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Interpretation of Outside Films CT Chest Clinical Information: 79-year-old male with history of bladder cancer Spec Inst: Bladder cancer - CT CAP from Grandview done 12-30-21 rec 1-5-22 Study reviewed: CT of chest with contrast performed at Grandview on December 30, 2021, The images are available in PACS. Findings: No prior CT for comparison. Diffuse increased peribronchial thickening is noted especially in the lower lobes with several segmental right lower lobe bronchi filled with mucous. Additional tiny nodules in both lower lobe basal segments right more than left with tree in bud distribution pattern. Minimal mixed emphysematous changes are present in the upper lobes. Only subcentimeter size nodes are present in the right lower paratracheal and subcarinal region. Extensive three-vessel coronary artery atherosclerotic disease. Calcified left costal pleural plaque are noted without pleural effusion. The pericardium is normal in thickness without effusion or calcification. There is no focal lytic or sclerotic bone lesion. Conclusion: 1. Airway dominant COPD with several right lower lobe segmental bronchi demonstrate mucous plugging. 2. Dependent bilateral lower lobe basal segmental tiny tree-in-bud distribution nodules possibly reflective of bronchiolitis perhaps due to aspiration. 3. Calcified left pleural plaque possibly asbestos related pleural disease. 4. No convincing intrathoracic metastatic disease
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Findings: No prior CT for comparison. Diffuse increased peribronchial thickening is noted especially in the lower lobes with several segmental right lower lobe bronchi filled with mucous. Additional tiny nodules in both lower lobe basal segments right more than left with tree in bud distribution pattern. Minimal mixed emphysematous changes are present in the upper lobes. Only subcentimeter size nodes are present in the right lower paratracheal and subcarinal region. Extensive three-vessel coronary artery atherosclerotic disease. Calcified left costal pleural plaque are noted without pleural effusion. The pericardium is normal in thickness without effusion or calcification. There is no focal lytic or sclerotic bone lesion.
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Findings: Previously noted focal hyperdensity within the right frontal corona radiata has resolved. Redemonstration of mild cerebral atrophy with with interval increase in ventricular volumes slightly out of proportion to degree of cerebral atrophy. Confluent periventricular hypoattenuation appears stable suggestive of microangiopathic change. The remaining images the brain demonstrate no intracranial mass, mass effect, edema, or hemorrhage seen. No acute infarction seen. The visualized paranasal sinuses and mastoid air cells are clear. No acute osseous or soft tissue abnormality seen. Chronic left inferior orbital wall fracture
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16,101 |
EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: History of bladder cancer COMPARISON: None. TECHNIQUE: Outside CT images of abdomen and pelvis with contrast and coronal and sagittal reformats dated 12/30/2021 were submitted for interpretation. The CT acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately reported chest CT. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Diffuse fatty atrophy. SPLEEN: Indeterminate hypodense lesion along the periphery of the spleen measuring approximately 6 mm (series 2 image 116). ADRENALS: Normal. KIDNEYS: There is a large simple renal cyst along the right upper pole. No obstructing mass, or radiopaque calculus identified.. There is symmetric dilation of the distal ureters just proximal to the bladder insertion. Probable small saccular calcified aneurysm from the distal right renal artery (on series 2/image 136) . LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Large area/fluid containing periampullary duodenal diverticulum.. COLON / APPENDIX: Scattered colonic diverticula without surrounding inflammation. The appendix is not definitively visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Aortic stent graft is visualized in the infrarenal aorta, extending into bilateral mid common iliac arteries. Stent graft is patent with small amount of intimal plaque/thrombus. Proximal SMA stent is visualized with probably patent lumen and focal moderate to high-grade narrowing of the stent proximally. Moderate atherosclerotic narrowing of proximal celiac trunk. URINARY BLADDER: Irregular eccentric thickening and nodularity of the lateral walls of the urinary bladder, likely represent residual bladder cancer. Also seen is distention of bilateral distal ureter, containing heterogenous contents, for example on series 5, image 58 and series 5, image 57. There is no proximal hydroureter or hydronephrosis. REPRODUCTIVE ORGANS: Prostatomegaly. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute or aggressive osseous abnormality. Mild degenerative changes involving the lumbar spine. CONCLUSION: 1. Irregular eccentric wall thickening and nodularity of the bladder wall, likely related to known bladder cancer. No large extravesical soft tissue mass. 2. Dilated bilateral distal ureters with heterogeneous contents on delayed phase which may represent blood products or extension of urothelial cancer. 3. No metastatic disease within the visualized abdomen/pelvis. Other incidental/chronic findings as outlined 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: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately reported chest CT. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Diffuse fatty atrophy. SPLEEN: Indeterminate hypodense lesion along the periphery of the spleen measuring approximately 6 mm (series 2 image 116). ADRENALS: Normal. KIDNEYS: There is a large simple renal cyst along the right upper pole. No obstructing mass, or radiopaque calculus identified.. There is symmetric dilation of the distal ureters just proximal to the bladder insertion. Probable small saccular calcified aneurysm from the distal right renal artery (on series 2/image 136) . LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Large area/fluid containing periampullary duodenal diverticulum.. COLON / APPENDIX: Scattered colonic diverticula without surrounding inflammation. The appendix is not definitively visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Aortic stent graft is visualized in the infrarenal aorta, extending into bilateral mid common iliac arteries. Stent graft is patent with small amount of intimal plaque/thrombus. Proximal SMA stent is visualized with probably patent lumen and focal moderate to high-grade narrowing of the stent proximally. Moderate atherosclerotic narrowing of proximal celiac trunk. URINARY BLADDER: Irregular eccentric thickening and nodularity of the lateral walls of the urinary bladder, likely represent residual bladder cancer. Also seen is distention of bilateral distal ureter, containing heterogenous contents, for example on series 5, image 58 and series 5, image 57. There is no proximal hydroureter or hydronephrosis. REPRODUCTIVE ORGANS: Prostatomegaly. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute or aggressive osseous abnormality. Mild degenerative changes involving the lumbar spine.
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. Mild bibasilar predominant subpleural reticulations and cystic changes are seen, predominantly in the right lung base. Mild peripheral bronchiectasis in the lower lobes and right middle lobe. Tiny 3 mm groundglass opacity in the right and left upper lobes. Scattered upper lobe centrilobular nodules. Mild paraseptal and centrilobular emphysematous changes. No suspicious pulmonary nodules. No focal consolidation, pneumothorax or pleural effusion. No evidence of air trapping. HEART / VESSELS: Heart size is normal. Mild atherosclerotic calcifications of the thoracic aorta. Mild ectasia of the distal descending thoracic aorta to 3.3 cm. MEDIASTINUM / ESOPHAGUS: No significant abnormality. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: No significant abnormality. MUSCULOSKELETAL: Multilevel chronic degenerative changes of the visualized spine. Grade 1 anterolisthesis of C7 on T1. No aggressive osseous lesion. Minimal loss of vertebral body height involving T11 and T12 with low bone mineral density.
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16,102 |
CTA head without contrast. Outside scan dated 12/13/2021 for interpretation only. Clinical Information: Hypoplastic ICA vs dissection. CTA Head from EAMC done 12-13-21 rec 1-5-22 Findings: CT head: The parenchyma appears normal with no mass, hemorrhage, visible infarct or extracerebral collection. Is preservation of gray-white margins. Posterior fossa contents appear normal. No defect is seen in the calvarium or skull base. Postcontrast scans show no abnormal enhancement. CTA neck: The top of the aortic arch and the brachiocephalic arteries appear normal. The common carotid artery is normal and the right ICA has expected appearance. The left common carotid artery is small at the bifurcation is normal. There is string sign with a uniform narrowing of the left ICA from its origin to the skull base. CTA head: The left osseous petrous canal is narrow and the left cavernous and supraclinoid ICA segments are uniformly small. The right carotid siphon is normal. The right A1 is large, supplying most of the flow to the bilateral pericallosal arteries. The left A1 is small. The left MCA and its branches have normal appearance. The basilar artery and its branches are unremarkable. --------------- Conclusion: Essentially negative pre and postcontrast cranial CT scan. String sign of the left ICA with uniform narrowing from its origin to the supraclinoid terminus. Narrowing of the osseous petrous canal indicating stable very long duration of the string sign. No finding to suggest dissection. Otherwise essentially negative CT angiograms of the neck and head.
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Findings: CT head: The parenchyma appears normal with no mass, hemorrhage, visible infarct or extracerebral collection. Is preservation of gray-white margins. Posterior fossa contents appear normal. No defect is seen in the calvarium or skull base. Postcontrast scans show no abnormal enhancement. CTA neck: The top of the aortic arch and the brachiocephalic arteries appear normal. The common carotid artery is normal and the right ICA has expected appearance. The left common carotid artery is small at the bifurcation is normal. There is string sign with a uniform narrowing of the left ICA from its origin to the skull base. CTA head: The left osseous petrous canal is narrow and the left cavernous and supraclinoid ICA segments are uniformly small. The right carotid siphon is normal. The right A1 is large, supplying most of the flow to the bilateral pericallosal arteries. The left A1 is small. The left MCA and its branches have normal appearance. The basilar artery and its branches are unremarkable. ---------------
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: No abnormality CHEST: LUNGS / AIRWAYS / PLEURA: Limited due to respiratory motion artifact. Prominent extrapleural fat bilaterally is unchanged. Grossly similar subpleural bandlike opacities. Minimally increased linear basilar opacities with some groundglass. No pleural effusion or pneumothorax. HEART / VESSELS: Heart size is normal. No pericardial effusion. Moderate coronary artery calcifications. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. Calcified right hilar lymph node. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Advanced atherosclerotic calcifications of the splanchnic vasculature. MUSCULOSKELETAL: No significant abnormality.
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16,103 |
EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Cirrhosis. COMPARISON: 8/7/2021. TECHNIQUE: Outside CT images without IV contrast dated 12/17/2021 were submitted for interpretation. The CT acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: IMAGE QUALITY: Suboptimal. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Large right pleural effusion with associated right lung base atelectasis. No left pleural effusion. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Normal in size without pericardial effusion. Severe coronary artery atherosclerotic calcification. ABDOMEN and PELVIS: LIVER: Cirrhotic. Sensitivity for the detection of focal lesion is limited by noncontrast technique. Large recanalized paraumbilical vein. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Splenomegaly. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Trace ascites, mildly increased compared to prior exam. No free intraperitoneal air. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic calcification of the abdominal aorta which is normal in caliber. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is surgically absent. No adnexal masses. BODY WALL: Moderate diffuse anasarca. MUSCULOSKELETAL: No aggressive osseous lesions. CONCLUSION: Hepatic cirrhosis with sequela of portal hypertension including minimally increased small volume ascites. Sensitivity for the detection of suspicious lesions is limited by noncontrast technique, and further evaluation with contrasted CT or MR abdomen is recommended, if clinically indicated. Chronic and incidental findings as above.
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FINDINGS: IMAGE QUALITY: Suboptimal. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Large right pleural effusion with associated right lung base atelectasis. No left pleural effusion. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Normal in size without pericardial effusion. Severe coronary artery atherosclerotic calcification. ABDOMEN and PELVIS: LIVER: Cirrhotic. Sensitivity for the detection of focal lesion is limited by noncontrast technique. Large recanalized paraumbilical vein. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Splenomegaly. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Trace ascites, mildly increased compared to prior exam. No free intraperitoneal air. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic calcification of the abdominal aorta which is normal in caliber. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is surgically absent. No adnexal masses. BODY WALL: Moderate diffuse anasarca. MUSCULOSKELETAL: No aggressive osseous lesions.
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FINDINGS: Aortic arch and proximal great vessels: Mild atherosclerotic calcifications of the arch. Right carotid: Calcified and noncalcified and plaque of the proximal internal carotid artery on the right with
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MRI brain without Indication: cirrhosis MR Brain 121821 Baptist Med Ctr Rec 1522 Spec Inst: cirrhosis MR Brain 121821 Baptist Med Ctr Rec 1522 Comparison: No previous similar studies are available for comparison at this time. Technique: Multiple T1 and T2-weighted MR sequence images of the brain from outside facility were reviewed. Findings: Echoplanar diffusion-weighted imaging demonstrates no evidence of restricted diffusion. Bilateral symmetric T1 shortening involving the bilateral basal ganglia. Multiple scattered discrete and mildly confluent T2/FLAIR white matter hyperintensities, likely related to chronic microvascular ischemic disease. Impression: 1. No evidence of acute infarct or hemorrhage. 2. Bilateral symmetric T1 shortening in the basal ganglia suggesting hepatic encephalopathy in this patient with cirrhosis. 3. Sequela of chronic microvascular ischemic disease.
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Findings: Echoplanar diffusion-weighted imaging demonstrates no evidence of restricted diffusion. Bilateral symmetric T1 shortening involving the bilateral basal ganglia. Multiple scattered discrete and mildly confluent T2/FLAIR white matter hyperintensities, likely related to chronic microvascular ischemic disease.
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FINDINGS: VASCULATURE: Moderate calcific and noncalcific atherosclerosis of the abdominal aorta and its branch vessels. Abdominal aortic endostent extends from the infrarenal aorta into the common iliac arteries. Descending thoracic aorta: No aneurysm, dissection, or stenosis. Abdominal aorta: Infrarenal fusiform aneurysm measures approximately 5.5 x 5.1 cm (series 301, image 169), previously 6.0 x 4.9 cm. Similar appearance of a patent aortoiliac stent with redemonstration of previously described type II endoleaks. The superiormost endoleak which communicates with the IMA appears stable on venous phases (series 303 image 158). More contrast is seen associated with the probable lumbar inferiormost endoleak than on the prior study, likely secondary to timing (series 303 image 181). Celiac axis: No aneurysm, dissection, or stenosis. Replaced right hepatic artery. Superior mesenteric artery: No aneurysm, dissection, or stenosis. Right renal: Multiple right renal arteries without aneurysm, dissection, or stenosis. Left renal: Multiple left renal arteries without aneurysm, dissection, or stenosis. Inferior mesenteric artery: Patent, arising from the aneurysmal sac. Right ILIAC/PROXIMAL FEMORAL ARTERIES: Redemonstration of fusiform aneurysm within the proximal internal iliac with slight interval enlargement measuring 11 mm (series 301 image 258). Moderately severe narrowing of the right internal iliac artery Left ILIAC/PROXIMAL FEMORAL ARTERIES: No aneurysm, dissection, or stenosis. ------------------------------------------------------------- LOWER CHEST: LUNG BASES: Normal. PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART: Mild calcific coronary atherosclerosis. ABDOMEN and PELVIS: Pelvis is moderately obscured secondary to streak artifact from the bilateral total hip arthroplasties. LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Unchanged left renal vascular coils. Normal right kidney. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered noninflamed colonic diverticula. No PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: Unremarkable. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostatomegaly. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: Bilateral hip arthroplasty hardware is intact without interval complication.
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16,105 |
MRI brain with and without, MRI cervical spine with and without contrast Indication: upper and lower extremity weakness MR Brain 122721 Rush Foundation Hosp Rec 1522 Spec Inst: upper and lower extremity weakness MR Brain 122721 Rush Foundation Hosp Rec 1522 Comparison: Multiple priors, most recent MRI brain with and without contrast 7/5/2021 and MRI cervical and thoracic spine 8/11/2021 Technique: Multiple T1 and T2-weighted MR sequence images of the brain and cervical spine from outside facility were reviewed. Findings: There is no evidence of acute infarct or hemorrhage. Again seen is extensive medullary and cord signal abnormality (extending at least to T1 level) with swelling and diffuse patchy enhancement, lower end beyond the field-of-view. This appears to have progressed since the prior study from August 2021 where it extended to C7. Impression: Interval worsening of the enhancing brainstem and cord signal abnormality.
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Findings: There is no evidence of acute infarct or hemorrhage. Again seen is extensive medullary and cord signal abnormality (extending at least to T1 level) with swelling and diffuse patchy enhancement, lower end beyond the field-of-view. This appears to have progressed since the prior study from August 2021 where it extended to C7.
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FINDINGS: AORTIC MEASUREMENTS: AORTIC ROOT AT THE SINUSES: 3.7 cm sinus-commissure. MID-ASCENDING THORACIC AORTA: 2.6 x 2.4 cm. AORTIC ARCH: 3.6 x 3.2 cm. PROXIMAL DESCENDING THORACIC AORTA: 2.4 x 2.3 cm. MID DESCENDING THORACIC AORTA: 1.8 x 1.7 cm. DISTAL DESCENDING THORACIC AORTA: 1.7 x 1.6 cm. STRUCTURED REPORT: CTA Chest VASCULATURE: CORONARY ARTERIES: There are no atherosclerotic calcifications of the native coronary arteries. PULMONARY ARTERIES: No central pulmonary embolus. Normal size. THORACIC AORTA: The aortic root is mildly dilated measuring 4.1 cm sinus-sinus (image 71 series 6 of the coronal series). Previously this measured 4.1 cm. Prior ascending aortic interposition graft and arch repair noted. There is some irregularity and tortuosity long the site of the arch repair which is unchanged. No significant focal stenosis is present. No focal aneurysmal dilation is identified. Arch vessels appear normally patent. No pseudoaneurysm or perigraft fluid collection is identified. The descending thoracic aorta is normal in caliber. ------------------------------------------------------------- LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: No focal consolidation, pneumothorax, or pleural effusion. Patent central airways. No suspicious pulmonary nodule. HEART / OTHER VESSELS: Normal heart size. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Healed median sternotomy. UPPER ABDOMEN: Cholelithiasis. Otherwise normal. MUSCULOSKELETAL: No aggressive osseous lesion. --------------------
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16,106 |
MRI brain with and without, MRI cervical spine with and without contrast Indication: upper and lower extremity weakness MR Brain 122721 Rush Foundation Hosp Rec 1522 Spec Inst: upper and lower extremity weakness MR Brain 122721 Rush Foundation Hosp Rec 1522 Comparison: Multiple priors, most recent MRI brain with and without contrast 7/5/2021 and MRI cervical and thoracic spine 8/11/2021 Technique: Multiple T1 and T2-weighted MR sequence images of the brain and cervical spine from outside facility were reviewed. Findings: There is no evidence of acute infarct or hemorrhage. Again seen is extensive medullary and cord signal abnormality (extending at least to T1 level) with swelling and diffuse patchy enhancement, lower end beyond the field-of-view. This appears to have progressed since the prior study from August 2021 where it extended to C7. Impression: Interval worsening of the enhancing brainstem and cord signal abnormality.
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Findings: There is no evidence of acute infarct or hemorrhage. Again seen is extensive medullary and cord signal abnormality (extending at least to T1 level) with swelling and diffuse patchy enhancement, lower end beyond the field-of-view. This appears to have progressed since the prior study from August 2021 where it extended to C7.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately dictated CT chest. ABDOMEN and PELVIS: LIVER: Unchanged indeterminate subcentimeter focus of hypoattenuation in hepatic segment VII/VIII. No new liver lesions. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Subcentimeter foci of hypoattenuation are too small for accurate characterization. LYMPH NODES: Decreased size of several prominent mesorectal lymph nodes, for example left mesorectal lymph node measures 7 x 4 mm on 315 series 3, previously 12 x 7 mm. Decreased size of left lateral pelvic sidewall lymph nodes. STOMACH / SMALL BOWEL: Right lower quadrant loop ileostomy. Small bowel is normal in caliber. COLON / APPENDIX: Resolving postsurgical changes from low anterior resection with anastomotic suture in the pelvis. No evidence of recurrent leak. Mild perianastomotic stranding, likely scarring/fibrosis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic wall calcifications of the infrarenal abdominal aorta. URINARY BLADDER: Partially distended REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Right lower quadrant with ileostomy with small peristomal hernia. Fat-containing ventral hernias. MUSCULOSKELETAL: No significant abnormality.
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12/16/2021 for interpretation only. CT soft tissues of the neck. Outside scan dated Findings: The nasopharynx and tongue base are are unremarkable. There is fullness of lymphoid tissue at the tongue base. There is posterior position of the epiglottis and there is soft tissue fullness in the vallecula. There is nodular fullness of supraglottic soft tissues extending to the true cords which have normal appearance. The trachea and cervical esophagus are unremarkable. No abnormal adenopathy is seen. There is apical pleural thickening bilaterally. The lung apices are clear. No defect is seen in cervical spine. --------------- Conclusion: Recurrent supraglottic tumor extending to the true cords.
