRI Orbits: The globes and lenses appear normal. The orbital fat and extraocular muscles appear normal. The optic nerves, chiasm, and tracts are normal in morphology and signal intensity. CONCLUSION: 1. No acute intracranial process. No pathologic enhancement. 2. No acute intraorbital or optic pathway abnormality. No pathologic 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: MRI Brain: INTRACRANIAL FINDINGS: The brain parenchyma appears normal without evidence for acute ischemia, hemorrhage, or mass lesion. The ventricles are normal in size. There is no abnormal extra-axial collection. There is no abnormal parenchymal or leptomeningeal enhancement. Mild, age-appropriate frontoparietal cerebral volume loss. Multifocal periventricular and scattered punctate subcortical/deep cerebral white matter T2/FLAIR hyperintensities, likely mild chronic microangiopathic changes. Bilateral basal ganglia susceptibility artifact, likely physiologic calcifications. Proportionate ex vacuo ventricular dilatation. 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 bilateral anterior ethmoid sinus mucosal thickening. The paranasal sinuses and mastoid air cells are otherwise clear. MRI Orbits: The globes and lenses appear normal. The orbital fat and extraocular muscles appear normal. The optic nerves, chiasm, and tracts are normal in morphology and signal intensity.
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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. Fixation hardware along the left lateral orbital rim from prior trauma. Chronic appearing dehiscence of the left lamina papyracea with minimal herniation of extraconal fat into the ethmoid air cells. No evidence of extraocular muscle herniation. No acute orbital fracture identified. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. FACIAL BONES: Acute, mildly displaced bilateral nasal bone fractures. Tiny minimally displaced fracture of the anterior nasal septum. No significant nasal septal hematoma. Pterygoid plates are intact. Chronic deformity of the left zygomatic process. Fixation hardware in the anterior left maxillary sinus from prior trauma. Numerous dental caries and periapical lucency. MANDIBLE: No fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Small amount of hemorrhage in the nasal cavity. Paranasal sinuses are clear.
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15,983 |
RADIOLOGIC EXAM: MR Brain wo+w contrast, MR Orbit wo+w contrast CLINICAL INFORMATION: Headache, new or worsening, Short lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT), not intractable, Ocular pain, unspecified eye. Per chart review, evaluated in Movement Disorders Clinic to have action/posture tremor of bilateral hands and voice. History of stable tremor disorder since 2013, extensive family history of Parkinson's disease, double vision. COMPARISON: Dopamine transporter nuclear medicine study dated 11/7/2012. MRI brain dated 12/11/2009. TECHNIQUE: MR Brain wo+w contrast, MR Orbit wo+w contrast Patient weight: 195 lbs. IV contrast: ProHance, 18 ml, per protocol. Multiplanar, multisequence MRI of the brain and orbits was performed before and after the intravenous administration of contrast. FINDINGS: MRI Brain: INTRACRANIAL FINDINGS: The brain parenchyma appears normal without evidence for acute ischemia, hemorrhage, or mass lesion. The ventricles are normal in size. There is no abnormal extra-axial collection. There is no abnormal parenchymal or leptomeningeal enhancement. Mild, age-appropriate frontoparietal cerebral volume loss. Multifocal periventricular and scattered punctate subcortical/deep cerebral white matter T2/FLAIR hyperintensities, likely mild chronic microangiopathic changes. Bilateral basal ganglia susceptibility artifact, likely physiologic calcifications. Proportionate ex vacuo ventricular dilatation. 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 bilateral anterior ethmoid sinus mucosal thickening. The paranasal sinuses and mastoid air cells are otherwise clear. MRI Orbits: The globes and lenses appear normal. The orbital fat and extraocular muscles appear normal. The optic nerves, chiasm, and tracts are normal in morphology and signal intensity. CONCLUSION: 1. No acute intracranial process. No pathologic enhancement. 2. No acute intraorbital or optic pathway abnormality. No pathologic 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: MRI Brain: INTRACRANIAL FINDINGS: The brain parenchyma appears normal without evidence for acute ischemia, hemorrhage, or mass lesion. The ventricles are normal in size. There is no abnormal extra-axial collection. There is no abnormal parenchymal or leptomeningeal enhancement. Mild, age-appropriate frontoparietal cerebral volume loss. Multifocal periventricular and scattered punctate subcortical/deep cerebral white matter T2/FLAIR hyperintensities, likely mild chronic microangiopathic changes. Bilateral basal ganglia susceptibility artifact, likely physiologic calcifications. Proportionate ex vacuo ventricular dilatation. 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 bilateral anterior ethmoid sinus mucosal thickening. The paranasal sinuses and mastoid air cells are otherwise clear. MRI Orbits: The globes and lenses appear normal. The orbital fat and extraocular muscles appear normal. The optic nerves, chiasm, and tracts are normal in morphology and signal intensity.
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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. Fixation hardware along the left lateral orbital rim from prior trauma. Chronic appearing dehiscence of the left lamina papyracea with minimal herniation of extraconal fat into the ethmoid air cells. No evidence of extraocular muscle herniation. No acute orbital fracture identified. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. FACIAL BONES: Acute, mildly displaced bilateral nasal bone fractures. Tiny minimally displaced fracture of the anterior nasal septum. No significant nasal septal hematoma. Pterygoid plates are intact. Chronic deformity of the left zygomatic process. Fixation hardware in the anterior left maxillary sinus from prior trauma. Numerous dental caries and periapical lucency. MANDIBLE: No fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Small amount of hemorrhage in the nasal cavity. Paranasal sinuses are clear.
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15,984 |
MR Lumbar Spine wo+w contrast 1/28/2022 2:45 PM CLINICAL INFORMATION: Lumbar radiculopathy, immunocompromised, G95.19 Other vascular myelopathies COMPARISON: None. TECHNIQUE: Axial T1/T2 and sagittal T1/T2/STIR and postcontrast axial and sagittal fat-sat T1-weighted images. Patient weight: 195 lbs. IV contrast: ProHance, 18 ml, per protocol. FINDINGS: Alignment: Mild dextroscoliosis. Normally preserved alignment. Vertebral body: No focal signal abnormality or enhancing lesion. Disc space: Within normal limits. Spinal canal: Capacious. No intradural contrast enhancing abnormality. Neural foramen: Patent. Conus medullaris: Normal. Cauda equina: Normal. No abnormal nerve root enhancement. Facet joint: No degenerative pathology. Paraspinal muscles: Diffuse fatty atrophy. IMPRESSION: Unremarkable MRI of the lumbar spine.
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FINDINGS: Alignment: Mild dextroscoliosis. Normally preserved alignment. Vertebral body: No focal signal abnormality or enhancing lesion. Disc space: Within normal limits. Spinal canal: Capacious. No intradural contrast enhancing abnormality. Neural foramen: Patent. Conus medullaris: Normal. Cauda equina: Normal. No abnormal nerve root enhancement. Facet joint: No degenerative pathology. Paraspinal muscles: Diffuse fatty atrophy.