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Findings: The nasopharynx and tongue base are are unremarkable. There is fullness of lymphoid tissue at the tongue base. There is posterior position of the epiglottis and there is soft tissue fullness in the vallecula. There is nodular fullness of supraglottic soft tissues extending to the true cords which have normal appearance. The trachea and cervical esophagus are unremarkable. No abnormal adenopathy is seen. There is apical pleural thickening bilaterally. The lung apices are clear. No defect is seen in cervical spine. ---------------
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: No suspicious pulmonary nodules. No focal consolidation, pleural effusion, or pneumothorax. HEART / VESSELS: Heart size is normal. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Please see same day CT abdomen for abdomen findings. MUSCULOSKELETAL: No significant abnormality. ---------------------------
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16,108 |
EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Renal mass. COMPARISON: None. TECHNIQUE: Outside CT images with IV contrast dated 12/7/2021 were submitted for interpretation. The CT acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Renal Mass LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN: KIDNEYS: RENAL MASS LOCATION: Left Kidney. SIZE IN 3 ORTHOGONAL DIMENSIONS (cm): 3.4 x 3.2 x 3.3 cm (series 6, image 41; series 5, image 177) COMPOSITION: Solid and homogeneous. BOSNIAK CLASSIFICATION: Not applicable. MARGINS: Partially ill-defined. PRESENCE OF MACROSCOPIC FAT: No. ENHANCEMENT: Not measured due to lack of noncontrast and nephrographic phase sequences. NEPHROMETRY SCORE: - Radius: =50% exophytic (1 point) - Nearness to sinus: 50% of the mass is central (3 points) - Axial location: Posterior and Lateral. - Hilar extent: No hilar invasion. - Nephrometry Score (Points): 8 LOCAL EXTENT OF DISEASE: - Contacts the perirenal (Gerota's) fascia: No. - Invades through the perirenal (Gerota's) fascia: No. - Invades central sinus fat: No. - Invades collecting system: No. - Invades ipsilateral adrenal: No. - Invades adjacent organs or structure: No. IPSILATERAL VESSELS: - Renal artery: Single ipsilateral renal artery without early branching. - Significant renal artery stenosis >70%: None. - Renal vein anatomy: Single ipsilateral renal vein with conventional anatomy. - Renal vein thrombus (describe extent of tumor and bland thrombus): No. - IVC thrombus (describe anatomy and extend of tumor and bland thrombus): No. OTHER RENAL FINDINGS: None. ADRENALS: - Direct invasion by renal mass: No. - Adrenal nodule(s): No. - Other findings: None. LYMPH NODES: - Retroperitoneal / Pararenal lymph nodes: Not enlarged. - Other findings: Not enlarged. LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. No wall thickening or pericholecystic fluid. PANCREAS: Normal. SPLEEN: Normal. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Collapsed, limiting evaluation. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Tiny fat-containing periumbilical hernia. MUSCULOSKELETAL: No aggressive osseous lesions. CONCLUSION: 1. Left renal mass as above concerning for malignancy. Left renal vein is grossly patent. No evidence of abdominopelvic metastatic disease. 2. Incidental findings as above.
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FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Renal Mass LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN: KIDNEYS: RENAL MASS LOCATION: Left Kidney. SIZE IN 3 ORTHOGONAL DIMENSIONS (cm): 3.4 x 3.2 x 3.3 cm (series 6, image 41; series 5, image 177) COMPOSITION: Solid and homogeneous. BOSNIAK CLASSIFICATION: Not applicable. MARGINS: Partially ill-defined. PRESENCE OF MACROSCOPIC FAT: No. ENHANCEMENT: Not measured due to lack of noncontrast and nephrographic phase sequences. NEPHROMETRY SCORE: - Radius: =50% exophytic (1 point) - Nearness to sinus: 50% of the mass is central (3 points) - Axial location: Posterior and Lateral. - Hilar extent: No hilar invasion. - Nephrometry Score (Points): 8 LOCAL EXTENT OF DISEASE: - Contacts the perirenal (Gerota's) fascia: No. - Invades through the perirenal (Gerota's) fascia: No. - Invades central sinus fat: No. - Invades collecting system: No. - Invades ipsilateral adrenal: No. - Invades adjacent organs or structure: No. IPSILATERAL VESSELS: - Renal artery: Single ipsilateral renal artery without early branching. - Significant renal artery stenosis >70%: None. - Renal vein anatomy: Single ipsilateral renal vein with conventional anatomy. - Renal vein thrombus (describe extent of tumor and bland thrombus): No. - IVC thrombus (describe anatomy and extend of tumor and bland thrombus): No. OTHER RENAL FINDINGS: None. ADRENALS: - Direct invasion by renal mass: No. - Adrenal nodule(s): No. - Other findings: None. LYMPH NODES: - Retroperitoneal / Pararenal lymph nodes: Not enlarged. - Other findings: Not enlarged. LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. No wall thickening or pericholecystic fluid. PANCREAS: Normal. SPLEEN: Normal. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Collapsed, limiting evaluation. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Tiny fat-containing periumbilical hernia. MUSCULOSKELETAL: No aggressive osseous lesions.
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Findings: CT head: Stable position of left frontal approach ventriculostomy catheter and shunted ventricles. Chronic tiny extra-axial collection underlying right parietal craniotomy appears stable. Right temporal encephalomalacia related to right terminal ICA aneurysm clipping are noted. Peripherally calcified and centrally thrombosed aneurysm sac is noted. Stable left frontal pericatheter hypoattenuation. No hydrocephalus, evidence of acute infarction, edema or hemorrhage is seen. No abnormal enhancement. Remote fracture deformity of the left lamina papyracea is noted. Antrostomy changes. The remainder of the visualized paranasal sinuses mastoid air cells are clear. No acute osseous or soft tissue abnormality seen. CTA head: No residual filling is seen within the thrombosed and peripherally calcified inferiorly projecting right terminal ICA aneurysm sac. The remaining intracranial arterial vasculature demonstrates no aneurysm, dissection, flow-limiting stenosis or occlusion. No vascular malformation seen. The The limited visualized images of the cervical arterial vasculature demonstrate approximately 75% narrowing of the left proximal cervical ICA best seen on series 604 image 95. ----------------
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Pancreatic cancer COMPARISON: None. TECHNIQUE: Outside CT images with IV contrast dated 11/29/2021 were submitted for interpretation. The CT acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: IMAGE QUALITY: Suboptimal. Increased imaging as well as degrades evaluation. Single phase study without arterial phase of contrast also degrades evaluation. STRUCTURED REPORT: CT Pancreatic Mass FINDINGS: LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: A 1.9 cm hypoattenuating lesion on the left hepatic lobe noted on axial series 5, image 36. Additional smaller hypoattenuating 1.3 cm lesion noted on axial series 5, image 38. PERITONEUM: No ascites. No peritoneal nodules. PANCREAS: Pancreatic mass: - Location: Head - Size: Difficult to accurately measure given the suboptimal image quality and infiltrative nature of the mass, however measures approximately 3.7 x 3.7 cm. - Composition: Solid - Enhancement relative to pancreas: Hypoenhancing - Margins: Ill-defined with irregular margins. - Pancreatic duct: Mild upstream pancreatic ductal dilatation. - Pancreatic atrophy: Mild upstream pancreatic atrophy. - Biliary ducts: Dilated. Moderate to severe intrahepatic biliary dilatation. Extrahepatic bile duct is dilated to the level of the pancreatic mass. - Gallbladder: Gallbladder is distended with hyperdense material, possibly sludge. VASCULATURE: Difficult to evaluate arterial anatomy with lack of arterial phase imaging. - Arterial anatomy: Conventional. - Celiac Axis (CA): No tumor contact. - Common Hepatic Artery (CHA): No tumor contact. - Superior Mesenteric Artery (SMA): No tumor contact. - Aorta: No tumor contact. - Main Portal Vein (PV) and Superior Mesenteric Vein (SMV): Tumor contact
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FINDINGS: IMAGE QUALITY: Suboptimal. Increased imaging as well as degrades evaluation. Single phase study without arterial phase of contrast also degrades evaluation. STRUCTURED REPORT: CT Pancreatic Mass FINDINGS: LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: A 1.9 cm hypoattenuating lesion on the left hepatic lobe noted on axial series 5, image 36. Additional smaller hypoattenuating 1.3 cm lesion noted on axial series 5, image 38. PERITONEUM: No ascites. No peritoneal nodules. PANCREAS: Pancreatic mass: - Location: Head - Size: Difficult to accurately measure given the suboptimal image quality and infiltrative nature of the mass, however measures approximately 3.7 x 3.7 cm. - Composition: Solid - Enhancement relative to pancreas: Hypoenhancing - Margins: Ill-defined with irregular margins. - Pancreatic duct: Mild upstream pancreatic ductal dilatation. - Pancreatic atrophy: Mild upstream pancreatic atrophy. - Biliary ducts: Dilated. Moderate to severe intrahepatic biliary dilatation. Extrahepatic bile duct is dilated to the level of the pancreatic mass. - Gallbladder: Gallbladder is distended with hyperdense material, possibly sludge. VASCULATURE: Difficult to evaluate arterial anatomy with lack of arterial phase imaging. - Arterial anatomy: Conventional. - Celiac Axis (CA): No tumor contact. - Common Hepatic Artery (CHA): No tumor contact. - Superior Mesenteric Artery (SMA): No tumor contact. - Aorta: No tumor contact. - Main Portal Vein (PV) and Superior Mesenteric Vein (SMV): Tumor contact
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Findings: There is almost normal appearance of the right posteromedial temporal lobe in the region of T2/FLAIR hyperintensity on the MR scan on 12/7/2021. The remainder the parenchyma appears normal. There is no mass, hemorrhage, visible infarct or extracerebral collection. Ventricles are small with normal appearance. There is preservation of gray-white margins. Posterior fossa contents appear normal. No defect is seen in the calvarium or skull base. ----------------
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EXAM: Outside MR Image Interpretation CLINICAL INFORMATION: Right calf mass COMPARISON: None. TECHNIQUE: Outside MR images of the right tibia/fibula without intravenous contrast dated 11/11/2021 were submitted for interpretation. The MRI acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: No abnormal marrow signal or enhancement to suggest acute fracture or aggressive osseous lesion. Within the posterior compartment of the proximal foreleg superficial to the medial head of the gastrocnemius, there is a heterogeneously hypointense T1 and heterogeneously hyperintense T2 mass measuring 6.8 x 3.5 x 16.8 cm (image 14, series 701; image 6, series 801). Within the mass, there are nodular areas of intermediate T1 signal which do not fully suppress fat saturated images. The mass has a well-defined capsule. Fluid is noted adjacent to the insertion of the sartorius, gracilis, and semitendinosus tendons. Edema is noted within the tibialis anterior muscle. The remaining visualized muscles and tendons are intact. Diffuse soft tissue edema of the distal foreleg. CONCLUSION: 1. Mass within the posterior compartment of the proximal foreleg superficial to the medial head of the gastrocnemius is favored to represent a sarcoma, likely myxoid sarcoma or myxoid liposarcoma. 2. Pes anserine bursitis. 3. Strain of the tibialis anterior muscle. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: No abnormal marrow signal or enhancement to suggest acute fracture or aggressive osseous lesion. Within the posterior compartment of the proximal foreleg superficial to the medial head of the gastrocnemius, there is a heterogeneously hypointense T1 and heterogeneously hyperintense T2 mass measuring 6.8 x 3.5 x 16.8 cm (image 14, series 701; image 6, series 801). Within the mass, there are nodular areas of intermediate T1 signal which do not fully suppress fat saturated images. The mass has a well-defined capsule. Fluid is noted adjacent to the insertion of the sartorius, gracilis, and semitendinosus tendons. Edema is noted within the tibialis anterior muscle. The remaining visualized muscles and tendons are intact. Diffuse soft tissue edema of the distal foreleg.
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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: Central airways are patent. Right middle lobe solid mass measures 4.8 x 2.5 cm (axial series 201, image 167), previously 4.9 x 2.7 cm. The mass abuts the pericardium and there is splaying of the adjacent right middle lobe subsegmental bronchi. Trace posterior dependent atelectatic changes. No focal consolidation, pneumothorax or pleural effusion. Elevation of left hemidiaphragm. HEART / VESSELS: Heart size is normal. Mild atherosclerotic calcifications of the coronary arteries. Main pulmonary artery is enlarged, measuring 3.5 cm. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: No significant abnormality. MUSCULOSKELETAL: Chronic degenerative changes of the thoracic spine. Mild exaggerated kyphotic curvature. No aggressive osseous lesion.
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Interpretation of Outside Films CT Chest Clinical Information: 41-year-old male with provided history of newly diagnosed mass in throat CT Chest 122621 Whitfield Regional Hosp Rec 1522 Spec Inst: newly diagnosed mass in throat CT Chest 122621 Whitfield Regional Hosp Rec 1522 Study reviewed: CT of chest without contrast performed at Whitfield regional Hospital on 12/26/2021, The images are available in PACS. Findings: Limitations: Noncontrasted study and motion artifact. Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: Mild paraseptal emphysema. No consolidation. No suspicious pulmonary nodule. No pleural effusion. Central airways are patent. Thoracic inlet, heart, and mediastinum: Fat interspersed thymic tissue in the anterior mediastinum, likely related to thymic hyperplasia. No lymphadenopathy in the axillary, mediastinal, or hilar regions. Calcified right hilar and subcarinal lymph nodes, likely related to prior granulomatous disease. The esophagus is nondilated. The thoracic aorta and main pulmonary artery are normal in caliber. The cardiac chambers are normal in size. No coronary artery atherosclerotic calcifications are noted, although the study is not optimized for coronary assessment. No pericardial effusion. Bones and soft tissues: No destructive bone lesion. Chest wall is unremarkable. Upper abdomen: Splenic granulomas. Conclusion: No convincing evidence of intrathoracic metastases. 'd, Jan 2022 'd, Jan 2022 'd, Jan 2022
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Findings: Limitations: Noncontrasted study and motion artifact. Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: Mild paraseptal emphysema. No consolidation. No suspicious pulmonary nodule. No pleural effusion. Central airways are patent. Thoracic inlet, heart, and mediastinum: Fat interspersed thymic tissue in the anterior mediastinum, likely related to thymic hyperplasia. No lymphadenopathy in the axillary, mediastinal, or hilar regions. Calcified right hilar and subcarinal lymph nodes, likely related to prior granulomatous disease. The esophagus is nondilated. The thoracic aorta and main pulmonary artery are normal in caliber. The cardiac chambers are normal in size. No coronary artery atherosclerotic calcifications are noted, although the study is not optimized for coronary assessment. No pericardial effusion. Bones and soft tissues: No destructive bone lesion. Chest wall is unremarkable. Upper abdomen: Splenic granulomas.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Pelvis LOWER ABDOMEN: BOWEL: Left lower quadrant colostomy is visualized. No abnormal dilatation of visualized bowel loops.. PERITONEUM: Normal. OTHER: No other abnormality. PELVIS: CYSTOGRAM: Bladder is moderately distended and contains suprapubic catheter. On cystogram, dependent hyperdensity contrast is visualized within the bladder without any active contrast extravasation. No contrast extravasation is seen into the pelvic wounds. Prostate gland is not enlarged. There is small amount of urine leak from the dorsal wound along the penile shaft however no contrast was visualized in this region.. VESSELS: Moderate aortic and iliac calcifications. LYMPH NODES: Several mildly enlarged reactive in iliac/inguinal lymph nodes.. PERIRECTAL / PERIANAL REGION: Rectosigmoid stump is visualized containing hyperdense contents. Mild perirectal stranding without any discrete fluid collection URINARY BLADDER: Cystogram as described above REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Persistent large decubitus ulcers with large defects overlying the sacrum and right ischial tuberosity. There is a percutaneous drainage catheter within the right gluteal region. No discrete fluid collection is seen at the tip of this catheter. There is inflammatory soft tissue thickening/stranding in the right gluteal region. Asymmetric thickening/small fluid in the left lateral gluteal region. Stable small right groin collection measuring 5.4 x 2.5 cm. Stable small fluid collection along the medial left thigh region measuring about 5.0 x 2.9 cm. MUSCULOSKELETAL: Extensive sclerotic changes in the pelvic bones consistent with chronic osteomyelitis. Right hip amputation changes are seen with calcifications. Moderate left hip osteoarthritis. Sacral joints are intact.
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Interpretation of Outside Films CT Chest Clinical Information: 81-year-old female with provided history of pulmonary nodules. pulmonary nodules CT Chest 122121 Grandview Imaging Trussville Rec 1522 Spec Inst: pulmonary nodules CT Chest 122121 Grandview Imaging Trussville Rec 1522 Study reviewed: CT of chest without contrast performed at Grandview imaging Trussville on 12/21/2021, The images are available in PACS. Findings: Study limitation: Respiratory motion artifact. Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: Moderate upper lobe predominant centrilobular and paraseptal emphysema with mild diffuse bronchial wall thickening and mucous plugs. Mild biapical pleuroparenchymal scarring. Multiple scattered calcified granulomas in both lungs mainly involving both upper lobes. Additional few subcentimeter noncalcified pulmonary nodules are noted, for example in the right middle lobe at image 71, series 2 and a 4 mm superior segment right lower lobe nodule (image 45). The trachea and main bronchi are patent. No pleural effusion. Thoracic inlet, heart, and mediastinum: No lymphadenopathy in the axillary, mediastinal, or hilar regions. Small hiatal hernia. The thoracic aorta and main pulmonary artery are normal in caliber. The cardiac chambers are normal in size. Facet hypertrophy of the interatrial septum. Moderate coronary artery atherosclerotic calcifications are noted, although the study is not optimized for coronary assessment. No pericardial effusion. Bones and soft tissues: No destructive bone lesion. Chest wall is unremarkable. Upper abdomen: Postcholecystectomy changes. Conclusion: 1. Emphysema with diffuse bronchial wall thickening and mucous plugs. Scattered calcified granulomas and biapical pleural parenchymal scarring. 2. Few subcentimeter (less than 6 mm) pulmonary nodules. Incidental Finding: No follow-up imaging for this/these incidentally detected lung nodule(s) is recommended. If there are risk factors for lung malignancy, a follow-up chest CT exam could be obtained in 12 months. 3. Other findings as described.
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Findings: Study limitation: Respiratory motion artifact. Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: Moderate upper lobe predominant centrilobular and paraseptal emphysema with mild diffuse bronchial wall thickening and mucous plugs. Mild biapical pleuroparenchymal scarring. Multiple scattered calcified granulomas in both lungs mainly involving both upper lobes. Additional few subcentimeter noncalcified pulmonary nodules are noted, for example in the right middle lobe at image 71, series 2 and a 4 mm superior segment right lower lobe nodule (image 45). The trachea and main bronchi are patent. No pleural effusion. Thoracic inlet, heart, and mediastinum: No lymphadenopathy in the axillary, mediastinal, or hilar regions. Small hiatal hernia. The thoracic aorta and main pulmonary artery are normal in caliber. The cardiac chambers are normal in size. Facet hypertrophy of the interatrial septum. Moderate coronary artery atherosclerotic calcifications are noted, although the study is not optimized for coronary assessment. No pericardial effusion. Bones and soft tissues: No destructive bone lesion. Chest wall is unremarkable. Upper abdomen: Postcholecystectomy changes.
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FINDINGS: STRUCTURED REPORT: CT AP Trauma LOWER CHEST: LUNG BASES: Clear ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Intrauterine] device with T arms appearing to invade into the myometrium superiorly. BODY WALL: Soft tissue stranding in the lower anterior abdominal wall and right anterior thigh likely represents soft tissue contusion. Small fat-containing umbilical hernia. MUSCULOSKELETAL: No significant abnormality. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Trace retrolisthesis of L5 on S1, likely degenerative.
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Interpretation of Outside Films CT Chest Clinical Information: 53-year-old male with provided history of emphysema emphysema CT Chest 121421 Flowers Hosp Rec 1522 Spec Inst: emphysema CT Chest 121421 Flowers Hosp Rec 1522 Study reviewed: HRCT of chest with inspiratory and expiratory supine position and expiratory prone position partial images. performed at flowers Hospital on 12/14/2021, The images are available in PACS. Findings: Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: Diffuse centrilobular and paraseptal emphysema with mild diffuse bronchial wall thickening. This is associated multifocal areas of cystic bronchiectatic changes involving mainly the posterior segment right upper lobe, right middle lobe and both lower lobes with areas of mucous plugs and tree-in-bud opacities. Left lower lobe emphysematous bulla is noted. Saber-sheath configuration of the trachea. The trachea and main bronchi are patent. Expiratory images demonstrate suboptimal expiration, however no significant areas of air trapping bilaterally. No evidence of tracheobronchomalacia. Thoracic inlet, heart, and mediastinum: No supraclavicular lymphadenopathy within the field of view. No axillary lymphadenopathy. Few borderline enlarged and subcentimeter mediastinal and hilar lymph nodes, probably reactive. The esophagus is nondilated. The thoracic aorta and main pulmonary arteries are normal in caliber. The overall heart size normal. No pericardial effusion. Mild coronary calcification. Bones and soft tissues: No destructive bone lesion. Chest wall is unremarkable. Upper abdomen: No abnormality in the imaged upper abdomen. Conclusion: Diffuse centrilobular and paraseptal emphysema with mild diffuse bronchial wall thickening. This is associated multifocal areas of cystic bronchiectatic changes involving mainly the posterior segment right upper lobe, right middle lobe and both lower lobes with areas of mucous plugs and tree-in-bud opacities. These findings likely related to known Alpha I antitrypsin deficiency.
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Findings: Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: Diffuse centrilobular and paraseptal emphysema with mild diffuse bronchial wall thickening. This is associated multifocal areas of cystic bronchiectatic changes involving mainly the posterior segment right upper lobe, right middle lobe and both lower lobes with areas of mucous plugs and tree-in-bud opacities. Left lower lobe emphysematous bulla is noted. Saber-sheath configuration of the trachea. The trachea and main bronchi are patent. Expiratory images demonstrate suboptimal expiration, however no significant areas of air trapping bilaterally. No evidence of tracheobronchomalacia. Thoracic inlet, heart, and mediastinum: No supraclavicular lymphadenopathy within the field of view. No axillary lymphadenopathy. Few borderline enlarged and subcentimeter mediastinal and hilar lymph nodes, probably reactive. The esophagus is nondilated. The thoracic aorta and main pulmonary arteries are normal in caliber. The overall heart size normal. No pericardial effusion. Mild coronary calcification. Bones and soft tissues: No destructive bone lesion. Chest wall is unremarkable. Upper abdomen: No abnormality in the imaged upper abdomen.
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FINDINGS: Scouts: No additional findings. Pulmonary arteries: There is excellent contrast density opacification of the pulmonary arterial tree. No evidence of filling defects noted within the main, lobar, segmental or subsegmental pulmonary arteries. The main pulmonary artery is normal in caliber. Heart and thoracic aorta: Cardiac chambers are normal in size. No evidence of right ventricular strain by CT criteria. No pericardial effusion. The thoracic aorta is normal in caliber, without evidence of acute thoracic aortic abnormalities. Mediastinum: Small posterior mediastinal hematoma appears slightly smaller when compared to prior, with no more foci of active extravasation is identified. No new mediastinal abnormalities. Interval placement of an esophagogastric tube, traversing the esophagus, with its tip and side-port are seen within the stomach, in appropriate position. Airways: Interval intubation, the endotracheal tube tip terminates within the mid thoracic trachea, in appropriate position. The trachea and central bronchi are otherwise patent and clear. Lungs : Interval increased atelectasis within the bilateral lungs, with complete atelectasis of the left lower lobe, segmental and subsegmental atelectasis of the right lower lobe as well as the posterior left upper lobe. Pleura: Trace bilateral slightly hyperdense pleural effusions are noted, likely bilateral trace hemothoraces. Interval placement of a right pleural drain, with resolution of the previously noted small right pneumothorax. Residual focus of posterior loculated pneumothorax appears smaller (series 5, image 114). Upper abdomen: The CT of the abdomen and pelvis will be reported separately. Bones and soft tissues: Chest wall soft tissues are unremarkable. Redemonstrated versus fracture of the T11 vertebral body with vertebral body height loss, extending into the left posterior elements, with similar appearance of the posterior bulge near to the inferior endplate sagittal (series 9, image 79). Redemonstrated multiple minimally displaced rib fractures.
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16,114 |
EXAM: Outside MR Image Interpretation CLINICAL INFORMATION: Left shoulder mass COMPARISON: None. TECHNIQUE: Outside MR images of the left shoulder without intravenous contrast dated 12/7/2021 were submitted for interpretation. The MRI acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: No abnormal bone marrow signal to suggest acute fracture or aggressive osseous lesion. There is a mass centered in that of the supraspinatus fossa that follows fat signal on all sequences. The mass extends into the spinoglenoid notch as well as into the infraspinous fossa. No thick septations are seen within the mass. Full-thickness tear of the distal supraspinatus tendon extending to the conjoined tendon. There is a second full-thickness tear seen at the supraspinatus anteriormost fibers at the footprint. Tendinosis of the infraspinatus tendon. The subscapularis tendon is intact and unremarkable. The teres minor tendon is intact. There is thickening and increased signal of the long head biceps tendon. The alignment of the glenohumeral joint is unremarkable. The articular cartilage is unremarkable. Mild degenerative signal is seen within the glenoid without discrete tear. Small amount of fluid is seen within the subacromial and subdeltoid spaces. Degenerative changes of the acromioclavicular joint. No muscle atrophy is seen. CONCLUSION: 1. Lipoma within the supraspinatus fossa protruding through the spinoglenoid notch and into the infraspinous fossa. 2. Full-thickness tear of the distal supraspinatus/infraspinatus tendon junction Second full-thickness tear involving the anterior fibers at the footprint. 3. Infraspinatus and long head biceps tendinosis. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: No abnormal bone marrow signal to suggest acute fracture or aggressive osseous lesion. There is a mass centered in that of the supraspinatus fossa that follows fat signal on all sequences. The mass extends into the spinoglenoid notch as well as into the infraspinous fossa. No thick septations are seen within the mass. Full-thickness tear of the distal supraspinatus tendon extending to the conjoined tendon. There is a second full-thickness tear seen at the supraspinatus anteriormost fibers at the footprint. Tendinosis of the infraspinatus tendon. The subscapularis tendon is intact and unremarkable. The teres minor tendon is intact. There is thickening and increased signal of the long head biceps tendon. The alignment of the glenohumeral joint is unremarkable. The articular cartilage is unremarkable. Mild degenerative signal is seen within the glenoid without discrete tear. Small amount of fluid is seen within the subacromial and subdeltoid spaces. Degenerative changes of the acromioclavicular joint. No muscle atrophy is seen.
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Findings: There has been interval increase in the size of the subdural hemorrhage along the posterior falx with extension to the right tentorial leaflet. The parafalcine hematoma now measures 1.6 cm compared to 1.1 cm previously. The right frontal convexity subdural hematoma is also larger with heterogeneity measuring up to 9 mm, compared to 8 mm previously. There is increased mass effect with partial effacement of the right lateral ventricle and a midline shift of approximately 12 mm compared to 8 mm previously. There is mild dilatation of the left lateral ventricle. There is increased effacement of the basal cisterns. Delayed postcontrast images demonstrate moderate foci of contrast extravasation along the right lateral aspect of the parafalcine subdural hemorrhage. There is otherwise no other abnormal enhancement. CT angiogram head demonstrates a distal right cervical dissection with a pseudoaneurysm at the skull base measuring approximately 3 x 6 mm (axial series 501, image 759). Remaining portions of the bilateral intracranial ICAs appear unremarkable. There is distortion of the circle of Willis vasculature due to mass effect and effacement of the basal cisterns. The proximal ACAs, MCAs and PCAs appear unremarkable. The CT angiogram neck demonstrates peripherally calcified right cervical ICA aneurysm measuring up to 12 mm in diameter, likely a chronic pseudoaneurysm. There is an intimal flap with moderate narrowing of the adjacent previous true lumen. There is tortuosity of the mid left cervical ICA with mildly beaded appearance and fusiform dilatation measuring up to 9 mm in diameter. Intimal flaps are also noted in the left vertebral artery at the C3 level without flow-limiting stenosis. There is mild luminal irregularity of the right vertebral artery at the C2-3 level with a 2 mm outpouching ventrally (best seen on sagittal series 504, image 265). There are multilevel degenerative changes in the cervical spine, most prominent at C5-6 and C6-7 with severe right and moderate left foraminal narrowing. There is a likely limbus vertebra at the anterior superior margin of the C5 vertebral body. There are extensive emphysematous changes in the visualized lungs. Maxillofacial fractures are again noted.
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16,115 |
Interpretation of Outside Films CT CSPN Clinical Information: 52-year-old male with newly diagnosed renal cell cancer. CT C Spine11121 Rec 1522 Spec Inst: newly diagnosed renal cell cancer CT C Spine11121 Rec 1522 Comparison: None available Technique: Helical axial noncontrast images of the cervical spine with sagittal and coronal reformations performed at outside facility dated 11/1/2021 Findings: Visualized skull base appears normal. No acute fracture or subluxation identified in cervical spine. There is a destructive lytic lesion involving the C2 vertebral body asymmetric to the left with cortical breakthrough at the anterior aspect of the vertebral body. No additional lytic or destructive lesions identified in the cervical spine or visualized T1-T2 levels. Alignment of the cervical spine is maintained. Moderate discogenic degenerative changes with disc space narrowing and uncovertebral spurring at C5-6 and C6-7. No significant appearing spinal canal stenosis. Paravertebral soft tissues are unremarkable. Lung apices are clear. Conclusion: Destructive lytic lesion involving the C2 vertebral body, highly concerning for osseous metastasis.
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Findings: Visualized skull base appears normal. No acute fracture or subluxation identified in cervical spine. There is a destructive lytic lesion involving the C2 vertebral body asymmetric to the left with cortical breakthrough at the anterior aspect of the vertebral body. No additional lytic or destructive lesions identified in the cervical spine or visualized T1-T2 levels. Alignment of the cervical spine is maintained. Moderate discogenic degenerative changes with disc space narrowing and uncovertebral spurring at C5-6 and C6-7. No significant appearing spinal canal stenosis. Paravertebral soft tissues are unremarkable. Lung apices are clear.
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Findings: There has been interval increase in the size of the subdural hemorrhage along the posterior falx with extension to the right tentorial leaflet. The parafalcine hematoma now measures 1.6 cm compared to 1.1 cm previously. The right frontal convexity subdural hematoma is also larger with heterogeneity measuring up to 9 mm, compared to 8 mm previously. There is increased mass effect with partial effacement of the right lateral ventricle and a midline shift of approximately 12 mm compared to 8 mm previously. There is mild dilatation of the left lateral ventricle. There is increased effacement of the basal cisterns. Delayed postcontrast images demonstrate moderate foci of contrast extravasation along the right lateral aspect of the parafalcine subdural hemorrhage. There is otherwise no other abnormal enhancement. CT angiogram head demonstrates a distal right cervical dissection with a pseudoaneurysm at the skull base measuring approximately 3 x 6 mm (axial series 501, image 759). Remaining portions of the bilateral intracranial ICAs appear unremarkable. There is distortion of the circle of Willis vasculature due to mass effect and effacement of the basal cisterns. The proximal ACAs, MCAs and PCAs appear unremarkable. The CT angiogram neck demonstrates peripherally calcified right cervical ICA aneurysm measuring up to 12 mm in diameter, likely a chronic pseudoaneurysm. There is an intimal flap with moderate narrowing of the adjacent previous true lumen. There is tortuosity of the mid left cervical ICA with mildly beaded appearance and fusiform dilatation measuring up to 9 mm in diameter. Intimal flaps are also noted in the left vertebral artery at the C3 level without flow-limiting stenosis. There is mild luminal irregularity of the right vertebral artery at the C2-3 level with a 2 mm outpouching ventrally (best seen on sagittal series 504, image 265). There are multilevel degenerative changes in the cervical spine, most prominent at C5-6 and C6-7 with severe right and moderate left foraminal narrowing. There is a likely limbus vertebra at the anterior superior margin of the C5 vertebral body. There are extensive emphysematous changes in the visualized lungs. Maxillofacial fractures are again noted.
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16,116 |
EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Right colon cancer. COMPARISON: None available. TECHNIQUE: Outside CT images with IV contrast dated 12/28/2021 were submitted for interpretation. The CT acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis Chest findings to be dictated separately. ABDOMEN and PELVIS: LIVER: Suspected hepatic steatosis. No suspicious lesions. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. No wall thickening or pericholecystic fluid. PANCREAS: Normal. SPLEEN: Hypoattenuating indeterminate lesion, likely cyst. ADRENALS: Minimal bilateral adrenal nodularity. KIDNEYS: Normal. LYMPH NODES: Borderline prominent right lower quadrant mesenteric nodes which are not pathologically enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered diverticulosis without evidence of diverticulitis. Otherwise, the colon is normal for technique. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic calcification the abdominal aorta which is normal in caliber. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous lesions. CONCLUSION: 1. No colonic abnormality visualized on CT within limits of technique. No abdominopelvic metastatic disease. 2. Incidental findings as above.
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FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis Chest findings to be dictated separately. ABDOMEN and PELVIS: LIVER: Suspected hepatic steatosis. No suspicious lesions. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. No wall thickening or pericholecystic fluid. PANCREAS: Normal. SPLEEN: Hypoattenuating indeterminate lesion, likely cyst. ADRENALS: Minimal bilateral adrenal nodularity. KIDNEYS: Normal. LYMPH NODES: Borderline prominent right lower quadrant mesenteric nodes which are not pathologically enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered diverticulosis without evidence of diverticulitis. Otherwise, the colon is normal for technique. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic calcification the abdominal aorta which is normal in caliber. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous lesions.
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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: Focal fat adjacent to the falciform ligament. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. Accessory spleen is noted.. ADRENALS: Normal. KIDNEYS: Delayed nephrographic enhancement of the right kidney with mild perinephric fat stranding. Mild right hydroureteronephrosis with a 4 mm distal ureteral stone, near the UVJ. Other tiny renal calculi bilaterally, without left hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Collapsed. REPRODUCTIVE ORGANS: Uterus is normal in size. Multiple left ovarian cysts are noted, likely physiologic. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. Sclerotic focus in the right inferior pubic ramus, likely represents bone island.
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Interpretation of outside CT the chest with contrast from Regional Medical Center Central Alabama dated 12/28/2021. Indication: COVID confirmed, right colon cancer Technique: Postcontrast 5 mm thick axial, coronal and sagittal reconstructions are presented. Comparison: None. Findings: A few borderline enlarged left axillary nodes are seen. No enlarged intrathoracic lymph nodes are identified. Coronary artery calcification is seen. The heart size and the mediastinum are otherwise normal. No pleural effusion. Small area of atelectasis is seen in the lingula. The lungs are otherwise normal with no nodules or masses. CT abdomen pelvis will be reported separately. No focal destructive osseous lesions. Conclusion: 1. A few borderline enlarged left axillary nodes which may be reactive. 2. No evidence of intrathoracic metastases. No acute disease.
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Findings: A few borderline enlarged left axillary nodes are seen. No enlarged intrathoracic lymph nodes are identified. Coronary artery calcification is seen. The heart size and the mediastinum are otherwise normal. No pleural effusion. Small area of atelectasis is seen in the lingula. The lungs are otherwise normal with no nodules or masses. CT abdomen pelvis will be reported separately. No focal destructive osseous lesions.
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Hypoattenuating right thyroid nodule measuring 0.4 x 0.6 cm on series 201 image five. CHEST: LUNGS / AIRWAYS / PLEURA: There is a tiny 3 mm pulmonary nodule in the right lower lobe on series 201 image 67. Otherwise, no suspicious pulmonary nodules are identified. There is moderate biapical predominant centrilobular emphysema. No focal consolidation, pleural effusion, or pneumothorax. Central airways are patent. HEART / VESSELS: Heart size is normal. Small pericardial effusion versus pericardial thickening. Severe atherosclerosis calcifications of the coronary arteries. Atherosclerotic disease of the aortic arch and thoracic aorta. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia LYMPH NODES: Prominent left axillary lymph node versus axillary vein varix measuring 1.0 x 1.4 cm on series 201 image 31. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Innumerable hypodense lesions throughout the visualized liver. Irregular attenuation of the spleen may be related to arterial phase contrast enhancement, underlying splenic lesions cannot be excluded. Incidental left adrenal nodularity. Mild perihepatic ascites. MUSCULOSKELETAL: Sclerotic lesion of the left lateral fifth rib as seen on series 201 image 60 and series 204 image 28. Sclerotic lesion of the right aspect of the T11 vertebral body, series 204 image 84. Anterior wedging of the T7 vertebral body with sclerosis of the superior T7 endplate resulting in the less than 25% height loss. Advanced degenerative changes of the left femoral head and glenohumeral joint. ------------------
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Interpretation of Outside Films CT Neck CLINICAL INFORMATION: 71 years Male with lung mass. CT Neck 121321 Russell Med Ctr Rec 1522 Spec Inst: lung mass CT Neck 121321 Russell Med Ctr Rec 1522 TECHNIQUE: CT of the neck with contrast performed at outside facility dated 12/13/2021. Axial images in addition to sagittal and coronal reformations were reviewed. COMPARISON: Outside CT chest also performed 12/13/2021. FINDINGS: SOFT TISSUES: No focal soft tissue abnormality. LYMPH NODES: No pathologically enlarged lymph nodes identified in the neck AERODIGESTIVE STRUCTURES: No asymmetric contrast enhancement or asymmetric soft tissue nodularity. PAROTID GLANDS: Normal. SUBMANDIBULAR GLANDS: Normal. THYROID GLAND: No suspicious nodule. VASCULAR STRUCTURES: Atherosclerotic calcifications of the left greater than right carotid bulbs and proximal left ICA. There is moderate stenosis of the proximal left ICA on the order of 50% although not well characterized on this exam. OSSEOUS STRUCTURES: Moderate degenerative spondylosis of the lower cervical spine. No destructive osseous lesions identified. ORBITS: Normal. PARANASAL SINUSES AND MASTOID AIR CELLS: Paranasal sinuses, mastoid air cells and middle ears are clear. INTRACRANIAL STRUCTURES: Visualized intracranial contents are grossly unremarkable. Please see separate CT head report for further details. LUNG APICES: Large mediastinal and left hilar mass, mediastinal adenopathy, and left upper lobe lesions as detailed in separate CT chest report. CONCLUSION: 1. No adenopathy or evidence of metastatic disease within the neck. 2. Partial visualization of mediastinal mass, adenopathy, and left upper lobe lesions as described on separate CT chest report. 3. Approximately 50% stenosis of the proximal left ICA secondary to atherosclerotic disease.
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FINDINGS: SOFT TISSUES: No focal soft tissue abnormality. LYMPH NODES: No pathologically enlarged lymph nodes identified in the neck AERODIGESTIVE STRUCTURES: No asymmetric contrast enhancement or asymmetric soft tissue nodularity. PAROTID GLANDS: Normal. SUBMANDIBULAR GLANDS: Normal. THYROID GLAND: No suspicious nodule. VASCULAR STRUCTURES: Atherosclerotic calcifications of the left greater than right carotid bulbs and proximal left ICA. There is moderate stenosis of the proximal left ICA on the order of 50% although not well characterized on this exam. OSSEOUS STRUCTURES: Moderate degenerative spondylosis of the lower cervical spine. No destructive osseous lesions identified. ORBITS: Normal. PARANASAL SINUSES AND MASTOID AIR CELLS: Paranasal sinuses, mastoid air cells and middle ears are clear. INTRACRANIAL STRUCTURES: Visualized intracranial contents are grossly unremarkable. Please see separate CT head report for further details. LUNG APICES: Large mediastinal and left hilar mass, mediastinal adenopathy, and left upper lobe lesions as detailed in separate CT chest report.
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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: Trace bronchiectasis of right upper, middle, and lower lobes. Right perihilar consolidation is unchanged. Unchanged peripheral predominant subpleural reticulation/scarring, likely posttreatment changes. No new suspicious pulmonary nodule. No new focal consolidation, pneumothorax, or pleural effusion. Paraseptal emphysema appears similar. HEART / VESSELS: Normal heart size. Trace pericardial effusion, unchanged. Moderate coronary atherosclerosis. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Normal. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: Old right-sided rib fractures and medial right clavicle fracture. No aggressive osseous lesion. ---------------------------
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Interpretation of Outside Films CT Head 1/5/2022 12:47 PM Clinical Information: 71-year-old male with lung mass. Evaluation for intracranial metastasis. CT Head 121321 Russell Med Ctr Rec 1522 Spec Inst: lung mass CT Head 121321 Russell Med Ctr Rec 1522 Comparison: No prior CT or MRI of the brain for comparison. Technique: CT head with contrast performed at Russell Medical Center 12/13/2021. Axial, sagittal, and coronal images were reviewed. Findings: There is no evidence of intracranial hemorrhage, acute territorial infarct, focal mass, or mass effect. Mild age-related cerebral volume loss. Small ill-defined regions of hypoattenuation in the subcortical white matter of the bilateral frontal lobes are nonspecific but most likely related to chronic microvascular disease. No enhancing lesions or abnormal postcontrast enhancement identified. Ventricles are normal in size and configuration. No abnormal extra-axial collection. The orbits and globes appear normal. Superficial soft tissues are unremarkable. The paranasal sinuses and mastoid air cells are clear. No destructive skull lesion or acute osseous abnormality identified. Conclusion: No acute intracranial abnormality. No abnormal enhancement or CT evidence of intracranial metastasis.
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Findings: There is no evidence of intracranial hemorrhage, acute territorial infarct, focal mass, or mass effect. Mild age-related cerebral volume loss. Small ill-defined regions of hypoattenuation in the subcortical white matter of the bilateral frontal lobes are nonspecific but most likely related to chronic microvascular disease. No enhancing lesions or abnormal postcontrast enhancement identified. Ventricles are normal in size and configuration. No abnormal extra-axial collection. The orbits and globes appear normal. Superficial soft tissues are unremarkable. The paranasal sinuses and mastoid air cells are clear. No destructive skull lesion or acute osseous abnormality identified.