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FINDINGS: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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15,985 |
EXAM: MR Brain wo+w contrast CLINICAL INFORMATION: Extrapyramidal movement disorder, fasciculations. COMPARISON: None. TECHNIQUE: MR Brain wo+w contrast. Patient weight: 256 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 0.50 ml per sec. FINDINGS: No abnormal restricted diffusion. No significant abnormal T2 or FLAIR signal. The ventricles are normal in size without midline shift. Basal cisterns are maintained. Expected vascular flow voids are unremarkable. The midline structures are unremarkable. No tonsillar ectopia or other herniation. Expected decreased signal intensity involving the red nuclei and substantia nigra on gradient echo sequence. No other significant susceptibility signal dropout. No extra-axial collection. No abnormal marrow signal. Trace bilateral mastoid effusions. The orbits and globes are unremarkable. Subcutaneous cyst in the posterior neck soft tissues. CONCLUSION: 1. No acute intracranial abnormality. 2. Moderate periodontoid soft tissue density, resulting in moderate narrowing of the craniocervical junction. No definite abnormal signal is identified in the spinal cord. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: No abnormal restricted diffusion. No significant abnormal T2 or FLAIR signal. The ventricles are normal in size without midline shift. Basal cisterns are maintained. Expected vascular flow voids are unremarkable. The midline structures are unremarkable. No tonsillar ectopia or other herniation. Expected decreased signal intensity involving the red nuclei and substantia nigra on gradient echo sequence. No other significant susceptibility signal dropout. No extra-axial collection. No abnormal marrow signal. Trace bilateral mastoid effusions. The orbits and globes are unremarkable. Subcutaneous cyst in the posterior neck soft tissues.
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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. Unchanged mild cerebellar tonsillar ectopia. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. Interval stapling and healing changes of the large left parietal scalp laceration with trace residual subcutaneous gas. Metallic fragments in the left zygomatic and temporal soft tissues, unchanged. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Paranasal sinuses are clear. VESSELS: Normal noncontrast appearance of the vessels.
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15,986 |
MR Rsh Forero ACRIN Breast F111216002 CLINICAL INFORMATION: MR2, C50.919 Malignant neoplasm of unspecified site of unspecified female breast Spec Inst: bill to insurance. Patient has a history of invasive mammary carcinoma and ipsilateral axillary metastasis. She is undergoing neoadjuvant chemotherapy and the study is performed to assess response TECHNIQUE: T1 axial, FSE T2 fat sat axial, pre and post contrast vibrant sequence with 3D reconstructions and time intensity curves. Delayed post contrast axials. A dedicated 8 channel breast imaging coil was utilized. COMPARISON: Prior studies including most recent breast MRI from 12/27/2021 FINDINGS: All measurements provided in the format AP, TV, CC dimensions Breast tissue is scattered fibroglandular tissue. Postcontrast administration there is minimal background enhancement. RIGHT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. LEFT BREAST: Left breast clumped segmental nonmass enhancement upper outer quadrant anterior depth measures 40 x 12 mm, previously 43 x 16 mm. Signal void within site is biopsy clip. This is biopsy-proven invasive mammary carcinoma. There is been interval decrease in size. Mass is seen on series 700 image 1266 BILATERAL Internal mammary nodes are normal. Interval decrease in size of bulky left axillary adenopathy with the largest lymph node currently measuring 51 x 30 mm, previously 68 x 45 mm on series 3 image 35. Additional lymphadenopathy also appears decreased in size compared to prior EXTRAMAMMARY: Liver lesion previously seen on prior DWI imaging is again seen in the left hepatic lobe.. IMPRESSION: RIGHT BREAST: No MRI evidence of malignancy.: BI-RADS 1: Negative LEFT BREAST: Interval decrease in size of clumped nonmass enhancement in the left breast upper outer quadrant anterior depth consistent with partial response to therapy. BI-RADS 6: Biopsy-proven malignancy. Surgical excision when clinically appropriate Interval decrease in size in large axillary nodal metastasis consistent with partial response to therapy: Again noted is a small left hepatic lobe lesion which is indeterminant and only seen on DWI. Dedicated liver imaging is recommended Overall BI-RADS assessment: BI-RADS 6
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FINDINGS: All measurements provided in the format AP, TV, CC dimensions Breast tissue is scattered fibroglandular tissue. Postcontrast administration there is minimal background enhancement. RIGHT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. LEFT BREAST: Left breast clumped segmental nonmass enhancement upper outer quadrant anterior depth measures 40 x 12 mm, previously 43 x 16 mm. Signal void within site is biopsy clip. This is biopsy-proven invasive mammary carcinoma. There is been interval decrease in size. Mass is seen on series 700 image 1266 BILATERAL Internal mammary nodes are normal. Interval decrease in size of bulky left axillary adenopathy with the largest lymph node currently measuring 51 x 30 mm, previously 68 x 45 mm on series 3 image 35. Additional lymphadenopathy also appears decreased in size compared to prior EXTRAMAMMARY: Liver lesion previously seen on prior DWI imaging is again seen in the left hepatic lobe..
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Right middle lobe pulmonary nodule measuring 2 mm on axial series 201 image 23, unchanged. Dependent atelectasis at the bilateral bases. No pleural effusion. DISTAL ESOPHAGUS: Small hiatal hernia. HEART / VESSELS: Coronary vascular calcifications. ABDOMEN and PELVIS: LIVER: Cirrhotic liver No enhancing lesion. BILIARY TRACT: Interval insertion of a PTC drain with its distal pigtail terminating within the jejunum via a hepaticojejunostomy. Associated left lobe predominant pneumobilia, unchanged from prior. There is mild associated intrahepatic duct dilatation. GALLBLADDER: Absent. PANCREAS: Unchanged pancreatic tail cystic lesion. SPLEEN: Unchanged hypoattenuating lesion in the superior aspect of the spleen. ADRENALS: Normal. KIDNEYS: Scattered simple renal cysts. LYMPH NODES: Prominent periportal lymph nodes are unchanged. STOMACH / SMALL BOWEL: Postsurgical changes of hepaticojejunostomy. Small bowel anastomosis in the anterior midabdomen. Otherwise the stomach and small bowel are normal. COLON / APPENDIX: The appendix and colon are unremarkable aside from diverticulosis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered vascular calcifications. Fusiform dilation of the celiac trunk is redemonstrated with an internal calcification. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The prostate is enlarged. BODY WALL: Umbilical hernia containing fat and a tiny portion of small bowel. Fat-containing ventral hernia more superiorly. MUSCULOSKELETAL: Advanced lower lumbar spine discogenic degenerative change with grade 1 anterolisthesis of L4 on L5 and advanced lower lumbar spine facet arthropathy. Stable sclerotic lesion in the left 5th rib.