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Findings: Subacute left frontoparietal SDH is larger, now 1.4 cm lytic with mass effect, compression of the left lateral ventricle and 9+ mm subfalcine herniation to the right. There is new dilatation of the right temporal horn and there is overt or impending uncal herniation. The right hemisphere and posterior fossa contents are unremarkable. ---------------
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Interpretation of outside CT the chest with contrast from Russell Medical Center dated 12/13/2021. Indication: Lung mass Technique: Postcontrast 1.25 and 2.5 mm axial reconstructions are presented. Additional 2.5 mm coronal and sagittal MPR reconstructions are also presented. Comparison: None Findings: Index lesions: Measured on series 302. 1. Large middle mediastinal mass extends through the AP window into the left hilum and measures 63 x 119 mm on image 163. 2. Enlarged right paratracheal node measures 30 x 46 mm on image 119. 3. The left upper lobe cluster of nodules on series 302 image 82 has the two largest combined nodules measuring 20 x 27 mm. An additional 10 mm nodule abuts these nodules posteriorly. Right paratracheal node abuts the left-sided mass but still appears to be separate from it. The left mediastinal mass nearly encases the left pulmonary artery and does encase branches to the left upper and lower lobes. The left main pulmonary artery is compressed by the mass. The mass also partially surrounds the left mainstem bronchus and the trachea. No additional intrathoracic adenopathy is identified. Calcific atherosclerosis is seen in the aorta and coronary arteries. The main pulmonary artery is mildly enlarged at 33 mm. The heart size and mediastinum are otherwise normal. No pleural effusion. The lungs are otherwise normal with no additional nodules or masses. Slightly prominent subpleural fat seen in the right lung base. Hepatic steatosis is present. Right adrenal nodule measures 16 x 17 mm on image 362 and left adrenal nodule measures 9 x 27 mm on image 379. An exophytic cyst is seen off the left kidney. Calcification is seen in the pancreatic head. Limited images of the upper abdomen are otherwise unremarkable. Prominent but symmetric bilateral gynecomastia is noted. No focal destructive osseous lesions. Impression: 1. Large predominantly left-sided mediastinal mass as described above. This mass surrounds and/or compresses the lower trachea, left mainstem bronchus, left main pulmonary artery and the left upper and left lower lobe proximal pulmonary artery branches. 2. Additional enlarged right paratracheal node. 3. Three conglomerate left upper lobe nodules abutting but not clearly contiguous with the left-sided mediastinal mass. Overall findings suggest small cell cancer but lymphoma would also be in the differential. 4. Hepatic steatosis. 5. Bilateral adrenal nodules unable to characterize these as adenomas versus metastases on this contrasted exam. Further evaluation of the face adrenal CT or MRI would be helpful for further staging.
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Findings: Index lesions: Measured on series 302. 1. Large middle mediastinal mass extends through the AP window into the left hilum and measures 63 x 119 mm on image 163. 2. Enlarged right paratracheal node measures 30 x 46 mm on image 119. 3. The left upper lobe cluster of nodules on series 302 image 82 has the two largest combined nodules measuring 20 x 27 mm. An additional 10 mm nodule abuts these nodules posteriorly. Right paratracheal node abuts the left-sided mass but still appears to be separate from it. The left mediastinal mass nearly encases the left pulmonary artery and does encase branches to the left upper and lower lobes. The left main pulmonary artery is compressed by the mass. The mass also partially surrounds the left mainstem bronchus and the trachea. No additional intrathoracic adenopathy is identified. Calcific atherosclerosis is seen in the aorta and coronary arteries. The main pulmonary artery is mildly enlarged at 33 mm. The heart size and mediastinum are otherwise normal. No pleural effusion. The lungs are otherwise normal with no additional nodules or masses. Slightly prominent subpleural fat seen in the right lung base. Hepatic steatosis is present. Right adrenal nodule measures 16 x 17 mm on image 362 and left adrenal nodule measures 9 x 27 mm on image 379. An exophytic cyst is seen off the left kidney. Calcification is seen in the pancreatic head. Limited images of the upper abdomen are otherwise unremarkable. Prominent but symmetric bilateral gynecomastia is noted. No focal destructive osseous lesions.
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FINDINGS: STRUCTURED REPORT: CTA Aorta Runoff VASCULATURE: ABDOMINAL AORTA: Interval removal of partially occluded aortobifemoral and femoral-femoral grafts. There has been interval placement of a graft involving the aorta and bilateral SFAs which appears patent. CELIAC AXIS: No significant abnormality. SMA: No significant abnormality. RIGHT RENAL: No significant abnormality. LEFT RENAL: No significant abnormality. IMA: Patent distally. RIGHT ILIAC ARTERIES: Chronic occlusion of right external iliac artery. Advanced calcific and noncalcific atherosclerotic disease. RIGHT FEMORAL \T\ POPLITEAL ARTERIES: Aorto-SFA bypass postsurgical changes. The common femoral artery is occluded and proximal femoral artery is significantly stenotic and occluded within the inguinal canal. RIGHT TIBIAL AND PERONEAL ARTERIES: No significant abnormality. RIGHT FOOT ARTERIES: Three-vessel runoff to the foot. LEFT ILIAC ARTERIES: Chronic occlusion of the left external iliac artery. Advanced calcific and noncalcific atherosclerosis within the remaining vessels. LEFT FEMORAL \T\ POPLITEAL ARTERIES: Aorto-SFA bypass postsurgical changes. Common femoral artery is occluded with proximal femoral and profunda arteries with reconstitution of flow distally. Narrowing at the insertion of the graft to mid SFA. Popliteal artery appears occluded. LEFT TIBIAL AND PERONEAL ARTERIES: Anterior-posterior and peroneal arteries reconstitute, with distal occlusion of the anterior tibial artery. LEFT FOOT ARTERIES: Two-vessel runoff is present to the foot. ------------------------------------------------------------- LOWER CHEST: LUNG BASES / PLEURA: Dependent atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Calcific coronary atherosclerosis. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Subcentimeter right renal hypodensity is statistically a cyst but formally indeterminate. Bilateral ureteral stents are seen. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No ascites RETROPERITONEUM: There is an ill-defined right pelvic sidewall gas containing fluid collection which appears to communicate with the right groin incision which measures approximately 5.3 x 1.7 x 5.0 cm (series 201 image 170). OTHER VESSELS: No significant abnormality. URINARY BLADDER: Air is seen in the nearly collapsed urinary bladder, likely postprocedural. REPRODUCTIVE ORGANS: Uterus and adnexa are unremarkable. BODY WALL: Ventral abdominal wall midline incisional scarring. MUSCULOSKELETAL: Redemonstration of antibiotic impregnated beads within the bilateral groin incisions with surrounding edema, grossly similar to prior.
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Interpretation of Outside Films MR Head 1/5/2022 12:51 PM Clinical Information: lymphoma, eval for stem cell transplant MR Brain 12221 Baptist Hosp Rec 1522 Spec Inst: lymphoma, eval for stem cell transplant MR Brain 12221 Baptist Hosp Rec 1522 Comparison: MRI of the brain dated 12/2/2021. Technique: Outside multiplanar multisequence MRI of the brain without IV contrast. Findings: There is no intracranial enhancing lesion or restricted diffusion abnormality to concern CNS lymphoma or acute ischemic pathology. Diffuse cerebral cortical atrophy, periventricular chronic small vessel ischemic changes and cortical ischemic changes of the bilateral precentral and middle frontal gyri are again noted. Intracranial leptomeningeal enhancement appears within normal limits. Mild left-sided ventriculomegaly is also noted. The calvarial marrow signal appears normal. Impression: No evidence of intracranial CNS lymphoma.
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Findings: There is no intracranial enhancing lesion or restricted diffusion abnormality to concern CNS lymphoma or acute ischemic pathology. Diffuse cerebral cortical atrophy, periventricular chronic small vessel ischemic changes and cortical ischemic changes of the bilateral precentral and middle frontal gyri are again noted. Intracranial leptomeningeal enhancement appears within normal limits. Mild left-sided ventriculomegaly is also noted. The calvarial marrow signal appears normal.
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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. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Nodular thickening with a focal lesion again seen KIDNEYS: Simple appearing right renal cyst. Left kidney is scarred/atrophic. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Trace ascites RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic disease URINARY BLADDER: Mildly thick-walled. REPRODUCTIVE ORGANS: Prostate is mildly enlarged BODY WALL: Tiny fat-containing umbilical hernia. Stent is seen in the chest wall entering the abdomen in the right upper quadrant with distal tip in the mid right pelvis without focal fluid adjacent. MUSCULOSKELETAL: No destructive osseous lesions seen.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: 80-year-old male with pancreatic body lesion COMPARISON: None available. TECHNIQUE: Outside CT images Birmingham VAMC dated 12/6/2021 were submitted for interpretation. The CT acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: IMAGE QUALITY: Satisfactory. Of note, only arterial phase axial sequence was available for review at time of dictation. Only 14 images of the portal venous axial sequence was imported for review. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Bibasilar linear atelectasis. Sensitivity for the detection of solid pulmonary nodule is limited by patient motion. DISTAL ESOPHAGUS: Oral contrast is seen within the distal esophagus. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal for technique. Not completely included within the study. BILIARY TRACT: Normal. GALLBLADDER: Numerous hypodense gallstones within the partially distended gallbladder with gallbladder wall thickening and apparent fistulization with the adjacent duodenum as detailed below. PANCREAS: Cystic-appearing lesion within the body of the pancreas measuring approximately 1.2 x 1.0 cm (series 3 image 28). No abnormal pancreatic parenchymal enhancement is visualized. No dilation of the pancreatic duct. SPLEEN: Normal. ADRENALS: Left adrenal nodule measuring 1.2 x 1.0 cm (series 3 image 29). The right adrenal is normal. KIDNEYS: Numerous bilateral simple renal cysts, the largest of which measures 9.2 x 8.9 cm (series 3 image 23) and is located on the right mid kidney. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Diffuse edema of the proximal duodenum wall with a fistulous connection to the gallbladder (series 3 image 28). There are numerous hypodense, well-circumscribed lesions throughout the duodenum and small bowel, likely corresponding to gallstones. The largest intraluminal stone measures 2.8 x 2.7 cm (series 3 image 59). Dilation of the small bowel upstream to this large gallstone is noted. No pneumatosis within the small bowel. COLON / APPENDIX: Diverticulosis. The appendix is normal. PERITONEUM / MESENTERY: Mesenteric fat stranding surrounding the gallbladder and proximal duodenum. Trace free pelvic fluid. No free intraperitoneal air. RETROPERITONEUM: Normal. VESSELS: Moderate to severe atherosclerotic calcifications of the abdominal aorta which is normal in caliber. URINARY BLADDER: Normal. Evaluation is limited secondary to streak artifact from bilateral total hip arthroplasties. REPRODUCTIVE ORGANS: Evaluation is limited secondary to streak artifact. BODY WALL: Fat-containing periumbilical hernia. MUSCULOSKELETAL: Discogenic degenerative changes throughout the lumbar spine most severe at L3-L4. Bilateral total hip arthroplasties. No aggressive osseous lesions. CONCLUSION: 1. Cholecystoduodenal fistula with numerous gallstones throughout the lumen of the small bowel. 2. Small bowel obstruction with a transition point within the left lower quadrant secondary to a large gallstone within the bowel lumen. 3. Cystic appearing lesion within the body of the pancreas measuring up to 1.2 cm, likely representing a side branch IPMN. No suspicious nodular enhancement is visualized on arterial phase. 4. Oral contrast within the distal esophagus suggestive of gastroesophageal reflux. Additional incidental findings as described above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: IMAGE QUALITY: Satisfactory. Of note, only arterial phase axial sequence was available for review at time of dictation. Only 14 images of the portal venous axial sequence was imported for review. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Bibasilar linear atelectasis. Sensitivity for the detection of solid pulmonary nodule is limited by patient motion. DISTAL ESOPHAGUS: Oral contrast is seen within the distal esophagus. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal for technique. Not completely included within the study. BILIARY TRACT: Normal. GALLBLADDER: Numerous hypodense gallstones within the partially distended gallbladder with gallbladder wall thickening and apparent fistulization with the adjacent duodenum as detailed below. PANCREAS: Cystic-appearing lesion within the body of the pancreas measuring approximately 1.2 x 1.0 cm (series 3 image 28). No abnormal pancreatic parenchymal enhancement is visualized. No dilation of the pancreatic duct. SPLEEN: Normal. ADRENALS: Left adrenal nodule measuring 1.2 x 1.0 cm (series 3 image 29). The right adrenal is normal. KIDNEYS: Numerous bilateral simple renal cysts, the largest of which measures 9.2 x 8.9 cm (series 3 image 23) and is located on the right mid kidney. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Diffuse edema of the proximal duodenum wall with a fistulous connection to the gallbladder (series 3 image 28). There are numerous hypodense, well-circumscribed lesions throughout the duodenum and small bowel, likely corresponding to gallstones. The largest intraluminal stone measures 2.8 x 2.7 cm (series 3 image 59). Dilation of the small bowel upstream to this large gallstone is noted. No pneumatosis within the small bowel. COLON / APPENDIX: Diverticulosis. The appendix is normal. PERITONEUM / MESENTERY: Mesenteric fat stranding surrounding the gallbladder and proximal duodenum. Trace free pelvic fluid. No free intraperitoneal air. RETROPERITONEUM: Normal. VESSELS: Moderate to severe atherosclerotic calcifications of the abdominal aorta which is normal in caliber. URINARY BLADDER: Normal. Evaluation is limited secondary to streak artifact from bilateral total hip arthroplasties. REPRODUCTIVE ORGANS: Evaluation is limited secondary to streak artifact. BODY WALL: Fat-containing periumbilical hernia. MUSCULOSKELETAL: Discogenic degenerative changes throughout the lumbar spine most severe at L3-L4. Bilateral total hip arthroplasties. No aggressive osseous lesions.
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Findings: Stable positioning of right frontal approach ventriculostomy catheter with interval decrease in size of shunted ventricular volume. For reference the left atrium measures 16 mm previously 20 mm. Redemonstration of mixed attenuation mass of the right cerebellar pontine angle with mild enlargement of the solid component measuring 25 mm in the maximum transverse diameter previously 21 mm. there is interval mild enlargement of the prominent extra-axial spaces in the bifrontal region with minimal increased density most consistent with a cystic hygroma versus old subdural hemorrhage. The remaining images the brain demonstrate no intracranial hemorrhage, hydrocephalus or evidence of acute infarction. Mucosal thickening of the sphenoidal sinuses suggestive for sinusitis. No acute osseous or soft tissue abnormality seen.
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EXAM: Outside MR Image Interpretation CLINICAL INFORMATION: Left humerus mass COMPARISON: None. TECHNIQUE: Outside MR images of the left humerus without and with intravenous contrast dated 12/28/2021 were submitted for interpretation. The MRI acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: No abnormal bone marrow signal or enhancement to suggest acute fracture or aggressive osseous lesion. Within the posterior compartment of the upper arm between the lateral and long head of the triceps and brachialis, there is a lipomatous mass following fat signal on all sequences. Within the lateral aspect of the mass, there is areas of low T1 and T2 signal possibly representing soft tissue component with punctate calcification. There is faint postcontrast enhancement within this region. The mass abuts the posterior cortex of the proximal humerus as well as the neurovascular bundle of the upper arm. There is mild thickening and enhancement of the long head biceps tendon sheath within the bicipital groove. The remaining visualized muscles and tendons of the upper arm are intact and unremarkable. There is mild pericapsular edema and postcontrast enhancement about the glenohumeral joint. CONCLUSION: 1. Lipomatous mass within the posterior compartment of the upper arm may represent atypical lipoma versus low grade liposarcoma. This mass would be amenable to percutaneous biopsy. 2. Long head biceps tenosynovitis. 3. There is mild pericapsular edema and postcontrast enhancement about the glenohumeral joint possibly representing capsulitis. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: No abnormal bone marrow signal or enhancement to suggest acute fracture or aggressive osseous lesion. Within the posterior compartment of the upper arm between the lateral and long head of the triceps and brachialis, there is a lipomatous mass following fat signal on all sequences. Within the lateral aspect of the mass, there is areas of low T1 and T2 signal possibly representing soft tissue component with punctate calcification. There is faint postcontrast enhancement within this region. The mass abuts the posterior cortex of the proximal humerus as well as the neurovascular bundle of the upper arm. There is mild thickening and enhancement of the long head biceps tendon sheath within the bicipital groove. The remaining visualized muscles and tendons of the upper arm are intact and unremarkable. There is mild pericapsular edema and postcontrast enhancement about the glenohumeral joint.
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Sensitivity is limited in areas by respiratory motion. Stable postsurgical changes of right lower lobe. No new suspicious lesion. No focal consolidation, pneumothorax, or pleural effusion. Anterior right upper lobe scarring, likely postradiation changes. There are new tree-in-bud type densities seen throughout the left lower lobe and centrally within the lingula HEART / VESSELS: Normal heart size without pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. Prominent right lower paratracheal node measuring 1.0 cm in short axis (series 12, image 73), unchanged from 2015. Subcarinal calcified node. Right axillary nodal dissection changes. CHEST WALL: No significant abnormality. MUSCULOSKELETAL: Old right lateral 5th rib fracture. No aggressive osseous lesion. Abdominal findings reported separately. ----------------------
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EXAM: Outside MR Image Interpretation CLINICAL INFORMATION: Right femur lesion COMPARISON: None. TECHNIQUE: Outside MR images of the right hip without and with intravenous contrast dated 12/17/2021 were submitted for interpretation. The MRI acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: Within the intertrochanteric region of the proximal right femur, there is a multilobulated, heterogeneous T1 and T2 lesion measuring 2.1 x 2.2 cm (image 14, series 501). The lesion demonstrates a narrow zone of transition with sharply defined margins. No surrounding marrow edema or periosteal reaction. The remaining osseous structures are unremarkable. The bilateral hip joints are unremarkable. The right acetabular labrum is unremarkable for nonarthrographic technique. Mild thickening and increased signal of the gluteal tendons at their insertion on the greater trochanter with mild adjacent fluid. CONCLUSION: 1. Enchondroma of the proximal right femur. 2. Tendinosis of the gluteal tendons at their insertion with associated trochanteric bursitis. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: Within the intertrochanteric region of the proximal right femur, there is a multilobulated, heterogeneous T1 and T2 lesion measuring 2.1 x 2.2 cm (image 14, series 501). The lesion demonstrates a narrow zone of transition with sharply defined margins. No surrounding marrow edema or periosteal reaction. The remaining osseous structures are unremarkable. The bilateral hip joints are unremarkable. The right acetabular labrum is unremarkable for nonarthrographic technique. Mild thickening and increased signal of the gluteal tendons at their insertion on the greater trochanter with mild adjacent fluid.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately dictated CT chest. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. Stable simple right hepatic dome cysts. No new liver lesions. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Kidneys demonstrate symmetric enhancement. Mild dilatation of right renal pelvis LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Multiple gas containing duodenal diverticuli. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Osteopenia. No destructive osseous lesion.
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Interpretation of Outside Films MR MSK Clinical information: 28 years Male with history of recurrent inflammatory myelofibroblastic tumor status post reexcision/ tumor debulking in October 2020. Patient was treated with chemotherapy in May 2021 with decreased size of the residual tumor on study dated 8/30/2021. Here for follow-up. Technique: Coronal, sagittal, and axial T1 postcontrast images, T1 coronal and sagittal, T2 fat saturated coronal, axial, and sagittal, T1 pre and postcontrast sequences were obtained through the right femur at Dothan Diangostic Medical Center on 12/22/2021. Please note the examination was performed outside of UAB protocol, monitoring and oversight. There are associated diagnostic limitations which should be considered prior to implementation of clinical decisions. Comparison: MRI right femur 8/30/2021, 4/22/2021, and multiple priors dating back to 1/23/2018 Findings: Postsurgical changes from prior tumor developing and internal fixation of pathologic fracture of the mid femoral diaphysis. There is new marrow replacement of the mid to distal femur with associated enhancement and hyperintensity on T2 sequences. There is new backing out of the anterior fixation plate with interposed T1 isointense, heterogeneously T2 hyperintense soft tissue mass, best seen on sagittal T1 sequences, measuring approximately 5.4 x 2.1 x 12.2 cm (TV by AP by CC) (series 12, image 11 and series 13, image 17). There is no definite enhancement within this mass, although, evaluation somewhat limited by artifact related to hardware. The distal most interlocking screws are no longer seated within bone. Unchanged alignment of the femoral fragments. The mass in the right abductor brevis musculature is unchanged in size, measuring 2.6 x 1.9 cm (TV by AP) (series 11, image 17). No enhancement is identified within the mass, however, evaluation limited in the absence of comparable axial T1 precontrast images. Mildly prominent popliteal lymph node is similar in size to prior exam (series 10, image 16). Mildly enlarged right pelvic sidewall and inguinal lymph nodes are similar to exam dated 4/22/2021. There is persistent edema within the abductor musculature and increasing intramuscular edema in the posterior compartment of the distal thigh. There is subcutaneous edema surrounding the knee. No knee effusion. Subcutaneous edema over the mid lateral thigh as well as within the quadriceps musculature has increased from prior. Conclusion: 1. Interval backing out of the anterior femoral fixation plate with new interposed soft tissue and marrow replacement of the distal femoral diaphysis, reflecting progression of disease. 2. Unchanged mass in the right abductor brevis, likely treated metastasis. 3. Persistent mildly enlarged right pelvic sidewall and inguinal lymph nodes. Unchanged mildly enlarged popliteal lymph node.