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15,987 |
EXAM: MR Pelvis wo+w contrast CLINICAL INFORMATION: Anal Squamous Cell Carcinoma, C21.0 Malignant neoplasm of anus, unspecified Spec Inst: Cancer Staging COMPARISON: Outside PET/CT dated 11/17/2021 TECHNIQUE: MR Pelvis wo+w contrast Patient weight: 230 lbs. IV contrast: ProHance, 10 ml, per protocol. IV contrast injection rate: 0.50 ml per sec. FINDINGS: STRUCTURED REPORT: MRI Pelvis LOWER ABDOMEN: BOWEL: No abnormality. PERITONEUM: Normal. OTHER: No other abnormality. PELVIS: VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Enhancing lesion involving the right gluteal cleft which appears contiguous with the anal canal and demonstrates restricted diffusion on image 23, series 101 where it measures up to 1.8 x 1.0 cm. There is a thin area of signal posterior to this which measures 9 mm, unclear if this is related to this lesion or demonstrate signal in the cleft as is seen on other images in this area. Additional anal and adjacent structures are not obviously involved, without evidence of additional mass lesion, abnormal enhancement, restricted diffusion. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Small soft tissue nodule involving the right gluteal cleft soft tissues demonstrates postcontrast enhancement, restricted diffusion, concerning for possible recurrent disease. This lesion appears contiguous with the anal canal however no definite lesion is visualized within the anal canal itself. No additional adjacent structures appear involved. There is no evidence of metastatic disease throughout the imaged pelvis. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: MRI Pelvis LOWER ABDOMEN: BOWEL: No abnormality. PERITONEUM: Normal. OTHER: No other abnormality. PELVIS: VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Enhancing lesion involving the right gluteal cleft which appears contiguous with the anal canal and demonstrates restricted diffusion on image 23, series 101 where it measures up to 1.8 x 1.0 cm. There is a thin area of signal posterior to this which measures 9 mm, unclear if this is related to this lesion or demonstrate signal in the cleft as is seen on other images in this area. Additional anal and adjacent structures are not obviously involved, without evidence of additional mass lesion, abnormal enhancement, restricted diffusion. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: STRUCTURED REPORT: CT Abdomen LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Mild stranding surrounding the uncinate process of the pancreas. SPLEEN: Splenomegaly ADRENALS: Normal. KIDNEYS: Hypodense lesion in the upper pole of the right kidney likely simple cyst. LYMPH NODES: Prominent central mesenteric lymph nodes. STOMACH / SMALL BOWEL: No abnormality. COLON/APPENDIX: No abnormality. PERITONEUM / MESENTERY: Mild increased attenuation in the central mesentery with associated prominent nodes. RETROPERITONEUM: Normal. VESSELS: Scattered vascular calcifications. BODY WALL: Fat-containing inguinal hernias. Scattered hyperattenuating nodules throughout the anterior abdominal wall which may be related to injection granulomas. MUSCULOSKELETAL: Mild multilevel discogenic degenerative change.
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15,988 |
MR Brain wo+w contrast, MR Perfusion 1/28/2022 1:49 PM Clinical Information: TIA, I66.9 Occlusion and stenosis of unspecified cerebral artery Comparison: MRI of the brain dated 8/20/2021. Technique: Axial T2, 2D EPI PASL perfusion in 18 slices, 3D GRASE pCASL perfusion, and dynamic susceptibility contrast perfusion followed by sagittal 3D SPACE fatsat T1. Patient weight: 130 lbs. IV contrast: ProHance, 12 ml, per protocol. IV contrast injection rate: 4 ml per sec. (accession MR220003715), Patient weight: 132 lbs. IV contrast: ProHance, 6 ml, per protocol. IV contrast injection rate: 4 ml per sec. (accession MR220003706) Findings: The right intracranial ICA shows diffusely attenuated luminal caliber. Mildly engorged pial vessels of the right side brain indicate vasomotor reactivity to compensate reduced cerebral blood flow. Parametric mapping of the DSC perfusion exam was failed due to lack of IV contrast bolus. Both PASL and pCASL perfusion studies are poorly performed and their relCBF maps are unreliable. Impression: Nondiagnostic MR perfusion exams.
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Findings: The right intracranial ICA shows diffusely attenuated luminal caliber. Mildly engorged pial vessels of the right side brain indicate vasomotor reactivity to compensate reduced cerebral blood flow. Parametric mapping of the DSC perfusion exam was failed due to lack of IV contrast bolus. Both PASL and pCASL perfusion studies are poorly performed and their relCBF maps are unreliable.
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Findings: Right frontal approach ventriculostomy catheter is again noted with surgical material underlying the burr hole along the right frontal convexity with pneumocephalus. The ventricles have further mildly increased in size with periventricular hypoattenuation. Heterogeneous slightly hyperdense lesion along the right frontal lobe and bilateral cerebellar hemispheres with associated edema are unchanged. There is associated prominent vasogenic edema with effacement of the fourth ventricle and some crowding at the foramen magnum. There is small amount of dependent subdural hemorrhage along the posterior falx near the vertex. The visualized paranasal sinuses and mastoid air cells are clear.
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15,989 |
MR Breast Diagnostic Bil wo+w contrast CLINICAL INFORMATION: breats cyst, left, N63.20 Unspecified lump in the left breast, unspecified quadrant, Z85.43 Personal history of malignant neoplasm of ovary, N60.19 Diffuse cystic mastopathy of unspecified breast. TECHNIQUE: T1 axial, FSE T2 fat sat axial, pre and post contrast vibrant sequence with 3D reconstructions and time intensity curves. Delayed post contrast axials. A dedicated 8 channel breast imaging coil was utilized. Patient weight: 156 lbs. IV contrast: ProHance, 15 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: Prior studies with the most recent from 2021 FINDINGS: All measurements provided in the format AP, TV, CC dimensions Breast tissue is scattered fibroglandular tissue. Postcontrast administration there is minimal background enhancement. RIGHT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. LEFT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. BILATERAL Internal mammary and axillary nodes are unremarkable. EXTRAMAMMARY: Large left thyroid nodule again noted. Otherwise unremarkable IMPRESSION: RIGHT BREAST: No MRI evidence of malignancy.: BI-RADS 1: Negative LEFT BREAST: No MRI evidence of malignancy.: BI-RADS 1: Negative Overall BI-RADS assessment: BI-RADS 1: Negative
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FINDINGS: All measurements provided in the format AP, TV, CC dimensions Breast tissue is scattered fibroglandular tissue. Postcontrast administration there is minimal background enhancement. RIGHT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. LEFT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. BILATERAL Internal mammary and axillary nodes are unremarkable. EXTRAMAMMARY: Large left thyroid nodule again noted. Otherwise unremarkable
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FINDINGS: BONES/JOINTS: Mildly displaced and impacted comminuted distal femoral metaphyseal fracture with intra-articular extension to the intercondylar notch and lateral femoral condyle. Several small intra-articular fracture fragments are present within the lateral tibiofemoral joint space. SOFT TISSUES: Trace lipohemarthrosis and soft tissue contusions about the knee.
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15,990 |
EXAM: CV MR Cardiac w contrast, CV MR for Velocity Flow PATIENT DATA Date of Study: 1/28/2022 1:59 PM Referring MD: Efstathia Andrikopoulou Height: 157 cm. Patient weight: 68 kg. BSA: 1.72208 Blood Pressure: 125/80 Heart Rate: 67 bpm. EGFR 60. The patient's creatinine was .8 on 11-03-2021. The patient received 13 cc's of gadavist at a rate of 2 ml per second without immediate complication. CLINICAL INFORMATION: Patient studied for evaluation of: myocarditis, I51.4 Myocarditis, unspecified History: 6 year old woman with past medical history of coronary artery disease, HTN, HLD, obesity, COPD, aortic insufficiency. COMPARISON: CMR 1/6/2020 TECHNIQUE: CV MR Cardiac w contrast, CV MR for Velocity Flow. Height: 157 cm. Patient weight: 68 kg. BSA: 1.72208 Blood Pressure: 125/80 Heart Rate: 67 bpm. FINDINGS: IMAGING DATA Imaging System: GE 1.5T Overall Image Quality: Excellent CARDIAC MORPHOLOGY AND VENTRICULAR FUNCTION Views: Axial Two chamber Four chamber Short axis LV LVOT Ascending aorta RVOT Short T2, phase contrast flow velocity mapping, perfusion delayed enhancement Sequences: FSE 2IR FSE 3IR SSFP FGRE ET Additional views: General: ECG gated: yes MEASUREMENTS: in millimeters Left Atrium: 28 LV End Diastolic Dimension: 43 LV End Systolic Dimension: 24 LV Posterior Wall: 11 Right Atrium 44 RV End Diastolic Dimension: 35 Interventricular Septum: 11 Left Ventricle (short axis): Volumes in mL, index in mL per square meter End Diastolic Volume: 92 ED index=55 End Systolic Volume: 36 ES index=21 Stroke Volume:56 SV index=34 Ejection Fraction: 61% Morphology: There is normal left ventricular size and function with normal wall motion. There is normal resting first pass gadolinium perfusion. There is no abnormal late gadolinium enhancement. Triple IR weighted images appear normal. Right Ventricle (short axis): Volumes in mL, index in mL per square meter End Diastolic Volume: 102 ED index=61 End Systolic Volume: 53 ES index=31 Stroke Volume: 49 SV index=30 Ejection Fraction: 49% Morphology: The right ventricle appears normal in size. Pericardium: Thickness: 2mm (1-3 mm) Effusion: none Pleural: There is no pleural effusion VALVULAR MORPHOLOGY Valve: Mitral: No significant stenosis or regurgitation. Aortic: There is a central regurgitant jet which appears mild to moderate. Regurgitation: Fraction: Stenosis: Tricuspid: No significant stenosis or regurgitation. Pulmonary: No significant stenosis or regurgitation. Atria: Both atria appear normal in size. The interatrial septum appears intact but aneurysmal. There are four pulmonary veins draining in to the left atria. The coronary sinus appears normal in size. The visualized portions of the thoracic aorta appear normal. Vessel dimensions: (In mm normal range dimensions mm) Main Pulmonary Artery 35 Aortic Root 27 Aortic Arch 25 [18-37] Right Pulmonary Artery 22 Ascending Aorta 31 [19-37] Left Pulmonary Artery 20 Inferior Vena Cava 30 Descending Aorta 22 [16-29] INCIDENTAL FINDINGS: none CONCLUSION: 1. There is normal left and right ventricular size and function. 2. There is mild to moderate aortic insufficiency. 3. The pulmonary artery is mildly dilated at 34x32mm 4. There is no evidence of LGE 5. Compared to prior CMR 1/2020, there is no significant change Cardiac MRI Technologist: Cathy Gunn As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: IMAGING DATA Imaging System: GE 1.5T Overall Image Quality: Excellent CARDIAC MORPHOLOGY AND VENTRICULAR FUNCTION Views: Axial Two chamber Four chamber Short axis LV LVOT Ascending aorta RVOT Short T2, phase contrast flow velocity mapping, perfusion delayed enhancement Sequences: FSE 2IR FSE 3IR SSFP FGRE ET Additional views: General: ECG gated: yes MEASUREMENTS: in millimeters Left Atrium: 28 LV End Diastolic Dimension: 43 LV End Systolic Dimension: 24 LV Posterior Wall: 11 Right Atrium 44 RV End Diastolic Dimension: 35 Interventricular Septum: 11 Left Ventricle (short axis): Volumes in mL, index in mL per square meter End Diastolic Volume: 92 ED index=55 End Systolic Volume: 36 ES index=21 Stroke Volume:56 SV index=34 Ejection Fraction: 61% Morphology: There is normal left ventricular size and function with normal wall motion. There is normal resting first pass gadolinium perfusion. There is no abnormal late gadolinium enhancement. Triple IR weighted images appear normal. Right Ventricle (short axis): Volumes in mL, index in mL per square meter End Diastolic Volume: 102 ED index=61 End Systolic Volume: 53 ES index=31 Stroke Volume: 49 SV index=30 Ejection Fraction: 49% Morphology: The right ventricle appears normal in size. Pericardium: Thickness: 2mm (1-3 mm) Effusion: none Pleural: There is no pleural effusion VALVULAR MORPHOLOGY Valve: Mitral: No significant stenosis or regurgitation. Aortic: There is a central regurgitant jet which appears mild to moderate. Regurgitation: Fraction: Stenosis: Tricuspid: No significant stenosis or regurgitation. Pulmonary: No significant stenosis or regurgitation. Atria: Both atria appear normal in size. The interatrial septum appears intact but aneurysmal. There are four pulmonary veins draining in to the left atria. The coronary sinus appears normal in size. The visualized portions of the thoracic aorta appear normal. Vessel dimensions: (In mm normal range dimensions mm) Main Pulmonary Artery 35 Aortic Root 27 Aortic Arch 25 [18-37] Right Pulmonary Artery 22 Ascending Aorta 31 [19-37] Left Pulmonary Artery 20 Inferior Vena Cava 30 Descending Aorta 22 [16-29] INCIDENTAL FINDINGS: none
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FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Centrilobular and paraseptal emphysema with an apical predominance. HEART / VESSELS: Coronary calcifications. Atheromatous disease involving the left subclavian artery. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Likely tiny gallstone near the gallbladder neck. PANCREAS: Small region of focal hypoenhancement in the tail the pancreas measuring 1.9 x 1.1 cm on axial series 201 image 270. SPLEEN: Normal. ADRENALS: Small 11 mm left adrenal nodule is indeterminate. KIDNEYS: Incidentally noted hypoattenuating lesion at the inferior aspect of the right kidney is indeterminate. Other scattered simple cysts are noted. Small nonobstructing left intrarenal calculi. LYMPH NODES: Scattered prominent mesenteric lymph nodes although none pathologically enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is normal. Scattered diverticulosis of the colon without evidence of diverticulitis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Extensive vascular calcifications. Mild infrarenal aortic ectasia measuring up to 2.5 cm URINARY BLADDER: Hyperdense fluid within the bladder. REPRODUCTIVE ORGANS: The prostate is enlarged. BODY WALL: Small fat-containing inguinal hernias. Fat-containing umbilical hernia. MUSCULOSKELETAL: Partially visualized proximal right humeral enchondroma. Degenerative changes of the thoracolumbar spine, most pronounced at L4-L5 where there is disc space narrowing, uncovertebral spurring, and facet hypertrophy with resultant mild neural foraminal narrowing.