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Findings: Postsurgical changes from prior tumor developing and internal fixation of pathologic fracture of the mid femoral diaphysis. There is new marrow replacement of the mid to distal femur with associated enhancement and hyperintensity on T2 sequences. There is new backing out of the anterior fixation plate with interposed T1 isointense, heterogeneously T2 hyperintense soft tissue mass, best seen on sagittal T1 sequences, measuring approximately 5.4 x 2.1 x 12.2 cm (TV by AP by CC) (series 12, image 11 and series 13, image 17). There is no definite enhancement within this mass, although, evaluation somewhat limited by artifact related to hardware. The distal most interlocking screws are no longer seated within bone. Unchanged alignment of the femoral fragments. The mass in the right abductor brevis musculature is unchanged in size, measuring 2.6 x 1.9 cm (TV by AP) (series 11, image 17). No enhancement is identified within the mass, however, evaluation limited in the absence of comparable axial T1 precontrast images. Mildly prominent popliteal lymph node is similar in size to prior exam (series 10, image 16). Mildly enlarged right pelvic sidewall and inguinal lymph nodes are similar to exam dated 4/22/2021. There is persistent edema within the abductor musculature and increasing intramuscular edema in the posterior compartment of the distal thigh. There is subcutaneous edema surrounding the knee. No knee effusion. Subcutaneous edema over the mid lateral thigh as well as within the quadriceps musculature has increased from prior.
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Findings: There is no evidence of acute infarction, hemorrhage or hydrocephalus. There is no vasogenic edema or mass effect. The visualized paranasal sinuses and mastoid air cells are clear. There is no acute osseous abnormality.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Pelvic mass and elevated CEA 125. Patient presented with abdominal pain to outside hospital emergency department on 12/27/2021. COMPARISON: None. TECHNIQUE: Outside CT images with intravenous contrast dated 12/28/2021 were submitted for interpretation. The CT acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: No pleural effusion. Very minimal subsegmental atelectasis in the lung bases bilaterally. DISTAL ESOPHAGUS: Small hiatal hernia. HEART / VESSELS: Minimal left anterior descending coronary artery calcifications. The heart is normal in size. ABDOMEN and PELVIS: LIVER: No intrahepatic lesion. Mass effect from large mass centered in the pelvis, as below. BILIARY TRACT: Normal. GALLBLADDER: Not seen. PANCREAS: No main pancreatic ductal dilation. The pancreas appears normal, but displaced to the left hemiabdomen by large pelvic mass. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No gastric or small bowel obstruction. COLON / APPENDIX: Mass effect on the colon by large pelvic mass. No colonic obstruction. PERITONEUM / MESENTERY: No ascites. RETROPERITONEUM: Normal. VESSELS: Minimal atherosclerotic calcifications of the normal in caliber abdominal aorta. Mass effect on the IVC and iliac vessels bilaterally by the large pelvic mass. URINARY BLADDER: Anteriorly displaced by the large pelvic mass. No intravesicular mass. REPRODUCTIVE ORGANS: Large septated cystic pelvic mass measuring at least 31 x 24 x 22 cm. The uterus and ovaries are not seen separate from this large pelvic mass. BODY WALL: Diffuse subcutaneous edema. MUSCULOSKELETAL: No destructive osseous lesion. CONCLUSION: 1. Indeterminate large septated cystic pelvic mass extending into the abdomen with mass effect on the pelvic and intra-abdominal organs, as detailed. Favor that this is an epithelial neoplasm ovarian in origin. Gynecological oncology consultation is recommended. 2. No ascites or peritoneal nodularity identified. No distant metastatic disease within the imaged abdomen and pelvis seen. 3. Mild atherosclerosis, minimal coronary artery calcifications, and subcutaneous edema with additional findings, as detailed.
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FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: No pleural effusion. Very minimal subsegmental atelectasis in the lung bases bilaterally. DISTAL ESOPHAGUS: Small hiatal hernia. HEART / VESSELS: Minimal left anterior descending coronary artery calcifications. The heart is normal in size. ABDOMEN and PELVIS: LIVER: No intrahepatic lesion. Mass effect from large mass centered in the pelvis, as below. BILIARY TRACT: Normal. GALLBLADDER: Not seen. PANCREAS: No main pancreatic ductal dilation. The pancreas appears normal, but displaced to the left hemiabdomen by large pelvic mass. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No gastric or small bowel obstruction. COLON / APPENDIX: Mass effect on the colon by large pelvic mass. No colonic obstruction. PERITONEUM / MESENTERY: No ascites. RETROPERITONEUM: Normal. VESSELS: Minimal atherosclerotic calcifications of the normal in caliber abdominal aorta. Mass effect on the IVC and iliac vessels bilaterally by the large pelvic mass. URINARY BLADDER: Anteriorly displaced by the large pelvic mass. No intravesicular mass. REPRODUCTIVE ORGANS: Large septated cystic pelvic mass measuring at least 31 x 24 x 22 cm. The uterus and ovaries are not seen separate from this large pelvic mass. BODY WALL: Diffuse subcutaneous edema. MUSCULOSKELETAL: No destructive osseous lesion.
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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. Visualized HEART / VESSELS: Calcific coronary atherosclerosis. Minimal aortic valve annular calcifications. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Scattered calcified granulomas. ADRENALS: Normal. KIDNEYS: No significant abnormality. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The colon is unremarkable. Normal appendix. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild to moderate calcific atherosclerosis of the abdominal aorta and its branch vessels. URINARY BLADDER: Partially collapsed. REPRODUCTIVE ORGANS: Mild prostatomegaly. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Moderate discogenic degenerative changes most prominent at L3-L4.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: 56-year-old female with potentially diffuse infiltrative hepatocellular carcinoma versus mixed hepatocellular carcinoma and cholangiocarcinoma. COMPARISON: Subsequent MR abdomen 1/5/2022 TECHNIQUE: Outside CT images with IV contrast dated 12/13/2021 were submitted for interpretation. The CT acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT HCC Screening FINDINGS: IMAGE QUALITY: Suboptimal, single phase LOWER CHEST: LUNG BASES / PLEURA: Right middle lobe 3 mm noncalcified pulmonary nodule. Minimal subsegmental atelectasis in the lung bases. Small pneumatocele right lower lobe. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Borderline cirrhotic. No steatosis. The liver is enlarged and heterogeneous in attenuation, most notably in the caudate lobe. LIVER LESIONS: Heterogeneous attenuation of the hepatic parenchyma, most pronounced in the caudate lobe and central liver. Given portal venous phase evaluation, washout is possible; however, no focal lesion identified on subsequent MR examination. LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: Small (
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FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT HCC Screening FINDINGS: IMAGE QUALITY: Suboptimal, single phase LOWER CHEST: LUNG BASES / PLEURA: Right middle lobe 3 mm noncalcified pulmonary nodule. Minimal subsegmental atelectasis in the lung bases. Small pneumatocele right lower lobe. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Borderline cirrhotic. No steatosis. The liver is enlarged and heterogeneous in attenuation, most notably in the caudate lobe. LIVER LESIONS: Heterogeneous attenuation of the hepatic parenchyma, most pronounced in the caudate lobe and central liver. Given portal venous phase evaluation, washout is possible; however, no focal lesion identified on subsequent MR examination. LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: Small (
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis Chest findings to be dictated separately; please see separate CT chest report same day. ABDOMEN and PELVIS: LIVER: The liver is normal in size and morphology. No hepatic steatosis on the current examination. Two subcentimeter hypoattenuating lesions in the right hepatic lobe are unchanged, probable cysts. No suspicious hepatic lesion. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Small hiatal hernia. No gastric or small bowel obstruction. COLON / APPENDIX: The colon is normal in caliber. Scattered noninflamed colonic diverticula. The appendix is not seen; however, no secondary signs of appendicitis. PERITONEUM / MESENTERY: No ascites. No peritoneal nodularity. RETROPERITONEUM: No other abnormality. VESSELS: Normal caliber of the abdominal aorta and IVC. Patent hepatic veins and portal venous system. Unchanged prominent right gonadal vein, possibly thrombosed. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus and adnexal structures are within normal size limits. No suspicious adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Similar appearance of old fracture right inferior pubic ramus and degenerative changes of the pubic symphysis. No destructive osseous lesion.
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Interpretation of Outside Films MR CSPN 1/6/2022 11:32 AM Clinical Information: query left branchial plexus problem following latissimus dorsi muscle free flap MR C Spine 122321 Rec 1622 Spec Inst: query left branchial plexus problem following latissimus dorsi muscle free flap MR C Spine 122321 Rec 1622 Comparison: None. Technique: Outside multisequence multiplanar MRI of C-spine. Findings: Anatomical curvature: Normal. Alignment: Normal. Vertebral marrow: Normal. Spinal canal: Moderate stenosis at C3-C4, C4-C5, C5-C6, and mild stenosis at C6-C7. Spinal cord: Normal in caliber and signal intensity. Brachial plexus: Unremarkable. Facet joint: Normal. Craniovertebral junction: Normal. Intervertebral disc and neural foramina at individual levels: C1-C2: Unremarkable. C2-C3: Unremarkable. C3-C4: Disc bulge. C4-C5: Disc bulge and mild ligamentum flavum thickening. Uncinate spurring with neural foraminal stenosis bilaterally. C5-C6: Disc bulge. Uncinate spurring with neural foraminal stenosis bilaterally. C6-C7: Disc bulge. Uncinate spurring with neural foraminal stenosis on the right. C7-T1: Unremarkable. Impression: 1. Disc bulge with moderate spinal canal stenosis at C3-C4, C4-C5, C5-C6. 2. Neural foraminal stenosis at C4-C5, C5-C6, and C6-C7.
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Findings: Anatomical curvature: Normal. Alignment: Normal. Vertebral marrow: Normal. Spinal canal: Moderate stenosis at C3-C4, C4-C5, C5-C6, and mild stenosis at C6-C7. Spinal cord: Normal in caliber and signal intensity. Brachial plexus: Unremarkable. Facet joint: Normal. Craniovertebral junction: Normal. Intervertebral disc and neural foramina at individual levels: C1-C2: Unremarkable. C2-C3: Unremarkable. C3-C4: Disc bulge. C4-C5: Disc bulge and mild ligamentum flavum thickening. Uncinate spurring with neural foraminal stenosis bilaterally. C5-C6: Disc bulge. Uncinate spurring with neural foraminal stenosis bilaterally. C6-C7: Disc bulge. Uncinate spurring with neural foraminal stenosis on the right. C7-T1: Unremarkable.
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Stable appearance of right thyroid goiter with internal calcification exerting mass effect on the trachea with leftward tracheal deviation. CHEST: LUNGS / AIRWAYS / PLEURA:The right lower lobe nodule appears grossly stable in size, difficult to measure due to the postobstructive mucus impaction. Currently this measures 2.6 x 1.4 cm (image 126 series 10), previously 2.6 x 1.4 cm (image 152 series 9). The distal mucoid impaction appears increased and there is some new satellite nodularity noted on image 128 series 10. The spiculated left upper lobe nodule is unchanged currently measuring 0.7 x 0.7 cm (image 51 series 10), previously 0.7 x 0.7 cm (image 56 series 9). HEART / VESSELS: Heart size is normal. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Continued decrease in size in the anterior mediastinal mass with trace residual anterior mediastinal nodularity measuring approximately 0.9 x 1.1 cm on series 10 image 87. LYMPH NODES: None enlarged. CHEST WALL: Bilateral breast prostheses are present. UPPER ABDOMEN: Please see same day CT abdomen for abdomen findings. MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality. ----------------------------
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Interpretation of Outside Films CT Chest Clinical Information: undiagnosed lymphoma CT Chest 112921 St Vincents Rec 1622 Spec Inst: undiagnosed lymphoma CT Chest 112921 St Vincents Rec 1622 Study reviewed: CT of chest performed at St. Vincent's on 11/29/2021. . The images are available in PACS. Please note the examination was performed outside of UAB protocol, monitoring and oversight. There are associated diagnostic limitations which should be considered prior to implementation of clinical decisions. Comparison:11/2/2021 Findings: Included images of the lower neck are unremarkable. Normal heart size. Mediastinal structures are within normal limits. No pathologically enlarged intrathoracic lymph nodes. The central airways are patent. Scattered small bilateral pulmonary nodules, the largest measuring up to 0.7 cm in the lingula (series 2; image 82), are unchanged from the prior examination. No new or growing pulmonary nodules. Included images of the upper abdomen demonstrate mildly enlarged spleen measuring up to 14.6 cm. Mildly enlarged bilateral axillary lymph nodes, for example a right axillary lymph node measures about 1.4 x 2.4 cm. A left axillary lymph node measures about 2.0 x 2.4 cm. All of these lymph nodes have benign appearing fatty hila. No aggressive osseous lesions. Conclusion: 1. No significant change in the mildly enlarged bilateral axillary lymph nodes. 2. No significant change in the scattered bilateral subcentimeter pulmonary nodules, largest measuring up to 0.7 cm in the lingula. 3. Mildly enlarged spleen measuring up to 14.6 cm.
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Findings: Included images of the lower neck are unremarkable. Normal heart size. Mediastinal structures are within normal limits. No pathologically enlarged intrathoracic lymph nodes. The central airways are patent. Scattered small bilateral pulmonary nodules, the largest measuring up to 0.7 cm in the lingula (series 2; image 82), are unchanged from the prior examination. No new or growing pulmonary nodules. Included images of the upper abdomen demonstrate mildly enlarged spleen measuring up to 14.6 cm. Mildly enlarged bilateral axillary lymph nodes, for example a right axillary lymph node measures about 1.4 x 2.4 cm. A left axillary lymph node measures about 2.0 x 2.4 cm. All of these lymph nodes have benign appearing fatty hila. No aggressive osseous lesions.
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Findings: There is evolution of the subdural hematoma in the left hemipons. There are two new smaller foci of hemorrhage along the left anterior and posterior margins of the original hematoma and there is slight central hypodensity surrounded by foci of hemorrhage. There is dolichoectasia of the basilar artery. There is slight hypodensity in the left M1, slightly more conspicuous than on the prior scan. There is slight diffuse atrophy but the ventricles are small with normal appearance. No other parenchymal abnormalities identified. No defect is seen calvarium or skull base. There is slight deformity of the right ear pinna, possible remote injury. ----------------
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Interpretation of Outside Films CT Neck 1/6/2022 12:09 PM Clinical Information: Left parotid tumor CT Neck 12921 Sacred Heart Hosp Rec 1622 Spec Inst: left parotid tumor CT Neck 12921 Sacred Heart Hosp Rec 1622 Comparison: None available Technique: Axial CT images of the neck are provided for interpretation with coronal and sagittal reconstructions. -Please note: Outside imaging is not obtained in a standardized format accepted by UAB. This may limit sensitivity and specificity of interpretation. If clinical suspicion for pathology remains, would recommend repeat imaging at this institution. Findings: There is heterogeneous fullness in the left parotid gland with an infiltrating solid and centrally necrotic mass, approximately measuring 3.7 x 2.8 cm. There is an additional small necrotic lymph node in left level II measuring 8 mm (axial series 2, image 61). There is a level III in large round lymph node measuring 14 mm in short axis (axial image 48). There are additional smaller scattered bilateral lymph nodes that do not appear to be pathologic or significantly enlarged. There is some encroachment on the adjacent parapharyngeal fat and periparotid fat extending adjacent to the skull base. There is possible soft tissue extending to the inferior aspect of the stylomastoid foramen when compared to the other side. There is moderate mucosal thickening in the left maxillary sinus. There is dental caries. The visualized intracranial structures grossly appear unremarkable. Mucosa of the aerodigestive tract appears unremarkable. The thyroid gland, submandibular glands and the right parotid gland appear normal. There is pleural-parenchymal scarring in the right upper lung.212 There are degenerative changes in the cervical spine, most prominent at C5-6 and C6-7 with foraminal narrowing at these levels. Impression: 1. Infiltrative solid and centrally necrotic mass in the left parotid gland encroaching on the parapharyngeal and periparotid fat, compatible with malignancy. Probable asymmetric soft tissue in the left stylomastoid foramen. Evaluation with contrast-enhanced MRI would be recommended to evaluate for perineural spread. Additional necrotic left level II and rounded enlarged left level III lymph nodes, concerning for pathologic adenopathy. Comment: This interpretation is not intended to supersede the original interpretation and should not be relied upon exclusively for clinical decision making.
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Findings: There is heterogeneous fullness in the left parotid gland with an infiltrating solid and centrally necrotic mass, approximately measuring 3.7 x 2.8 cm. There is an additional small necrotic lymph node in left level II measuring 8 mm (axial series 2, image 61). There is a level III in large round lymph node measuring 14 mm in short axis (axial image 48). There are additional smaller scattered bilateral lymph nodes that do not appear to be pathologic or significantly enlarged. There is some encroachment on the adjacent parapharyngeal fat and periparotid fat extending adjacent to the skull base. There is possible soft tissue extending to the inferior aspect of the stylomastoid foramen when compared to the other side. There is moderate mucosal thickening in the left maxillary sinus. There is dental caries. The visualized intracranial structures grossly appear unremarkable. Mucosa of the aerodigestive tract appears unremarkable. The thyroid gland, submandibular glands and the right parotid gland appear normal. There is pleural-parenchymal scarring in the right upper lung.212 There are degenerative changes in the cervical spine, most prominent at C5-6 and C6-7 with foraminal narrowing at these levels.
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Findings: There is a small hypodensity in the left anterior thalamus, which was not seen on the prior study, could represent an evolving subacute to chronic infarct. There is a small left superior cerebellar hypoattenuation, also not seen on the prior exam, likely also an evolving subacute to chronic infarct. Diffuse cerebral volume loss is noted. Mild dilatation of lateral and third ventricles is seen likely due to ex vacuo dilatation. There are confluent areas of deep white matter and periventricular hypodensity secondary to moderate chronic microangiopathic changes. No mass effect, edema, hemorrhage, or hydrocephalus is seen. The visualized paranasal sinuses and mastoid air cells are clear. No acute osseous or soft tissue abnormality seen.
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16,131 |
EXAM: Interpretation of Outside Films MR MSK CLINICAL INFORMATION: 18-year-old female with MCL tear. COMPARISON: Left knee radiographs 12/22/2022 TECHNIQUE: Interpretation of Outside Films MR MSK STRUCTURED REPORT: MRI Knee v5/23//2019 FINDINGS: OSSEOUS and ARTICULAR STRUCTURES: Bones:?Osseous edema in the inferior patellar pole and anteromedial medial tibial plateau without fracture. No aggressive osseous lesion. Patellofemoral compartment: No cartilage defect.? Medial compartment:?No cartilage defect. Lateral compartment:?No cartilage defect. MENISCI: Medial meniscus:?Intact. Lateral meniscus:?Intact. LIGAMENTS: Cruciate ligaments:?Intact. Medial collateral ligament:?In the same the proximal fibers are increased in signal and thickened with longitudinal tear of the anterior fibers and complete tear of the posterior fibers. There is edema superficial to the superficial MCL. Lateral collateral ligament:?Intact. Posterolateral corner structures:?Intact. EXTENSOR MECHANISM:The distal quadriceps and patellar tendons are intact. FLUID: No joint effusion. No Baker's cyst. SOFT TISSUES: Subcutaneous soft tissue edema in the anterior medial knee soft tissues. There is fluid signal intervening between the heads and surrounding and superficial MCL at the level of the tibia. CONCLUSION: 1. Complete tear of the MCL with associated edema of the medial knee soft tissues. 2. No cruciate ligament or meniscal injury. 3. Contusions of the medial tibial plateau and inferior patella. 4. Pes anserine bursitis. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: OSSEOUS and ARTICULAR STRUCTURES: Bones:?Osseous edema in the inferior patellar pole and anteromedial medial tibial plateau without fracture. No aggressive osseous lesion. Patellofemoral compartment: No cartilage defect.? Medial compartment:?No cartilage defect. Lateral compartment:?No cartilage defect. MENISCI: Medial meniscus:?Intact. Lateral meniscus:?Intact. LIGAMENTS: Cruciate ligaments:?Intact. Medial collateral ligament:?In the same the proximal fibers are increased in signal and thickened with longitudinal tear of the anterior fibers and complete tear of the posterior fibers. There is edema superficial to the superficial MCL. Lateral collateral ligament:?Intact. Posterolateral corner structures:?Intact. EXTENSOR MECHANISM:The distal quadriceps and patellar tendons are intact. FLUID: No joint effusion. No Baker's cyst. SOFT TISSUES: Subcutaneous soft tissue edema in the anterior medial knee soft tissues. There is fluid signal intervening between the heads and surrounding and superficial MCL at the level of the tibia.
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Findings: The unenhanced images demonstrate no acute infarction, hemorrhage or hydrocephalus. There is no vasogenic edema or mass effect. Delayed postcontrast images demonstrate no abnormal parenchymal or meningeal enhancement. The visualized paranasal sinuses and mastoid air cells are clear. The visualized paranasal sinuses and mastoid air cells are clear. CT angiogram demonstrates focal segmental occlusion of left MCA inferior M2 branches with distal reconstitution. The remaining visualized portions of the ACA, MCA, and PCA territories demonstrate no focal aneurysm or stenosis. The intracranial ICAs appear unremarkable. The basilar artery is relatively small but patent. CT angiogram neck demonstrates no flow-limiting stenosis of the common carotid or internal carotid arteries. There are mild atherosclerotic changes without resulting stenosis or occlusion. The aortic arch appears unremarkable. The visualized lungs are clear. Visualized neck soft tissues appear unremarkable.
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EXAM: Outside MR Image Interpretation CLINICAL INFORMATION: Right proximal femur lesion COMPARISON: Right hip radiograph 1/6/22. TECHNIQUE: Outside MR images of the right femurs without and with intravenous contrast dated 12/30/2021 were submitted for interpretation. The MRI acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: Within the proximal right femur at the level of the lesser trochanter, there is a lesion demonstrating T1 hypointensity and intermediate T2 signal with postcontrast enhancement. The lesion measures approximately 2.3 x 2.5 x 6.1 cm. There is destruction of the medial and posterior cortex with associated periosteal reaction. Additionally, there is mild edema and enhancement within the iliopsoas muscle. The remaining osseous structures are unremarkable. The remaining visualized muscles and tendons are intact and unremarkable. No inguinal adenopathy is identified. CONCLUSION: 1. Right femur lesion at the level of the lesser trochanter is favored to represent lymphoma versus metastasis. There is associated edema and enhancement within the iliopsoas may be reactive or possibly represent invasion. As the attending 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: Within the proximal right femur at the level of the lesser trochanter, there is a lesion demonstrating T1 hypointensity and intermediate T2 signal with postcontrast enhancement. The lesion measures approximately 2.3 x 2.5 x 6.1 cm. There is destruction of the medial and posterior cortex with associated periosteal reaction. Additionally, there is mild edema and enhancement within the iliopsoas muscle. The remaining osseous structures are unremarkable. The remaining visualized muscles and tendons are intact and unremarkable. No inguinal adenopathy is identified.
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Findings: The unenhanced images demonstrate no acute infarction, hemorrhage or hydrocephalus. There is no vasogenic edema or mass effect. Delayed postcontrast images demonstrate no abnormal parenchymal or meningeal enhancement. The visualized paranasal sinuses and mastoid air cells are clear. The visualized paranasal sinuses and mastoid air cells are clear. CT angiogram demonstrates focal segmental occlusion of left MCA inferior M2 branches with distal reconstitution. The remaining visualized portions of the ACA, MCA, and PCA territories demonstrate no focal aneurysm or stenosis. The intracranial ICAs appear unremarkable. The basilar artery is relatively small but patent. CT angiogram neck demonstrates no flow-limiting stenosis of the common carotid or internal carotid arteries. There are mild atherosclerotic changes without resulting stenosis or occlusion. The aortic arch appears unremarkable. The visualized lungs are clear. Visualized neck soft tissues appear unremarkable.
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16,133 |
EXAM: Interpretation of Outside Films CT Body CLINICAL INFORMATION: Pancreatic mass COMPARISON: None. TECHNIQUE: Outside CT abdomen and pelvis with IV contrast images dated 12/4/2021 were submitted for interpretation. STRUCTURED REPORT: CT Abdomen Pelvis Outside FINDINGS: LOWER CHEST: LUNG BASES: 4 mm nodule in the right lung base. Scattered atelectasis. PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART: Scattered coronary calcifications. ABDOMEN and PELVIS: LIVER: Slight widening of the fissure is noted. No overt nodularity. BILIARY TRACT: Normal. GALLBLADDER: The gallbladder is normal in appearance. SPLEEN: Normal. PANCREAS: No pancreatic ductal dilation. There is a cystic lesion involving the pancreatic body/tail junction on series 201 image 49 measuring 2.1 x 2.0 cm. This measures simple fluid density. ADRENALS: 1.1 cm right adrenal nodule. Left gland is unremarkable. KIDNEYS: No hydronephrosis in either kidney. Multiple left renal cysts. LYMPH NODES: None pathologically enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The colon is unremarkable. Suture material at the base of the cecum may reflect prior appendectomy. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Diffuse atherosclerosis without aneurysm. URINARY BLADDER: Bladder is full of urine with mild distention of the bilateral ureters. There is a cystocele present. REPRODUCTIVE ORGANS: Prior hysterectomy. BODY WALL: Midline postsurgical changes are apparent. MUSCULOSKELETAL: No destructive osseous lesions. Degenerative changes in the spine. Multilevel lumbosacral fusion. CONCLUSION: 1. Unilocular pancreatic body/tail junction cystic lesion as described above, likely IPMN. 12 month follow-up CT/MRI is recommended. 2. Small right adrenal nodule, technically indeterminate. This could be assessed at the time of future CT/MRI as indicated. 3. Suggestion of pelvic floor dysfunction with full urinary bladder and cystocele. Consider correlation with postvoid residual ultrasound if there is concern for retention. 4. Other incidental and noncontributory findings as described above.
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FINDINGS: LOWER CHEST: LUNG BASES: 4 mm nodule in the right lung base. Scattered atelectasis. PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART: Scattered coronary calcifications. ABDOMEN and PELVIS: LIVER: Slight widening of the fissure is noted. No overt nodularity. BILIARY TRACT: Normal. GALLBLADDER: The gallbladder is normal in appearance. SPLEEN: Normal. PANCREAS: No pancreatic ductal dilation. There is a cystic lesion involving the pancreatic body/tail junction on series 201 image 49 measuring 2.1 x 2.0 cm. This measures simple fluid density. ADRENALS: 1.1 cm right adrenal nodule. Left gland is unremarkable. KIDNEYS: No hydronephrosis in either kidney. Multiple left renal cysts. LYMPH NODES: None pathologically enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The colon is unremarkable. Suture material at the base of the cecum may reflect prior appendectomy. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Diffuse atherosclerosis without aneurysm. URINARY BLADDER: Bladder is full of urine with mild distention of the bilateral ureters. There is a cystocele present. REPRODUCTIVE ORGANS: Prior hysterectomy. BODY WALL: Midline postsurgical changes are apparent. MUSCULOSKELETAL: No destructive osseous lesions. Degenerative changes in the spine. Multilevel lumbosacral fusion.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Prominent distal paraesophageal lymph node measuring 1.1 cm in short axis on image 5 series 8 is unchanged in size compared to the CT abdomen and pelvis dated 7/15/2021. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hepatic cirrhosis. No suspicious liver lesions. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Enlarged ADRENALS: Normal. KIDNEYS: Post surgical changes from right nephrectomy. No evidence of local recurrence. Multiple cysts in the left kidney. Punctate nonobstructing calculi throughout the left kidney. LYMPH NODES: Stable prominent mesenteric and retroperitoneal lymph nodes. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Trace perihepatic ascites. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Postsurgical changes from ventral hernia repair with similar protrusion of mesenteric fat and bowel at the site of repair. Similar size of the thick-walled subcutaneous fluid collection, which measures 6.0 x 1.9 cm on image 163 on series 900. Simple fluid along the inferior margin of the defect likely represents ascites. Adjacent skin thickening. MUSCULOSKELETAL: No significant abnormality.
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Interpretation of Outside Films MR Head 1/6/2022 2:17 PM Clinical Information: Left-sided trigeminal neuralgia Comparison: None available Technique: Multiplanar multisequence unenhanced images were provided from an outside institution examination dated 11/8/2021 Findings: No intracranial mass, mass effect, edema, hemorrhage, hydrocephalus, or evidence of acute infarction is seen. Age-appropriate cerebral volume. Major vascular flow voids are well-maintained. Sequences optimized for evaluation of the brainstem are degraded by motion, poor visualization of the trigeminal nerves. Trace fluid seen throughout the paranasal sinuses and mastoid air cells. No acute osseous or soft tissue abnormality. Impression: No acute intracranial abnormality. Suboptimal examination for the evaluation of trigeminal neuralgia secondary to motion and examination protocol and. Unable to exclude microvascular nerve compression. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: No intracranial mass, mass effect, edema, hemorrhage, hydrocephalus, or evidence of acute infarction is seen. Age-appropriate cerebral volume. Major vascular flow voids are well-maintained. Sequences optimized for evaluation of the brainstem are degraded by motion, poor visualization of the trigeminal nerves. Trace fluid seen throughout the paranasal sinuses and mastoid air cells. No acute osseous or soft tissue abnormality.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately dictated CT chest. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Subcentimeter hypoattenuating focus in the pancreatic tail, stable since prior CT likely represents side branch type IPMN.. Pancreas is otherwise unremarkable. Pancreatic duct is nondilated. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Left upper pole cyst. Multiple other subcentimeter foci of hypoattenuation in post kidneys are too small fracture characterization. Nonobstructing left lower pole an interpolar nephrolithiasis. LYMPH NODES: Prominent mesenteric lymph nodes, similar to prior. Stable small mildly prominent mesenteric right common iliac lymph node measuring 1.5 cm (series 302, image 236). Stable small mildly enlarged right external iliac lymph node. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic calcifications of the abdominal aorta and branch vessels. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Coarse calcifications in the prostate gland. BODY WALL: Tiny fat-containing umbilical hernia. Hernia repair clips in the left lower anterior abdominal wall. MUSCULOSKELETAL: Partially visualized right femoral internal fixation hardware. Unchanged mild anterior wedging of the T12 vertebral body with associated sclerosis. Unchanged mixed lytic and sclerotic osseous metastases. No new osseous metastases.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: History of ulcerative colitis, status post total proctocolectomy with ileo J-pouch-anal anastomosis COMPARISON: 4/26/2021 TECHNIQUE: Outside CT images of the abdomen and pelvis with IV contrast and coronal reformat dated 12/23/2021 were submitted for interpretation. The CT acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Bibasilar subsegmental atelectasis. Small calcified granuloma within the right lower lobe. No pleural effusion or concerning nodule or mass. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: The most superior portion of the dome of the liver is not visualized on images with IV contrast. However, the visualized liver is within normal limits. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Indeterminate isoenhancing lesion involving the inferior portion the spleen is stable, measuring 6.6 x 6.0 (series 5 image 45), previously 6.8 x 5.8 cm. ADRENALS: There is nonspecific thickening of the left adrenal gland, unchanged. The right adrenal gland is within normal limits. KIDNEYS: There is mild lobulation of the kidneys bilaterally without atrophy. There is a partially duplicated collecting system on the left side, unchanged. No hydroureteronephrosis or obstructing mass or stone. LYMPH NODES: There are a few scattered nodules along the anterior aspect of the mesentery that are stable in appearance and size since prior exam, likely benign lymph nodes, for example series 5 image 62. STOMACH / SMALL BOWEL: Status post ileoanal anastomosis. The anastomotic sites are within normal limits. A few dilated loops of small bowel are noted within the left upper quadrant, with moderate diffuse wall thickening and small bowel feces sign, indicative of slow transit. A definite transition point is not visualized. No mass is seen. No pneumatosis or pneumoperitoneum are noted. COLON / APPENDIX: Surgically removed. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is surgically absent. No adnexal masses. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute or aggressive osseous abnormality. Mild degenerative changes involving the lumbar spine. CONCLUSION: 1. Stable postsurgical changes related to total colectomy and ileoanal anastomosis. 2. Probable partial mechanical small bowel obstruction due to adhesions and involving a few loops of small bowel within the left upper quadrant. 2. Stable appearing indeterminate splenic lesion. 3. Other stable/incidental findings as outlined 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: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Bibasilar subsegmental atelectasis. Small calcified granuloma within the right lower lobe. No pleural effusion or concerning nodule or mass. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: The most superior portion of the dome of the liver is not visualized on images with IV contrast. However, the visualized liver is within normal limits. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Indeterminate isoenhancing lesion involving the inferior portion the spleen is stable, measuring 6.6 x 6.0 (series 5 image 45), previously 6.8 x 5.8 cm. ADRENALS: There is nonspecific thickening of the left adrenal gland, unchanged. The right adrenal gland is within normal limits. KIDNEYS: There is mild lobulation of the kidneys bilaterally without atrophy. There is a partially duplicated collecting system on the left side, unchanged. No hydroureteronephrosis or obstructing mass or stone. LYMPH NODES: There are a few scattered nodules along the anterior aspect of the mesentery that are stable in appearance and size since prior exam, likely benign lymph nodes, for example series 5 image 62. STOMACH / SMALL BOWEL: Status post ileoanal anastomosis. The anastomotic sites are within normal limits. A few dilated loops of small bowel are noted within the left upper quadrant, with moderate diffuse wall thickening and small bowel feces sign, indicative of slow transit. A definite transition point is not visualized. No mass is seen. No pneumatosis or pneumoperitoneum are noted. COLON / APPENDIX: Surgically removed. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is surgically absent. No adnexal masses. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute or aggressive osseous abnormality. Mild degenerative changes involving the lumbar spine.
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. Bilobed region of cystic airspaces in the right upper lobe with surrounding fat density is unchanged. Internal nodule measuring up to 6 mm is stable in size and appearance compared with exam from 9/2/2020 (axial series 2, image 50). Scarring in the left lower lobe and lingula is unchanged. No focal consolidation or new suspicious pulmonary nodule. No pleural effusion or pneumothorax. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged by CT criteria. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Exophytic left interpolar renal cyst is unchanged with indeterminate density. No other significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: 67-year-old male with bladder neck obstruction, enlarged prostate. COMPARISON: None available. TECHNIQUE: Outside CT images SEHMC dated 12/5/2021 were submitted for interpretation. The CT acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal mild right lower lobe atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Numerous hypodensities scattered throughout the liver with the largest measuring 3.7 x 3.0 cm (series 2 image 25), consistent with simple cysts. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: There are bilateral percutaneous nephrostomy tubes. Bilateral ureteral stents are present extending from the renal pelvises to the bladder. The right double-J ureteral stent is partially retracted with a portion of the coil in the distal ureter and the tip extending into the bladder. Mild left hydroureteronephrosis with perinephric stranding. Right mid renal hypodensity measures 1.8 x 1.7 cm, likely a cyst (series 2 image 43). LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis without evidence of diverticulitis. The appendix is not well visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: The urinary bladder is significantly distended with areas of intraluminal hyperdensity. REPRODUCTIVE ORGANS: Prostatomegaly measuring up to 7.1 cm (series 2 image 137). BODY WALL: Umbilical hernia containing fat, the anterior wall of a section of small bowel, and mesentery. MUSCULOSKELETAL: Mild discogenic degenerative changes. No aggressive osseous lesions. CONCLUSION: 1. Significant bladder distention with intraluminal hyperdensity suggestive of hemorrhage/hematoma. Margins of the hematoma are somewhat inseparable from the adjacent enlarged prostate. No definite evidence of active hemorrhage on this single phase study. 2. Mild left hydroureteronephrosis with left perinephric stranding. Bilateral nephrostomy tubes and ureteral stents are in place. 3. Umbilical hernia containing fat and the anterior wall of a bowel loop. 4. Additional chronic and incidental findings as described above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal mild right lower lobe atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Numerous hypodensities scattered throughout the liver with the largest measuring 3.7 x 3.0 cm (series 2 image 25), consistent with simple cysts. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: There are bilateral percutaneous nephrostomy tubes. Bilateral ureteral stents are present extending from the renal pelvises to the bladder. The right double-J ureteral stent is partially retracted with a portion of the coil in the distal ureter and the tip extending into the bladder. Mild left hydroureteronephrosis with perinephric stranding. Right mid renal hypodensity measures 1.8 x 1.7 cm, likely a cyst (series 2 image 43). LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis without evidence of diverticulitis. The appendix is not well visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: The urinary bladder is significantly distended with areas of intraluminal hyperdensity. REPRODUCTIVE ORGANS: Prostatomegaly measuring up to 7.1 cm (series 2 image 137). BODY WALL: Umbilical hernia containing fat, the anterior wall of a section of small bowel, and mesentery. MUSCULOSKELETAL: Mild discogenic degenerative changes. No aggressive osseous lesions.
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FINDINGS: Index lesions are measured in axial series 3 and coronal series 6. There is a slightly lobular obstructing soft tissue mass in the right lower lobe measuring approximately 38 x 33 mm in image 68, series 6. A small endobronchial nodule is also present in the right lower lobe bronchus measuring 9 x 6 mm in axial image 54, series 3. Partial post obstructive changes are present in the right lower lobe. No other discrete lung nodule or mass in either lung. Multiloculated complex right pleural effusion with thickened pleura without pneumothorax. Small pericardial effusion is also present. There are several enlarged nodes especially in the right upper and lower paratracheal and subcarinal region. The distal left innominate vein as well as right innominate vein appear relatively small in caliber. The SVC however is normal in size. There is no focal lytic or sclerotic bone lesion and upper abdomen is unremarkable.
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EXAM: Outside MR Image Interpretation CLINICAL INFORMATION: Elevated PSA COMPARISON: None. TECHNIQUE: Outside MR images without and with IV contrast dated 12/21/2021 were submitted for interpretation. The MRI acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: STRUCTURED REPORT: MRI Prostate Prostate: Measurement: 5.3 x 4.0 cm in axial dimension. Prostate volume is suboptimally evaluated due to lack of coronal or sagittal images. Prostate height is estimated at 4.8 cm with a total estimated volume of 53 cc. Estimated volume: cc; Focal lesion(s): No high risk lesion is identified in the prostate Diffuse abnormalities: Enlargement of the transitional zone with numerous BPH nodules; Bladder: Trabeculated appearance. Adenopathy: No pathologically enlarged lymph nodes. Bones: No aggressive bony lesions. Other: No significant pelvic free fluid. Note: For more details about the Prostate Imaging-Reporting and Data System (PI-RADS) version 2.1, please visit: http://www.acr.org/Quality-Safety/Resources/PIRADS CONCLUSION: No high-risk lesion is identified in the prostate. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: MRI Prostate Prostate: Measurement: 5.3 x 4.0 cm in axial dimension. Prostate volume is suboptimally evaluated due to lack of coronal or sagittal images. Prostate height is estimated at 4.8 cm with a total estimated volume of 53 cc. Estimated volume: cc; Focal lesion(s): No high risk lesion is identified in the prostate Diffuse abnormalities: Enlargement of the transitional zone with numerous BPH nodules; Bladder: Trabeculated appearance. Adenopathy: No pathologically enlarged lymph nodes. Bones: No aggressive bony lesions. Other: No significant pelvic free fluid. Note: For more details about the Prostate Imaging-Reporting and Data System (PI-RADS) version 2.1, please visit: http://www.acr.org/Quality-Safety/Resources/PIRADS
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Thyroid is surgically absent. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. Calcified granuloma in the posterior right lower lobe. Innumerable tiny pulmonary nodules are seen diffusely in a random pattern, similar to prior exam. No enlarging or pulmonary nodule. No focal consolidation, pleural effusion or pneumothorax. HEART / VESSELS: Cardiomegaly with biatrial enlargement. Trace pericardial effusion. Stable left chest biventricular pacemaker. Mild coronary artery calcifications. Enlarged main pulmonary artery is redemonstrated, measuring up to 3.6 cm. MEDIASTINUM / ESOPHAGUS: No significant abnormality. LYMPH NODES: None enlarged. Few calcified paratracheal, subcarinal and right hilar lymph nodes. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Please see separately dictated CT abdomen and pelvis report. MUSCULOSKELETAL: Mild multilevel chronic degenerative changes of the thoracic spine. No aggressive osseous lesion.
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Interpretation of Outside Films CT Chest Clinical Information: pancreatic cancer, surveillance scan to compare with 122021 CT for metastatic disease in liver CT Chest 122021 Clearview Imaging Rec 1622 Spec Inst: pancreatic cancer, surveillance scan to compare with 122021 CT for metastatic disease in liver CT Chest 122021 Clearview Imaging Rec 1622 Study reviewed: CT of chest performed at Clearview diagnostic imaging on 12/20/2021. . The images are available in PACS. Please note the examination was performed outside of UAB protocol, monitoring and oversight. There are associated diagnostic limitations which should be considered prior to implementation of clinical decisions. Comparison:6/22/2021 Findings: Included images of the lower neck are unremarkable. Normal heart size. Moderate coronary artery calcifications. Left dual lead pacer with intact leads. A right chest port terminates in the superior vena cava. Nonenlarged mediastinal and right hilar lymph nodes are again seen including an atypical paraesophageal lymph node which measures about 0.7 cm in short axis. Mediastinal structures are otherwise within normal limits. String-like filling defect within the right main bronchus likely represents retained secretions. Mild to moderate bilateral upper lung predominant paraseptal emphysema. Probable old granulomatous disease bilaterally. No new or growing pulmonary nodules. Please note that the concurrently obtained CT scan of the Abdomen will be dictated separately. No aggressive osseous lesions. Soft tissues of the chest wall are unremarkable. Conclusion: Stable chest findings without intrathoracic metastatic disease.