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15,991 |
MR Lumbar Spine wo contrast 1/28/2022 8:10 PM Clinical information: RLE weakness and pain Comparison: None available. Technique: Sagittal T1, T2, STIR, axial T1 and T2. Findings: Lumbar intervertebral alignment is maintained. There are no malignant appearing bone marrow signal changes conus terminates at the level of lower endplate of L1. Multilevel degenerative changes will be described on a level by level basis. L1-L2: No significant disc herniation or spinal canal narrowing. Mild right neural from narrowing secondary to facet DJD. L2-L3: No significant disc herniation. There is moderate to severe bilateral facet DJD and ligamentum flavum hypertrophy resulting in moderate bilateral neural foramen narrowing. L3-L4: There is circumferential disc bulge, bilateral severe facet DJD and ligamentum flavum hypertrophy resulting in severe spinal canal stenosis with crowding of the cauda equina. There is severe right and moderate left neural foramen narrowing, contacting the exiting right L3 nerve root. There is narrowing of bilateral lateral recesses as well contacting the transiting L4 nerve roots. L4-L5: Circumferential disc bulge, severe facet DJD and ligamentum flavum hypertrophy results in severe spinal canal stenosis with compression of the cauda equina. There is fluid in the right L4-L5 facet. There is severe bilateral neural foramen narrowing right greater than left with compression of the exiting right L4 nerve root. L5-S1: Circumferential disc bulge, severe bilateral facet DJD resulting in moderate spinal canal stenosis. There is no significant neural foramen narrowing. There is edema surrounding the right L4-L5 facet joint and dependent edema in the lower subcutaneous soft tissues and left paraspinal musculature. Impression: Multilevel advanced degenerative changes of the lumbar spine as detailed above with severe spinal canal stenosis from L3 to L5 with crowding/compression of the cauda equina at L3-L4 and L4-L5. Multilevel neural foramen narrowing as above. Facet arthropathy is most severe at L4-L5 on the right with associated joint effusion and surrounding edema.
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Findings: Lumbar intervertebral alignment is maintained. There are no malignant appearing bone marrow signal changes conus terminates at the level of lower endplate of L1. Multilevel degenerative changes will be described on a level by level basis. L1-L2: No significant disc herniation or spinal canal narrowing. Mild right neural from narrowing secondary to facet DJD. L2-L3: No significant disc herniation. There is moderate to severe bilateral facet DJD and ligamentum flavum hypertrophy resulting in moderate bilateral neural foramen narrowing. L3-L4: There is circumferential disc bulge, bilateral severe facet DJD and ligamentum flavum hypertrophy resulting in severe spinal canal stenosis with crowding of the cauda equina. There is severe right and moderate left neural foramen narrowing, contacting the exiting right L3 nerve root. There is narrowing of bilateral lateral recesses as well contacting the transiting L4 nerve roots. L4-L5: Circumferential disc bulge, severe facet DJD and ligamentum flavum hypertrophy results in severe spinal canal stenosis with compression of the cauda equina. There is fluid in the right L4-L5 facet. There is severe bilateral neural foramen narrowing right greater than left with compression of the exiting right L4 nerve root. L5-S1: Circumferential disc bulge, severe bilateral facet DJD resulting in moderate spinal canal stenosis. There is no significant neural foramen narrowing. There is edema surrounding the right L4-L5 facet joint and dependent edema in the lower subcutaneous soft tissues and left paraspinal musculature.
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FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Centrilobular and paraseptal emphysema with an apical predominance. HEART / VESSELS: Coronary calcifications. Atheromatous disease involving the left subclavian artery. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Likely tiny gallstone near the gallbladder neck. PANCREAS: Small region of focal hypoenhancement in the tail the pancreas measuring 1.9 x 1.1 cm on axial series 201 image 270. SPLEEN: Normal. ADRENALS: Small 11 mm left adrenal nodule is indeterminate. KIDNEYS: Incidentally noted hypoattenuating lesion at the inferior aspect of the right kidney is indeterminate. Other scattered simple cysts are noted. Small nonobstructing left intrarenal calculi. LYMPH NODES: Scattered prominent mesenteric lymph nodes although none pathologically enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is normal. Scattered diverticulosis of the colon without evidence of diverticulitis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Extensive vascular calcifications. Mild infrarenal aortic ectasia measuring up to 2.5 cm URINARY BLADDER: Hyperdense fluid within the bladder. REPRODUCTIVE ORGANS: The prostate is enlarged. BODY WALL: Small fat-containing inguinal hernias. Fat-containing umbilical hernia. MUSCULOSKELETAL: Partially visualized proximal right humeral enchondroma. Degenerative changes of the thoracolumbar spine, most pronounced at L4-L5 where there is disc space narrowing, uncovertebral spurring, and facet hypertrophy with resultant mild neural foraminal narrowing.
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15,992 |
MR Brain wo contrast 1/28/2022 2:16 PM Clinical Information: Evaluation for ataxia Comparison: MRI brain dated 11/2/2028 Technique: Diffusion weighted series, sagittal T1, axial FLAIR, and axial T2 sequences were acquired of the brain without the use of intravenous contrast. Findings: There are scattered foci of FLAIR hyper signal intensity in deep white matter of bilateral centrum semiovale, unchanged since prior study. Posterior fossa is within normal limits. No intracranial mass, mass effect, edema, hemorrhage, hydrocephalus, or evidence of acute infarction is seen. Evidence of partial empty sella is noted. The visualized paranasal sinuses and mastoid air cells are clear. Mucous retention cyst in right maxillary sinus is noted. No acute osseous or soft tissue abnormality. Impression: No acute intracranial abnormality. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: There are scattered foci of FLAIR hyper signal intensity in deep white matter of bilateral centrum semiovale, unchanged since prior study. Posterior fossa is within normal limits. No intracranial mass, mass effect, edema, hemorrhage, hydrocephalus, or evidence of acute infarction is seen. Evidence of partial empty sella is noted. The visualized paranasal sinuses and mastoid air cells are clear. Mucous retention cyst in right maxillary sinus is noted. No acute osseous or soft tissue abnormality.
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Findings: The unenhanced images demonstrate no acute infarction, hemorrhage or hydrocephalus. There is no vasogenic edema or mass effect. The visualized paranasal sinuses and mastoid air cells are clear. Delayed postcontrast images demonstrate no abnormal parenchymal or meningeal enhancement. CT angiogram demonstrates a stable 2 mm outpouching from the right P1 PCA segment projecting superiorly. There is no flow-limiting stenosis or large arterial occlusion. The remaining visualized portions of the ACA, MCA, and PCA territories demonstrate no focal aneurysm or stenosis.