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Findings: Included images of the lower neck are unremarkable. Normal heart size. Moderate coronary artery calcifications. Left dual lead pacer with intact leads. A right chest port terminates in the superior vena cava. Nonenlarged mediastinal and right hilar lymph nodes are again seen including an atypical paraesophageal lymph node which measures about 0.7 cm in short axis. Mediastinal structures are otherwise within normal limits. String-like filling defect within the right main bronchus likely represents retained secretions. Mild to moderate bilateral upper lung predominant paraseptal emphysema. Probable old granulomatous disease bilaterally. No new or growing pulmonary nodules. Please note that the concurrently obtained CT scan of the Abdomen will be dictated separately. No aggressive osseous lesions. Soft tissues of the chest wall are unremarkable.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Subcentimeter area of peripheral arterial enhancement on image 45 series 50 without washout on the portal venous phase may be perfusional. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Small calcification is unchanged within the pancreatic head. SPLEEN: Small accessory spleen. ADRENALS: Normal. KIDNEYS: Tiny nonobstructing right renal calculus (series 201 image 109). Multiple bilateral hypoattenuating lesions appear similar to prior and likely represent cysts. No enhancing renal mass. LYMPH NODES: Similar appearance of enlarged aortocaval lymph node conglomerate measures 3.9 x 2.7 cm on image 258 series 602, previously 4.0 x 2.6 cm on image 89 series 7, remeasured by me. STOMACH / SMALL BOWEL: Small hiatal hernia COLON / APPENDIX: Colonic diverticulosis without diverticulitis. Normal appendix. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild calcific atherosclerosis of the abdominal aorta and its branch vessels. URINARY BLADDER: Collapsed and mildly thick-walled. REPRODUCTIVE ORGANS: Prostatomegaly. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: No aggressive osseous lesion. Mild discogenic lumbosacral degenerative changes.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Pancreatic cancer status post Whipple. COMPARISON: 6/22/2021 TECHNIQUE: Outside CT images without and with IV contrast dated 12/20/2021 were submitted for interpretation. FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Interval development of ill-defined areas of hypoenhancement along the periphery of the right hepatic lobe, the largest of which measures approximately 2.7 cm on series 4, image 133. Several of these lesions have vessels running through them, suggestive of a pseudolesion. An additional suspected cyst in the posterior right hepatic lobe on series 4, image 126 is unchanged. No additional liver lesion. BILIARY TRACT: Nondilated. Pneumobilia is present. GALLBLADDER: Absent. PANCREAS: Postsurgical changes from pancreaticoduodenectomy. There is increasing perivascular soft tissue predominantly surrounding the superior mesenteric vein, measuring 2.8 x 2.0 cm on series 4, image 127 (previously 2.2 x 1.4 cm). There is increasing mass effect on the superior mesenteric vein and portosplenic confluence. Mild dilation of the pancreatic duct diffusely is similar to prior exam. No focal pancreatic masses identified. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Nonobstructing bilateral renal calculi and tiny cysts. No solid renal mass or hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Gastrojejunostomy is patent. No evidence of gastric or bowel obstruction. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Slight interval increase in perivascular mesenteric stranding. No definite omental or peritoneal nodularity. No ascites. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerosis without aneurysm. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Postsurgical changes from pancreatic duodenectomy with suspected local recurrence of pancreatic cancer as outlined above. 2. Interval development of ill-defined areas of hypoenhancement along the periphery of the right hepatic lobe with vessels running through them, suggestive of pseudolesions rather than hepatic metastases. These could represent focal fat deposition and this could be confirmed with abdominal MRI as indicated.
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FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Interval development of ill-defined areas of hypoenhancement along the periphery of the right hepatic lobe, the largest of which measures approximately 2.7 cm on series 4, image 133. Several of these lesions have vessels running through them, suggestive of a pseudolesion. An additional suspected cyst in the posterior right hepatic lobe on series 4, image 126 is unchanged. No additional liver lesion. BILIARY TRACT: Nondilated. Pneumobilia is present. GALLBLADDER: Absent. PANCREAS: Postsurgical changes from pancreaticoduodenectomy. There is increasing perivascular soft tissue predominantly surrounding the superior mesenteric vein, measuring 2.8 x 2.0 cm on series 4, image 127 (previously 2.2 x 1.4 cm). There is increasing mass effect on the superior mesenteric vein and portosplenic confluence. Mild dilation of the pancreatic duct diffusely is similar to prior exam. No focal pancreatic masses identified. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Nonobstructing bilateral renal calculi and tiny cysts. No solid renal mass or hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Gastrojejunostomy is patent. No evidence of gastric or bowel obstruction. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Slight interval increase in perivascular mesenteric stranding. No definite omental or peritoneal nodularity. No ascites. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerosis without aneurysm. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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Findings: There is interval evolution of previously noted cerebellar hemorrhage without residual hemorrhage and mild encephalomalacia. Previously seen subdural hemorrhages have also resolved. There is unchanged left frontal hypodensity, which could be a structure or cystic encephalomalacia. There is a stable left temporal hypodensity, likely choroidal fissure cyst. No new edema or hemorrhage or hydrocephalus is seen. No acute infarction seen. There is a partially empty sella. The visualized paranasal sinuses and mastoid air cells are clear. Subtle opacification of ethmoidal air cells is seen. No acute osseous or soft tissue abnormality seen.
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Interpretation of Outside Films MR Head 1/6/2022 3:12 PM Clinical Information: Right CP angle schwannoma versus meningioma status post SRS, follow-up Comparison: MRI brain without and with contrast dated 10/19/2021 Technique: Diffusion weighted series, axial FLAIR, axial T2 FS, sagittal T1, and axial T1 postcontrast sequences were acquired with field-of-view centered on the whole brain. Additional axial and coronal T1, axial 3-D T2, and axial and coronal T1 FS postcontrast sequences were acquired with field-of-view centered on the IAC. Findings: Grossly unchanged size and appearance of enhancing lesion of the right cerebellar pontine angle with extension into the right Meckel cave measuring approximately 15 x 12 mm on series 12 image 28. Apparent internal flow voids are noted. This lesion continues to abut the inferior margin of the right trigeminal nerve. There is encroachment to lesser degree upon the anterior inferior margin the right vestibulocochlear nerves. Age-appropriate cerebral volume with slight ex vacuo ventricular dilation, mild microangiopathic changes. Several prominent perivascular spaces. Major vascular flow voids are well-maintained. Visualized paranasal sinuses and mastoid air cells are unremarkable. No acute osseous or soft tissue abnormality is seen. Impression: Stable size and appearance of enhancing lesion within the right cerebellar pontine angle, extending into the Meckel cave most suggestive of schwannoma. As the attending 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: Grossly unchanged size and appearance of enhancing lesion of the right cerebellar pontine angle with extension into the right Meckel cave measuring approximately 15 x 12 mm on series 12 image 28. Apparent internal flow voids are noted. This lesion continues to abut the inferior margin of the right trigeminal nerve. There is encroachment to lesser degree upon the anterior inferior margin the right vestibulocochlear nerves. Age-appropriate cerebral volume with slight ex vacuo ventricular dilation, mild microangiopathic changes. Several prominent perivascular spaces. Major vascular flow voids are well-maintained. Visualized paranasal sinuses and mastoid air cells are unremarkable. No acute osseous or soft tissue abnormality is seen.
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FINDINGS: AORTIC MEASUREMENTS: AORTIC ROOT AT THE SINUSES: 3.7 cm sinus-commissure. MID-ASCENDING THORACIC AORTA: 6.4 x 5.9 cm. AORTIC ARCH: 3.4 x 3.0 cm. PROXIMAL DESCENDING THORACIC AORTA: 3.2 x 2.8 cm. MID DESCENDING THORACIC AORTA: 2.7 x 2.4 cm. DISTAL DESCENDING THORACIC AORTA: 2.5 x 2.3 cm. There is fusiform aneurysmal dilation of the ascending thoracic aorta. On the axial images is currently measures 6.0 cm in greatest transverse diameter (image 109 series 6), previously 5.7 cm (image 98 series 8). The aorta tapers to a normal caliber in the aortic arch. There is a common origin of the innominate artery and left common carotid artery. A moderate diameter stenosis of the proximal left subclavian artery is seen. No dissection is present. There is a small-to-moderate sized predominantly anterior and inferior pericardial effusion, worsened modestly. The main pulmonary artery is normal in caliber. There is no adenopathy or pleural effusion. Limited imaging through the upper abdomen demonstrates stable hepatic, splenic, and renal cysts. The likely splenic hemangioma is also unchanged. The 0.6 cm subpleural right upper lobe nodule on image 44 series 6 is unchanged. Other smaller calcified and noncalcified granulomas also appear similar. There is scarring/subsegmental atelectasis seen in both lung bases. Lungs are otherwise clear. No acute or aggressive osseous lesion. ------------------------------------------------------------------------------ --------------------------------------
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EXAM: Interpretation of Outside Films CT Face CLINICAL INFORMATION: Male patient 51 years with Spec Inst: FRONTAL LES CT ORBIT 121021 ST VINCENT REC 1622 TECHNIQUE: 1 mm thick serial axial images were obtained through the facial bones without and with intravenous contrast. Sagittal and coronal reformatted views were also obtained COMPARISON: MRI dated 10/18/2021 FINDINGS: Outside examination dated 12/10/2021 is submitted for interpretation on 1/7/2022. There is a relatively well-circumscribed lucent lesion within the right frontal bone. There is mild expansion of the lesion and there is also adjacent groundglass attenuation at the periphery of the lucent portion of the lesion. There are small irregular sclerotic foci within the central portion of the lesion. There is focal dehiscence along the inferior medial aspect bordering the right orbit. There is however no abnormal extension of soft tissue into the right orbit. This lesion measures approximately six 22 x 13 mm in the axial plane. There is another lesion involving the roof of the left orbit demonstrating heterogeneous groundglass attenuation. There is mild associated expansion. It measures 14 x 10 mm. There is a small incidental osteoma within the right ethmoid air cells. There is very mild mucosal thickening within both maxillary sinuses. Remaining paranasal sinuses are clear. CONCLUSION: Heterogeneous partially lytic and expansile right frontal bone lesion involving the superolateral right orbit with focal dehiscence. There is an additional slightly expansile lesion involving the left orbital roof. Both lesions contain groundglass attenuation. Findings most likely represent fibrous dysplasia
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FINDINGS: Outside examination dated 12/10/2021 is submitted for interpretation on 1/7/2022. There is a relatively well-circumscribed lucent lesion within the right frontal bone. There is mild expansion of the lesion and there is also adjacent groundglass attenuation at the periphery of the lucent portion of the lesion. There are small irregular sclerotic foci within the central portion of the lesion. There is focal dehiscence along the inferior medial aspect bordering the right orbit. There is however no abnormal extension of soft tissue into the right orbit. This lesion measures approximately six 22 x 13 mm in the axial plane. There is another lesion involving the roof of the left orbit demonstrating heterogeneous groundglass attenuation. There is mild associated expansion. It measures 14 x 10 mm. There is a small incidental osteoma within the right ethmoid air cells. There is very mild mucosal thickening within both maxillary sinuses. Remaining paranasal sinuses are clear.
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FINDINGS: A left-sided port is present with the tip at the SVC/right atrial junction. Severe coronary arterial calcification is seen. No pericardial effusion is present. The thoracic aorta and main pulmonary artery is normal in caliber. Shotty mildly enlarged mediastinal and hilar nodes are unchanged, for example the reference right hilar node again measuring 1.2 cm short axis on image 63 series 2. No new or progressive adenopathy is identified. There is no pleural effusion. Limited imaging through the upper abdomen demonstrates stable size of the left adrenal mass, unchanged since April 2021 and previously non-FDG avid. Extensive atherosclerotic calcification is also noted with small calcified splenic granulomas present. The poorly defined groundglass nodularity in the right upper lobe on image 29 series 2 is unchanged. Mild centrilobular and paraseptal emphysema is again noted. There are some new tree-in-bud type densities seen within the left lower lobe anteromedial basilar segment (image 111 series 2) as well as similar appearing opacities in the central lingula. No acute or aggressive osseous lesion. A small intramuscular lipoma anterior to the left scapula appears unchanged. ------------------------------------------------------------------------------ --------------------------------------
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Interpretation of Outside Films MR MSK CLINICAL INFORMATION: 54 years Male Spec Inst: RT SHOULD MASS MRI UP EXT 123021 HELEN KELLER REC 1/6/2022 COMPARISON: Right shoulder radiographs 12/17/2021 and shoulder MRI 10/14/2021. TECHNIQUE:Interpretation of Outside Films MR MSK FINDINGS: BONES: No acute fracture or marrow replacement. Flattening with depressed cortical irregularity of the posterior lateral humeral head again suggests remote Hill-Sachs impaction fracture. There are chronic appearing erosions of the anterior and lateral humeral head, suggesting sequela of inflammatory arthropathy. ROTATOR CUFF: Supraspinatus: Near complete full-thickness tear with tendinous retraction to the level of the AC joint. Infraspinatus: Partial-thickness articular sided tear. Subscapularis: Normal. Teres minor: Normal. LONG HEAD BICEPS TENDON: Complete biceps tendon rupture with diffuse synovial thickening and enhancement, suggesting synovitis. GLENOHUMERAL JOINT: Position: Normal. Articular cartilage: Diffuse thinning of the articular cartilage without focal full thickness defect. Ligaments/Capsule: Small glenohumeral joint effusion with marked diffuse capsular/synovial thickening and enhancement. Labrum: Normal for arthrogram technique. BURSAE: Interval increased fluid distention of the multiseptated subacromial, subdeltoid and subcoracoid bursa with diffuse synovial thickening and enhancement. ACROMIAL CLAVICULAR JOINT: Mild degenerative change. No os acromiale. SUBACROMIAL ENCROACHMENT: None. MUSCLES: There is moderate fatty atrophy of the supraspinatus musculature. There is marked edema of the supraspinatus muscle with less prominent edema also noted within the infraspinatus muscle. CONCLUSION: 1. Complex fluid and marked synovial pannus filling the subacromial/subdeltoid bursa and glenohumeral joint. There are a few humeral head erosions suggesting crystalline arthropathy or seropositive/negative inflammatory arthropathy. Infection is difficult to exclude although there has been no progressive osteolysis since the October 2021 study which would be unusual. The fluid and synovitis have increased since the prior study. 2. Near complete, full thickness tear of the supraspinatus tendon with retraction to the AC joint. There is moderate fatty atrophy of the supraspinatus musculature. The subacromial/subdeltoid bursa and glenohumeral joint spaces communicate as a result of the rotator cuff tear. 4. Partial-thickness, articular sided tear of the infraspinatus tendon. 5. Complete tear of the intra-articular long head biceps tendon. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: BONES: No acute fracture or marrow replacement. Flattening with depressed cortical irregularity of the posterior lateral humeral head again suggests remote Hill-Sachs impaction fracture. There are chronic appearing erosions of the anterior and lateral humeral head, suggesting sequela of inflammatory arthropathy. ROTATOR CUFF: Supraspinatus: Near complete full-thickness tear with tendinous retraction to the level of the AC joint. Infraspinatus: Partial-thickness articular sided tear. Subscapularis: Normal. Teres minor: Normal. LONG HEAD BICEPS TENDON: Complete biceps tendon rupture with diffuse synovial thickening and enhancement, suggesting synovitis. GLENOHUMERAL JOINT: Position: Normal. Articular cartilage: Diffuse thinning of the articular cartilage without focal full thickness defect. Ligaments/Capsule: Small glenohumeral joint effusion with marked diffuse capsular/synovial thickening and enhancement. Labrum: Normal for arthrogram technique. BURSAE: Interval increased fluid distention of the multiseptated subacromial, subdeltoid and subcoracoid bursa with diffuse synovial thickening and enhancement. ACROMIAL CLAVICULAR JOINT: Mild degenerative change. No os acromiale. SUBACROMIAL ENCROACHMENT: None. MUSCLES: There is moderate fatty atrophy of the supraspinatus musculature. There is marked edema of the supraspinatus muscle with less prominent edema also noted within the infraspinatus muscle.
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Findings: The necrotic mass extending posteriorly and downward from the angle right mandible is slightly smaller now 4.2 x 4.9 x 5.4 cm, previously 4.8 x 5 x 6.4 cm. The carotid bifurcation and proximal ICA are displaced medially and the ICA is partially encased as before. There is suggestion of tumor in the soft palate and likely the right pharyngeal tonsil. No abnormal adenopathy is seen. The hypopharynx and larynx have normal appearance. The infraglottic visceral space appears normal. The remaining soft tissues of the neck are unremarkable. There is early degenerative changes in the cervical spine but no lytic or blastic lesion is seen. ---------------
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EXAM:Interpretation of Outside Films MR MSK CLINICAL INFORMATION:10 year history of left foot pain localized to the midfoot with progressive yearly worsening. COMPARISON:1/5/2022 radiographs. TECHNIQUE: Outside MR images without IV contrast dated 12/9/2021 were submitted for interpretation. The MRI acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: BONES:No fracture, marrow replacement, or aggressive osseous lesion. ARTICULATIONS: Tibiotalar joint:Small effusion with loose osteochondral bodies. Subchondral edema. Subtalar joint:Normal. Tarsal joints: Increased signal within the subchondral marrow with of the second and third tarsometatarsal joints with loss of joint space. Additionally, there are cystic degenerative changes present within the navicular and medial cuneiform at the medial cuneonavicular joint. MEDIAL COMPARTMENT: Medial malleolus:Normal. Posterior tibial tendon:Normal. Flexor digitorum longus tendon:Normal. Deltoid ligament complex:Normal. LATERAL COMPARTMENT: Lateral malleolus:Normal. Peroneus longus tendon:Normal. Peroneus brevis tendon:Normal. Anterior tibiofibular ligament:Normal. Posterior tibiofibular ligament:Normal. Anterior talofibular ligament: Increased signal with surrounding edema likely reflecting chronic tear. Calcaneofibular ligament:Normal. POSTERIOR COMPARTMENT: Flexor hallucis longus:Normal. Achilles tendon:Normal. Plantar fascia:Normal. ANTERIOR COMPARTMENT: Anterior tibial tendon:Normal. Extensor hallucis longus:Normal. Extensor digitorum longus:Normal. TARSAL TUNNEL:Normal. SINUS TARSI:Normal. CONCLUSION: 1. Moderate degenerative changes within the tibiotalar and joints midfoot as detailed above. 2. Small tibiotalar joint effusion with multiple posterior osteochondral bodies. No objective evidence of posterior impingement or FHL tendon irritation is seen. 3. Chronic tear of the ATFL. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: BONES:No fracture, marrow replacement, or aggressive osseous lesion. ARTICULATIONS: Tibiotalar joint:Small effusion with loose osteochondral bodies. Subchondral edema. Subtalar joint:Normal. Tarsal joints: Increased signal within the subchondral marrow with of the second and third tarsometatarsal joints with loss of joint space. Additionally, there are cystic degenerative changes present within the navicular and medial cuneiform at the medial cuneonavicular joint. MEDIAL COMPARTMENT: Medial malleolus:Normal. Posterior tibial tendon:Normal. Flexor digitorum longus tendon:Normal. Deltoid ligament complex:Normal. LATERAL COMPARTMENT: Lateral malleolus:Normal. Peroneus longus tendon:Normal. Peroneus brevis tendon:Normal. Anterior tibiofibular ligament:Normal. Posterior tibiofibular ligament:Normal. Anterior talofibular ligament: Increased signal with surrounding edema likely reflecting chronic tear. Calcaneofibular ligament:Normal. POSTERIOR COMPARTMENT: Flexor hallucis longus:Normal. Achilles tendon:Normal. Plantar fascia:Normal. ANTERIOR COMPARTMENT: Anterior tibial tendon:Normal. Extensor hallucis longus:Normal. Extensor digitorum longus:Normal. TARSAL TUNNEL:Normal. SINUS TARSI:Normal.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Chest CT is reported separately. ABDOMEN and PELVIS: LIVER: Mild hepatomegaly and steatosis. No focal hepatic lesions. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Kidneys demonstrate symmetric enhancement. No hydronephrosis. LYMPH NODES: Few pelvic sidewall lymph nodes are seen, for example enlarged right pelvic sidewall lymph node measures 2.3 x 1.8 cm and on the left the node measures 2.8 x 1.9 cm. Several other subcentimeter to mildly enlarged aortocaval lymph nodes are seen. STOMACH / SMALL BOWEL: Stomach is partially distended. No abnormal dilatation of small bowel loops. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: There are a few small mesenteric nodules, for example 1.0 cm nodules in the paraumbilical region (on series 202, image 354) and small nodule in the left hemiabdomen on series 202, image 308. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Partially distended REPRODUCTIVE ORGANS: Uterus is anteverted and contains small amount of endometrial fluid. Heterogenous lower endometrial cervical mass seen without any obvious parametrial extension to the pelvic sidewall. Trace pelvic free fluid. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute osseous findings. Lumbar vertebra demonstrate normal height.
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EXAM: Outside MR Image Interpretation CLINICAL INFORMATION: Elevated PSA COMPARISON: None. TECHNIQUE: Outside hospital MRI of pelvis dated 12/02/2021. The MRI acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: STRUCTURED REPORT: MRI Prostate Prostate: Measurement: 5.8 x 4.5 x 4.6 cm cm; estimated volume: 66 cc; Focal lesion(s): Lesion # 1 (index lesion): - Key image: series 9; image 18; - Size: 1.2 x 1.0 cm; - Location: right; mid; posterolateral peripheral zone; - T2WI: 4 ; DWI: 3; DCE (early and focal enhancement): positive; - PI-RADS v2.1 score: 4; - Likelihood of extraprostatic extension: 1 - Highly unlikely; - Likelihood of seminal vesicle invasion: 1 - Highly unlikely; Diffuse abnormalities: Diffuse ill-defined T2 hypointensity in the left posterior medial and lateral peripheral zone and right peripheral zone without any focal restricted diffusion. Small extruded BPH nodule arising from the transition zone in the left lateral mid gland.; Bladder: Trabeculated appearance. Adenopathy: No pathologically enlarged lymph nodes. Bones: No aggressive bony lesions. Other: Small fat-containing left inguinal hernia. 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. A 1.2 cm PIRADS-4 in the right prostatic mid gland peripheral zone. 2. Prostatomegaly. No suspicious enlarged pelvic lymph nodes. No enhancing marrow lesions. Small fat-containing left inguinal hernia.