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15,993 |
Clinical Information: Evaluation for multiple sclerosis Comparison: Brain MR dated 1/28/2022 Technique: Axial and sagittal T1, axial and sagittal T2, and sagittal STIR sequences were acquired of the cervical spine, with and without the use of intravenous contrast. Findings: Moderate straightening of cervical lordosis noted. The bone marrow is of normal signal intensity. The visualized portions of the posterior fossa and craniocervical junction appear normal. There are patchy areas of T2 hyper signal intensity in the cervical cord at C2-3, C3-4, and C6-7 levels, predominantly involving the right hemicord/posterior columns, secondary to multiple sclerosis, after contrast injection no significant enhancement is seen in the mentioned lesions. Degenerative changes of the cervical spine are described on a level by level basis below: C2-C3: There is diffuse disc bulge with associated bilateral mild facet arthropathy, without significant spinal canal or neural foraminal narrowing. C3-C4: There is diffuse disc bulge, with associated bilateral facet arthropathy, without significant spinal canal or neural foramina narrowing. C4-C5: There is left paracentral disc protrusion which indentation of posterior aspect of thecal sac and mild cord compression. There is also moderate right neural foraminal narrowing. C5-C6: There is diffuse disc bulge with mild anterior cord compression and spinal canal narrowing. There is also mild left moderate right neural foraminal narrowing C6-C7: There is diffuse disc bulge with indentation on the anterior aspect of thecal sac there is also evidence of bilateral facet flava hypertrophy, without significant spinal canal or neural foraminal narrowing. C7-T1: There is no evidence of spinal canal or neural foramina narrowing. The visualized prevertebral and paravertebral soft tissues are unremarkable. Impression: 1. Multifocal multiple sclerosis plaques involving the cervical spinal cord as described above, without significant enhancement after contrast injection to suggest active disease.. 2. Degenerative changes as disc bulge and facet arthropathy, most prominent at C4-C5 and C5-C6 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: Moderate straightening of cervical lordosis noted. The bone marrow is of normal signal intensity. The visualized portions of the posterior fossa and craniocervical junction appear normal. There are patchy areas of T2 hyper signal intensity in the cervical cord at C2-3, C3-4, and C6-7 levels, predominantly involving the right hemicord/posterior columns, secondary to multiple sclerosis, after contrast injection no significant enhancement is seen in the mentioned lesions. Degenerative changes of the cervical spine are described on a level by level basis below: C2-C3: There is diffuse disc bulge with associated bilateral mild facet arthropathy, without significant spinal canal or neural foraminal narrowing. C3-C4: There is diffuse disc bulge, with associated bilateral facet arthropathy, without significant spinal canal or neural foramina narrowing. C4-C5: There is left paracentral disc protrusion which indentation of posterior aspect of thecal sac and mild cord compression. There is also moderate right neural foraminal narrowing. C5-C6: There is diffuse disc bulge with mild anterior cord compression and spinal canal narrowing. There is also mild left moderate right neural foraminal narrowing C6-C7: There is diffuse disc bulge with indentation on the anterior aspect of thecal sac there is also evidence of bilateral facet flava hypertrophy, without significant spinal canal or neural foraminal narrowing. C7-T1: There is no evidence of spinal canal or neural foramina narrowing. The visualized prevertebral and paravertebral soft tissues are unremarkable.
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FINDINGS: BONES/JOINTS: There are bilateral sacral alar fractures. The fracture involves the first and second sacral neural foramina on the left. There is also suggestion of involvement of the first and second sacral neural foramina but evaluation is limited secondary to osteopenia. Fractures are relatively vertically oriented. There is no extension across the sacroiliac joints. There is very mild presacral soft tissue swelling. There is also asymmetric enlargement of the right iliacus. There is however no definite increased attenuation muscle There is partial ankylosis of both sacroiliac joints. There is a fracture of the left L5 transverse process. There is no additional fracture of the pelvis. Both femoral heads are well-seated within the acetabulum. . There are mild degenerative changes of both hip joints. The pubic symphysis is normally positioned. There are bilateral pars defects at L5. There is grade 1 L5-S1 spondylolisthesis. There is mild facet arthropathy at L3-L4, L4-L5 and L5-S1. SOFT TISSUES: No large hematoma or fluid collection.
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15,994 |
EXAM: MR Brain wo+w contrast CLINICAL INFORMATION: Multiple sclerosis. COMPARISON: None. TECHNIQUE: MR Brain wo+w contrast. Patient weight: 266 lbs. IV contrast: ProHance, 20 ml, per protocol. FINDINGS: No abnormal restricted diffusion. There is T2/flair hyperintense signal along the callososeptal margin and hyperintense lesions in the inferior margin of the corpus callosum as well as multifocal periventricular and subcortical hyperintense signal. The left periventricular lesions appear perpendicular to the ventricular margins. These do not show associated corresponding foci of contrast enhancement. The ventricles are normal in size without midline shift. Basal cisterns are maintained. Expected vascular flow voids are unremarkable. The midline structures are unremarkable. No tonsillar ectopia or other herniation. No extra-axial collection. No abnormal marrow signal. The middle ears, mastoid air cells, and paranasal sinuses are clear. The orbits and globes are unremarkable. No significant soft tissue abnormality. CONCLUSION: Bilateral periventricular and subcortical white matter T-2/flair hyperintensities, consistent with with multiple sclerosis plaques, no associated regions of enhancement to suggest active demyelination. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: No abnormal restricted diffusion. There is T2/flair hyperintense signal along the callososeptal margin and hyperintense lesions in the inferior margin of the corpus callosum as well as multifocal periventricular and subcortical hyperintense signal. The left periventricular lesions appear perpendicular to the ventricular margins. These do not show associated corresponding foci of contrast enhancement. The ventricles are normal in size without midline shift. Basal cisterns are maintained. Expected vascular flow voids are unremarkable. The midline structures are unremarkable. No tonsillar ectopia or other herniation. No extra-axial collection. No abnormal marrow signal. The middle ears, mastoid air cells, and paranasal sinuses are clear. The orbits and globes are unremarkable. No significant soft tissue 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. Mild diffuse parenchymal volume loss. Periventricular and subcortical white matter hypoattenuation presumably chronic microangiopathic changes. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Chronic defects in the posterior parietal calvarium consistent with parietal foramina. Bilateral mastoid air cells are clear. VENTRICULAR SYSTEM: Normal. ORBITS: Right phthisis bulbi. Left pseudophakia. SINUSES: Paranasal sinuses are clear. VESSELS: Normal noncontrast appearance of the vessels.
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15,995 |
EXAM: MR Abdomen wo+w contrast, MR Cholangiopancreatography MRCP CLINICAL INFORMATION: Renal mass, K76.9 Liver disease, unspecified Spec Inst: Abnormal US with renal mass .br Abnormal LFTs COMPARISON: Abdominal ultrasound dated 12/13/2021 TECHNIQUE: MR Abdomen wo+w contrast, MR Cholangiopancreatography MRCP Patient weight: 200 lbs. IV contrast: ProHance, 10 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: Atelectasis/scarring in the right lung base. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Normal. BILIARY TRACT: Normal. No internal or external biliary ductal dilatation, filling defects, or strictures. Common bile duct tapers smoothly at the ampulla. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Small focus of cortical scarring within the left interpolar region correlating with lesion seen on recent ultrasound. No masses or abnormal postcontrast enhancement. 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. Left renal lesion seen on recent ultrasound correlates to a focus of cortical scarring. No suspicious renal lesions are identified. 2. Normal MRCP without biliary duct dilatation, filling defect, or stricture. 3. No focal hepatic lesion or additional significant abnormality within the imaged 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: Atelectasis/scarring in the right lung base. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Normal. BILIARY TRACT: Normal. No internal or external biliary ductal dilatation, filling defects, or strictures. Common bile duct tapers smoothly at the ampulla. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Small focus of cortical scarring within the left interpolar region correlating with lesion seen on recent ultrasound. No masses or abnormal postcontrast enhancement. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: The trachea and central airways are patent. Basilar and peripheral predominant patchy consolidation and groundglass, bilaterally. No pleural effusion or pneumothorax. HEART / OTHER VESSELS: The heart is borderline-enlarged. The aortic root is mildly dilated. The left common carotid artery arises from the brachiocephalic artery. Scattered vascular calcifications. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Multiple prominent/enlarged mediastinal and hilar lymph nodes, likely related to known COVID 19 pneumonia. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No significant abnormality.
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15,996 |
EXAM: MR Abdomen wo+w contrast, MR Cholangiopancreatography MRCP CLINICAL INFORMATION: Renal mass, K76.9 Liver disease, unspecified Spec Inst: Abnormal US with renal mass .br Abnormal LFTs COMPARISON: Abdominal ultrasound dated 12/13/2021 TECHNIQUE: MR Abdomen wo+w contrast, MR Cholangiopancreatography MRCP Patient weight: 200 lbs. IV contrast: ProHance, 10 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: Atelectasis/scarring in the right lung base. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Normal. BILIARY TRACT: Normal. No internal or external biliary ductal dilatation, filling defects, or strictures. Common bile duct tapers smoothly at the ampulla. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Small focus of cortical scarring within the left interpolar region correlating with lesion seen on recent ultrasound. No masses or abnormal postcontrast enhancement. 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. Left renal lesion seen on recent ultrasound correlates to a focus of cortical scarring. No suspicious renal lesions are identified. 2. Normal MRCP without biliary duct dilatation, filling defect, or stricture. 3. No focal hepatic lesion or additional significant abnormality within the imaged 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: Atelectasis/scarring in the right lung base. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Normal. BILIARY TRACT: Normal. No internal or external biliary ductal dilatation, filling defects, or strictures. Common bile duct tapers smoothly at the ampulla. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Small focus of cortical scarring within the left interpolar region correlating with lesion seen on recent ultrasound. No masses or abnormal postcontrast enhancement. 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 imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube distal tip terminates just superior to the carina. The trachea and central airways are patent. There are minimally mucus plugging is noted at the right base. Scattered nodular and reticular opacities in both apices. Small bilateral pleural effusions with associated overlying atelectasis. Calcified granuloma in the left upper lobe. HEART / VESSELS: Right approach central venous catheter distal tip terminates in the distal SVC. The heart size is normal. Small pericardial effusion. Scattered coronary calcifications. MEDIASTINUM / ESOPHAGUS: Postsurgical changes of prior median sternotomy and the anterior mediastinum. LYMPH NODES: Enlarged peritracheal mediastinal lymph nodes. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Diffuse symmetric gallbladder wall thickening. PANCREAS: Normal. SPLEEN: Indeterminate hypoattenuating lesion in the inferior aspect of the spleen. ADRENALS: Normal. KIDNEYS: Hyperdense right upper pole renal lesion favoring to represent an hyperdense cyst. Otherwise the kidneys are unremarkable. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube distal tip terminates in the distal gastric body. COLON / APPENDIX: No acute abnormality. Noninflamed diverticula. PERITONEUM / MESENTERY: Scattered regions of free fluid within the pelvis as well as in the perihepatic region. RETROPERITONEUM: Trace inferior left retroperitoneal fluid. VESSELS: Moderate to advanced vascular calcifications. URINARY BLADDER: Collapsed around a Foley balloon. REPRODUCTIVE ORGANS: The uterus is present. 2.5 cm right ovarian cyst. BODY WALL: Fat-containing umbilical hernia. MUSCULOSKELETAL: Minimally displaced sternal fracture best appreciated on sagittal series 80369 image 78. Questionable age-indeterminate superior endplate deformity involving the T11 vertebral body.
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15,997 |
EXAM: MR Enterography CLINICAL INFORMATION: Possible Crohn's disease. Fistula. COMPARISON: Previous MRI 12/29/2021 TECHNIQUE: MR Enterography Patient weight: 220 lbs. IV contrast: ProHance, 20 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: Limited exam secondary to underdistention of the small bowel. STOMACH: No abnormality. SMALL BOWEL: Minimal enhancement in the region of the terminal ileum series 604 image 39 is difficult to evaluate given poor distention. This is less prominent on the coronal sequences. No other areas concerning for inflammatory bowel disease. PERITONEUM / MESENTERY: Small peripherally enhancing nodule in the left lower quadrant series 604 image 42 and also seen on the T2-weighted sequences series 301 image 16 of unclear significance but appears separate from bowel. COLORECTAL: No abnormal bowel wall thickening or enhancement. The previously seen rectal inflammatory changes and fistula are not identified by this technique. See separate report from prior. APPENDIX: Normal. LIVER: Partially imaged portions are normal. BILIARY TRACT: Normal. GALLBLADDER: Gallstones. 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: Known tiny urethral diverticulum is again poorly visualized by this technique. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Questionable faint enhancement in the terminal ileum as described above, indeterminate given underdistention. Otherwise, no findings suggestive of active inflammatory bowel disease. 2. Small ring enhancing focus in the left lower quadrant mesentery of unclear significance. 3. Findings seen on recent pelvic CT are not well evaluated today, secondary to differences in technique.
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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: Limited exam secondary to underdistention of the small bowel. STOMACH: No abnormality. SMALL BOWEL: Minimal enhancement in the region of the terminal ileum series 604 image 39 is difficult to evaluate given poor distention. This is less prominent on the coronal sequences. No other areas concerning for inflammatory bowel disease. PERITONEUM / MESENTERY: Small peripherally enhancing nodule in the left lower quadrant series 604 image 42 and also seen on the T2-weighted sequences series 301 image 16 of unclear significance but appears separate from bowel. COLORECTAL: No abnormal bowel wall thickening or enhancement. The previously seen rectal inflammatory changes and fistula are not identified by this technique. See separate report from prior. APPENDIX: Normal. LIVER: Partially imaged portions are normal. BILIARY TRACT: Normal. GALLBLADDER: Gallstones. 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: Known tiny urethral diverticulum is again poorly visualized by this technique. 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 CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube distal tip terminates just superior to the carina. The trachea and central airways are patent. There are minimally mucus plugging is noted at the right base. Scattered nodular and reticular opacities in both apices. Small bilateral pleural effusions with associated overlying atelectasis. Calcified granuloma in the left upper lobe. HEART / VESSELS: Right approach central venous catheter distal tip terminates in the distal SVC. The heart size is normal. Small pericardial effusion. Scattered coronary calcifications. MEDIASTINUM / ESOPHAGUS: Postsurgical changes of prior median sternotomy and the anterior mediastinum. LYMPH NODES: Enlarged peritracheal mediastinal lymph nodes. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Diffuse symmetric gallbladder wall thickening. PANCREAS: Normal. SPLEEN: Indeterminate hypoattenuating lesion in the inferior aspect of the spleen. ADRENALS: Normal. KIDNEYS: Hyperdense right upper pole renal lesion favoring to represent an hyperdense cyst. Otherwise the kidneys are unremarkable. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube distal tip terminates in the distal gastric body. COLON / APPENDIX: No acute abnormality. Noninflamed diverticula. PERITONEUM / MESENTERY: Scattered regions of free fluid within the pelvis as well as in the perihepatic region. RETROPERITONEUM: Trace inferior left retroperitoneal fluid. VESSELS: Moderate to advanced vascular calcifications. URINARY BLADDER: Collapsed around a Foley balloon. REPRODUCTIVE ORGANS: The uterus is present. 2.5 cm right ovarian cyst. BODY WALL: Fat-containing umbilical hernia. MUSCULOSKELETAL: Minimally displaced sternal fracture best appreciated on sagittal series 80369 image 78. Questionable age-indeterminate superior endplate deformity involving the T11 vertebral body.
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15,998 |
MR Lumbar Spine wo contrast HISTORY: Evaluation for radiculopathy TECHNIQUE: Multiplanar, multisequence MRI of the lumbar spine was performed without intravenous contrast . COMPARISON: lumbar spine radiograph dated 1/25/2022. FINDINGS: ALIGNMENT: The vertebral alignment seems normal.. VERTEBRAE: There is no vertebral body compression fracture or aggressive marrow lesion. A 15 x 19 mm hemangioma is seen in L3 vertebral body. CONUS MEDULLARIS: Normal in position and appearance. Conus medullaris ends at T12 level. No evidence of soft tissue abnormalities noted.. At T12-L1, there is mild diffuse disc bulge without significant spinal canal or neural foraminal narrowing. At L1-2, there is no evidence of the spinal canal or neural foraminal narrowing. At L2-3, there is moderate disc bulge with associated mild facet arthropathy without significant spinal canal or neural foraminal narrowing.. At L3-4, there is moderate bilateral facet arthropathy with associated bilateral mild neural foraminal narrowing. At L4-5, there is diffuse disc bulge, bilateral facet arthropathy causing moderate bilateral neural foraminal narrowing.. At L5-S1,there is diffuse disc bulge without significant neural foraminal or spinal canal narrowing. There is mild asymmetric heterogenous T2 hyper signal intensity in the sacral bone. A small cortical cyst is seen in thel left kidney. IMPRESSION: Mild degenerative changes as disc bulge and facet arthropathy most prominent at L3-L4 and L4-L5 level with mild to moderate neural foraminal narrowing without nerve root indentation. No cauda equina compression. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: ALIGNMENT: The vertebral alignment seems normal.. VERTEBRAE: There is no vertebral body compression fracture or aggressive marrow lesion. A 15 x 19 mm hemangioma is seen in L3 vertebral body. CONUS MEDULLARIS: Normal in position and appearance. Conus medullaris ends at T12 level. No evidence of soft tissue abnormalities noted.. At T12-L1, there is mild diffuse disc bulge without significant spinal canal or neural foraminal narrowing. At L1-2, there is no evidence of the spinal canal or neural foraminal narrowing. At L2-3, there is moderate disc bulge with associated mild facet arthropathy without significant spinal canal or neural foraminal narrowing.. At L3-4, there is moderate bilateral facet arthropathy with associated bilateral mild neural foraminal narrowing. At L4-5, there is diffuse disc bulge, bilateral facet arthropathy causing moderate bilateral neural foraminal narrowing.. At L5-S1,there is diffuse disc bulge without significant neural foraminal or spinal canal narrowing. There is mild asymmetric heterogenous T2 hyper signal intensity in the sacral bone. A small cortical cyst is seen in thel left kidney.
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Findings: There is no evidence of acute infarction, hemorrhage or hydrocephalus. There is no vasogenic edema or mass effect. There are minimal areas of low attenuation in the periventricular and subcortical white matter, likely microangiopathic changes. There is a partially empty sella. The visualized paranasal sinuses and mastoid air cells are clear. There is no acute osseous abnormality.
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15,999 |
EXAM: MR Brain wo contrast CLINICAL INFORMATION: Left parietal headache, increasing frequency. COMPARISON: None. TECHNIQUE: Axial FLAIR, axial T2, axial DWI, sagittal T1, axial SWI images of the brain were obtained. FINDINGS: No abnormal restricted diffusion. Periventricular and subcortical white matter FLAIR hyperintensities are most consistent with chronic microangiopathic ischemic changes. There is mild diffuse cerebral atrophy with prominence of the cortical sulci, sylvian fissures and compensatory dilatation of the ventricles. Expected vascular flow voids are unremarkable. The midline structures are unremarkable. No tonsillar ectopia or other herniation. No abnormal susceptibility signal dropout. No extra-axial collection. No abnormal marrow signal. The middle ears, mastoid air cells, and paranasal sinuses are clear. The orbits and globes are unremarkable. No significant soft tissue abnormality. CONCLUSION: No acute intracranial abnormality. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: No abnormal restricted diffusion. Periventricular and subcortical white matter FLAIR hyperintensities are most consistent with chronic microangiopathic ischemic changes. There is mild diffuse cerebral atrophy with prominence of the cortical sulci, sylvian fissures and compensatory dilatation of the ventricles. Expected vascular flow voids are unremarkable. The midline structures are unremarkable. No tonsillar ectopia or other herniation. No abnormal susceptibility signal dropout. No extra-axial collection. No abnormal marrow signal. The middle ears, mastoid air cells, and paranasal sinuses are clear. The orbits and globes are unremarkable. No significant soft tissue abnormality.
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FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: An endotracheal tube terminates in the midthoracic trachea. Large bilateral pleural effusions with compressive atelectasis. Expiratory phase timing. HEART / OTHER VESSELS: Dilated right ventricle with reflux of contrast into the IVC suggestive of elevated right atrial pressures. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Anasarca with asymmetric edema overlying the left upper chest wall. UPPER ABDOMEN: See separate abdominal dictation. MUSCULOSKELETAL: No significant abnormality.
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