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FINDINGS: STRUCTURED REPORT: MRI Prostate Prostate: Measurement: 5.8 x 4.5 x 4.6 cm cm; estimated volume: 66 cc; Focal lesion(s): Lesion # 1 (index lesion): - Key image: series 9; image 18; - Size: 1.2 x 1.0 cm; - Location: right; mid; posterolateral peripheral zone; - T2WI: 4 ; DWI: 3; DCE (early and focal enhancement): positive; - PI-RADS v2.1 score: 4; - Likelihood of extraprostatic extension: 1 - Highly unlikely; - Likelihood of seminal vesicle invasion: 1 - Highly unlikely; Diffuse abnormalities: Diffuse ill-defined T2 hypointensity in the left posterior medial and lateral peripheral zone and right peripheral zone without any focal restricted diffusion. Small extruded BPH nodule arising from the transition zone in the left lateral mid gland.; Bladder: Trabeculated appearance. Adenopathy: No pathologically enlarged lymph nodes. Bones: No aggressive bony lesions. Other: Small fat-containing left inguinal hernia. 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: LINES AND TUBES: None. LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: A 4 mm solid pulmonary nodule is identified in the left lower lobe on series #202 image #131. Mild apical predominant emphysematous changes. No consolidation, pneumothorax, or large effusions. HEART / VESSELS: Cardiomegaly. The aorta is normal in caliber. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: See separate abdominal dictation. MUSCULOSKELETAL: No significant abnormality. No osseous destructive lesions.
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EXAM: Interpretation of Outside Films CT Face CLINICAL INFORMATION: Female patient 59 years with Spec Inst: POSSILE CELL CT EYE 123021 EMI REC 1622 TECHNIQUE: 1.25 mm thick serial axial images were obtained through the orbits with intravenous contrast. Sagittal and coronal reformatted views were also obtained. COMPARISON: None available. FINDINGS: Outside examination dated 12/30/2021 is submitted for interpretation on 1/7/2022. There is complete opacification of the left frontal sinus and also the anterior left ethmoid air cells. There is focal destruction of the left lamina papyracea and extension of abnormal tissue into the medial aspect of the left orbit.. The opacification of the left frontal sinus is believed to be on a post obstructive basis and represents proteinaceous obstructed fluid. However there is mild enhancement of lesion within the anterior left ethmoid air cells and within the left orbit. This lesion measures approximately 2.4 x 2.7 cm in the axial plane. The lesion measures approximately 3.6 cm in craniocaudal dimension. The lesion results in focal mass effect upon the medial rectus muscle which is displaced medially. There is also leftward and downward displacement of the left lobe. There there is no extension into the intraconal region. The mass encroaches upon but does not invade the left globe. The right frontal sinus and right ethmoid air cells are clear. There are air-fluid levels and inspissated secretions within the sphenoid sinuses bilaterally. There have been bilateral maxillary antrostomies. There is moderate right and mild left mucosal thickening within both maxillary sinuses. The right orbit is unremarkable. There is no acute abnormality within the brain. CONCLUSION: 01. Large solidly enhancing destructive lesion involving the left ethmoid air cells and left medial extraconal orbital compartment. Lesion results in mass effect upon the left globe which is displaced laterally and anteriorly and also results in obstruction of the left frontal ostium resulting in chronic left frontal sinusitis 02. Lesion likely represents neoplasm such as squamous cell carcinoma. 03. Bilateral nonobstructive sphenoid sinusitis
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FINDINGS: Outside examination dated 12/30/2021 is submitted for interpretation on 1/7/2022. There is complete opacification of the left frontal sinus and also the anterior left ethmoid air cells. There is focal destruction of the left lamina papyracea and extension of abnormal tissue into the medial aspect of the left orbit.. The opacification of the left frontal sinus is believed to be on a post obstructive basis and represents proteinaceous obstructed fluid. However there is mild enhancement of lesion within the anterior left ethmoid air cells and within the left orbit. This lesion measures approximately 2.4 x 2.7 cm in the axial plane. The lesion measures approximately 3.6 cm in craniocaudal dimension. The lesion results in focal mass effect upon the medial rectus muscle which is displaced medially. There is also leftward and downward displacement of the left lobe. There there is no extension into the intraconal region. The mass encroaches upon but does not invade the left globe. The right frontal sinus and right ethmoid air cells are clear. There are air-fluid levels and inspissated secretions within the sphenoid sinuses bilaterally. There have been bilateral maxillary antrostomies. There is moderate right and mild left mucosal thickening within both maxillary sinuses. The right orbit is unremarkable. There is no acute abnormality within the brain.
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Findings: None
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: 44-year-old female with history of colon cancer. COMPARISON: None. TECHNIQUE: Outside CT images with IV contrast dated 12/13/2021 were submitted for interpretation. The CT acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis CT chest findings are reported separately. ABDOMEN and PELVIS: LIVER: Multiple hypoattenuating lesions scattered throughout the liver, largest in hepatic segment 5 and measuring approximately 1.3 x 1.2 cm on axial series 2, image 62. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Asymmetrically decreased size of the left kidney with slightly delayed enhancement. Left double-J ureteral stent in place with distal aspect projecting near the level of the urethra. Irregular soft tissue stranding extending from the sigmoid colon towards the adjacent right distal ureter. Right kidney is normal. LYMPH NODES: A few mildly prominent retroperitoneal lymph nodes. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Circumferential wall thickening noted involving portion of the proximal sigmoid colon. Questionable luminal narrowing seen near the mid sigmoid colon on axial series 2, image 99. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Normal caliber abdominal aorta. Mild atherosclerotic disease. URINARY BLADDER: Incompletely distended. REPRODUCTIVE ORGANS: Left ovarian cyst/follicle. Intrauterine device in place. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Circumferential thickening of the proximal sigmoid colon wall, consistent with colonoscopically reported colon cancer. Luminal narrowing/stricture suspected near the mid sigmoid colon. 2. Multiple indeterminate hypoattenuating lesions throughout the liver, largest in hepatic segment 5. Although indeterminate, these lesions are concerning for metastatic disease. 3. Left renal atrophy with double-J ureteral stent in place. Irregular stranding/scarring extends from the sigmoid colon towards the adjacent left distal ureter. Distal aspect of the stent projects near the level of the urethra. Recommend clinical correlation.
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FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis CT chest findings are reported separately. ABDOMEN and PELVIS: LIVER: Multiple hypoattenuating lesions scattered throughout the liver, largest in hepatic segment 5 and measuring approximately 1.3 x 1.2 cm on axial series 2, image 62. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Asymmetrically decreased size of the left kidney with slightly delayed enhancement. Left double-J ureteral stent in place with distal aspect projecting near the level of the urethra. Irregular soft tissue stranding extending from the sigmoid colon towards the adjacent right distal ureter. Right kidney is normal. LYMPH NODES: A few mildly prominent retroperitoneal lymph nodes. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Circumferential wall thickening noted involving portion of the proximal sigmoid colon. Questionable luminal narrowing seen near the mid sigmoid colon on axial series 2, image 99. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Normal caliber abdominal aorta. Mild atherosclerotic disease. URINARY BLADDER: Incompletely distended. REPRODUCTIVE ORGANS: Left ovarian cyst/follicle. Intrauterine device in place. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Chronic thickening of the right pleura with bibasilar parenchymal bands of scarring/atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Not enlarged. No abnormality seen given limitations of unenhanced technique. BILIARY TRACT: Normal for technique. GALLBLADDER: Cholelithiasis. PANCREAS: Normal for technique. SPLEEN: Enlarged. No abnormality seen given limitations of unenhanced technique. ADRENALS: Normal. KIDNEYS: Increased calcifications are present in the inferior pole of the right kidney, the largest measuring up to 1.5 cm. Stone burden is similar in volume in the inferior pole of the left kidney, the largest measuring up to 8 mm. No hydronephrosis is evident. There is mild urothelial thickening involving the bilateral renal pelves and proximal right ureter. LYMPH NODES: Mildly enlarged pelvic and retroperitoneal lymph nodes appear similar. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Postsurgical changes from left lower quadrant end colostomy. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Accessory right renal artery. URINARY BLADDER: Suprapubic catheter noted. No bladder calculi are evident.4 REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Extensive thoracolumbar spinal hardware are redemonstrated. Diffuse paraspinal and gluteal muscular atrophy. Sacral decubitus ulcer with large skin defect reaching the bone (sacrum and right medial ilium) is again noted. Chronic skin thickening and diffuse sclerosis with focal destruction of the right ilium likely represents chronic osteomyelitis. Soft tissue thickening anterior to the right ilium is also unchanged. Right femur is absent. Chronic neuropathic destruction of the left femoral head is again noted.
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Interpretation of Outside Films CT Chest Clinical Information: 44-year-old female with provided history of colon cancer. Spec Inst: COLON CA CT CHEST 121321 OUTSIDE FAC REC 1622 Study reviewed: CT of chest with contrast performed at DCH regional on 12/13/2021, The images are available in PACS. Comparison: Outside CT chest 8/23/2021 Findings: Limitations: None. Chest: Lines, tubes, and devices: Left IJ catheter with tip at the cavoatrial junction. Lung parenchyma and pleura: No consolidation. No suspicious pulmonary nodule. No pleural effusion. Central airways are patent. Thoracic inlet, heart, and mediastinum: No lymphadenopathy in the axillary, mediastinal, or hilar regions. The esophagus is nondilated. The thoracic aorta and main pulmonary artery are normal in caliber. The cardiac chambers are normal in size. No coronary artery atherosclerotic calcifications are noted, although the study is not optimized for coronary assessment. No pericardial effusion. Bones and soft tissues: No destructive bone lesion. Chest wall is unremarkable. Upper abdomen: Reported separately. Conclusion: No evidence of metastatic disease in the chest.
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Findings: Limitations: None. Chest: Lines, tubes, and devices: Left IJ catheter with tip at the cavoatrial junction. Lung parenchyma and pleura: No consolidation. No suspicious pulmonary nodule. No pleural effusion. Central airways are patent. Thoracic inlet, heart, and mediastinum: No lymphadenopathy in the axillary, mediastinal, or hilar regions. The esophagus is nondilated. The thoracic aorta and main pulmonary artery are normal in caliber. The cardiac chambers are normal in size. No coronary artery atherosclerotic calcifications are noted, although the study is not optimized for coronary assessment. No pericardial effusion. Bones and soft tissues: No destructive bone lesion. Chest wall is unremarkable. Upper abdomen: Reported separately.
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Findings: There is no evidence of acute infarction, hemorrhage or hydrocephalus. There is no vasogenic edema or mass effect. The visualized paranasal sinuses and mastoid air cells are clear. There is a left concha bullosa. There is no acute osseous abnormality.
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16,148 |
Interpretation of Outside Films MR Head 1/6/2022 9:08 PM Clinical information: Spec Inst: NEURO WORSEN MRI BRAIN 122821 BAPTIST MED REC 1622 Comparison: Multiple prior brain MRIs, most recent from 7/23/2021 Technique: Multiplanar multisequence images of the brain before and after contrast Findings: Image quality is degraded due to motion artifacts. There is T2/FLAIR signal abnormality involving the left thalamus, midbrain and pons with associated patchy contrast enhancement. On diffusion series, there is a small focus of low ADC in the left thalamus on image #16, series 300 with corresponding increased diffusion signal abnormality. These changes are new since the prior brain MRI from 7/23/2021 and somewhat similar to the brain MRI from 2015. Impression: T2/STIR signal abnormality involving the left thalamus, midbrain and pons with associated patchy enhancement and suspected diffusion restriction. Findings are concerning for glioma recurrence. Consider repeat MRI under sedation as clinically warranted.
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Findings: Image quality is degraded due to motion artifacts. There is T2/FLAIR signal abnormality involving the left thalamus, midbrain and pons with associated patchy contrast enhancement. On diffusion series, there is a small focus of low ADC in the left thalamus on image #16, series 300 with corresponding increased diffusion signal abnormality. These changes are new since the prior brain MRI from 7/23/2021 and somewhat similar to the brain MRI from 2015.
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FINDINGS: AORTIC MEASUREMENTS: AORTIC ROOT AT THE SINUSES: 2.8 cm sinus-commissure. MID-ASCENDING THORACIC AORTA: 2.4 x 2.2 cm. AORTIC ARCH: 2.0 x 1.9 cm. PROXIMAL DESCENDING THORACIC AORTA: 1.7 x 1.6 cm. MID DESCENDING THORACIC AORTA: 1.4 x 1.4 cm. DISTAL DESCENDING THORACIC AORTA: 1.5 x 1.4 cm. CORONARY ARTERIES: The coronary arteries are reasonably well visualized and appear normal. HEART: There is calcification seen along the prior right ventricular outflow tract patch repair. There is mild narrowing of the right ventricular outflow tract measuring 1.6 x 1.1 cm in systole and 2.1 x 1.7 cm in diastole. No convincing residual VSD is seen. Left ventricular function: Left ventricular ejection fraction: 71%. Left ventricular end-diastolic volume: 100 mL. Left ventricular end-systolic volume: 28 mL. Left ventricular stroke volume: 71 mL. Left ventricular end-diastolic volume index: 69 mL/sq m. Left ventricular end-systolic volume index: 20 mL/sq m. Left ventricular stroke index: 49 mL/sq m. Left ventricular cardiac index: 2.8 L/m/sq m. Right ventricular systolic function: Right ventricular ejection fraction: 63%. Right ventricular end-diastolic volume: 151 mL. Right ventricular end-systolic volume: 56 mL. Right ventricular stroke volume: 95 mL. Right ventricular end-diastolic volume index: 105 mL/sq m. Right ventricular end-systolic volume index: 39 mL/sq m. Right ventricular stroke index: 66 mL/sq m. Right ventricular cardiac index: 3.8 L/m/sq m. PULMONARY ARTERIES: The pulmonic valve is thickened but open well. The main pulmonary artery is normal in caliber measuring 2.1 cm. The right branch pulmonary artery is normal in caliber measuring 1.9 cm. The proximal left branch pulmonary artery is dilated measuring 2.9 cm. No peripheral pulmonic stenosis is present. ASCENDING THORACIC AORTA: No significant abnormality. AORTIC ARCH: No significant abnormality. ARCH VESSELS: Common origin of innominate artery and left common carotid artery. No additional abnormality. DESCENDING THORACIC AORTA: No significant abnormality. UPPER ABDOMINAL AORTA: No significant abnormality. ------------------------------------------------------------- LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Lung apices not included. No focal consolidation, pneumothorax, or pleural effusion. No suspicious pulmonary nodule. Patent central airways. MEDIASTINUM / ESOPHAGUS: Mild circumferential thickening of the distal thoracic esophagus is noted. LYMPH NODES: None enlarged. CHEST WALL: Healed median sternotomy. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No significant abnormality. ------------------------
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: 77-year-old male with right renal mass COMPARISON: None available. TECHNIQUE: Outside CT images Jackson imaging dated 12/23/2021 were submitted for interpretation. The CT acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Mild dependent atelectasis. Right lower lung nodule measuring up to 8 mm (series 4 image 6). Additional right lower lung nodule measuring up to 6 mm (series 4 image 20). DISTAL ESOPHAGUS: Small hiatal hernia. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Subcentimeter hypodensity within the superior left hepatic lobe (series 16 image 21), too small to characterize. However, statistically representing a cyst. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: There is a well-circumscribed, heterogeneously enhancing lesion arising from the inferior pole of the right kidney measuring up to 9.1 x 8.7 cm (series 4 image 69). Subcentimeter hypodensities within the left kidney are too small to characterize; however, statistically representing cysts. Large amount of collaterals around the right kidney. Portal venous phase is suboptimal for renal vein thrombus detection although none is seen. LYMPH NODES: There is an enlarged left periaortic lymph node measuring prominent 0.7 cm minimal axial dimension (series 4 image 62. Additional prominent para-aortic and pericaval lymph nodes. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis without evidence of diverticulitis. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild scattered atherosclerotic calcifications of the abdominal aorta which is normal in caliber. URINARY BLADDER: Partially collapsed. REPRODUCTIVE ORGANS: Prostatomegaly. BODY WALL: Tiny fat-containing periumbilical hernia. Fat-containing right inguinal hernia. MUSCULOSKELETAL: Multilevel discogenic degenerative changes most prominent at L3-L4 and L4-L5. No aggressive osseous lesions. CONCLUSION: 1. Large, heterogeneously enhancing right renal mass measuring up to 9.1 cm, concerning for renal cell carcinoma. Prominent periaortic and pericaval lymph nodes, metastasis cannot be excluded. 2. Right lower lobe nodules as described above. Recommend chest CT for further evaluation. 3. Additional chronic and incidental findings as described above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Mild dependent atelectasis. Right lower lung nodule measuring up to 8 mm (series 4 image 6). Additional right lower lung nodule measuring up to 6 mm (series 4 image 20). DISTAL ESOPHAGUS: Small hiatal hernia. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Subcentimeter hypodensity within the superior left hepatic lobe (series 16 image 21), too small to characterize. However, statistically representing a cyst. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: There is a well-circumscribed, heterogeneously enhancing lesion arising from the inferior pole of the right kidney measuring up to 9.1 x 8.7 cm (series 4 image 69). Subcentimeter hypodensities within the left kidney are too small to characterize; however, statistically representing cysts. Large amount of collaterals around the right kidney. Portal venous phase is suboptimal for renal vein thrombus detection although none is seen. LYMPH NODES: There is an enlarged left periaortic lymph node measuring prominent 0.7 cm minimal axial dimension (series 4 image 62. Additional prominent para-aortic and pericaval lymph nodes. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis without evidence of diverticulitis. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild scattered atherosclerotic calcifications of the abdominal aorta which is normal in caliber. URINARY BLADDER: Partially collapsed. REPRODUCTIVE ORGANS: Prostatomegaly. BODY WALL: Tiny fat-containing periumbilical hernia. Fat-containing right inguinal hernia. MUSCULOSKELETAL: Multilevel discogenic degenerative changes most prominent at L3-L4 and L4-L5. No aggressive osseous lesions.
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Findings: There is interval increase in size of the subdural hematoma along the posterior aspect of the falx, now measures 2.3 cm in transverse diameter previously measured 1.1 cm. The hamartoma is extended trough the right tentorial leaflet. Right temporoparietal craniectomy with associated pneumocephalus is noted. There is decreased mass effect and right-to-left midline shift compared to previous CT dated 1/18/ 2022, which now measures 6 mm, previously 11.8 mm. Fractures of the anterior and lateral walls of left maxillary sinus and lateral wall of the left orbit associated with opacification and hematoma of the left maxillary sinus. Bilateral nasal bone and nasal septum fractures with associated opacification of ethmoidal air cells is seen. --------------
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Interpretation of Outside Films CT Chest Clinical Information: 72-year-old male with provided history of laryngeal cancer. Spec Inst: Leiomyosarcoma, ho laryngeal cancer - CT Chest from BMCS done 11-1-21 rec 1-7-22 Study reviewed: CT of chest with contrast performed at Carmichael imaging Center on 11/1/2021, The images are available in PACS. Findings: Limitations: Respiratory motion artifact. Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: No consolidation. No suspicious pulmonary nodule. Bilateral dependent atelectasis. No pleural effusion. Central airways are patent. Thoracic inlet, heart, and mediastinum: No lymphadenopathy in the axillary, mediastinal, or hilar regions. The esophagus is nondilated. The thoracic aorta and main pulmonary artery are normal in caliber. The cardiac chambers are normal in size. Scattered coronary artery atherosclerotic calcifications are noted, although the study is not optimized for coronary assessment. No pericardial effusion. Bones and soft tissues: No destructive bone lesion. Chest wall is unremarkable. Upper abdomen: Reported separately. Conclusion: No convincing evidence of metastatic disease in the chest.
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Findings: Limitations: Respiratory motion artifact. Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: No consolidation. No suspicious pulmonary nodule. Bilateral dependent atelectasis. No pleural effusion. Central airways are patent. Thoracic inlet, heart, and mediastinum: No lymphadenopathy in the axillary, mediastinal, or hilar regions. The esophagus is nondilated. The thoracic aorta and main pulmonary artery are normal in caliber. The cardiac chambers are normal in size. Scattered coronary artery atherosclerotic calcifications are noted, although the study is not optimized for coronary assessment. No pericardial effusion. Bones and soft tissues: No destructive bone lesion. Chest wall is unremarkable. Upper abdomen: Reported separately.
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FINDINGS: Several scattered subcentimeter size noncalcified nodules in both lungs are stable without new nodule or mass, airspace consolidation or interstitial abnormality. Linear scarring in the inferior lingula also persist. No enlarged nodes are seen in the mediastinum or either axilla. Persistent distal esophageal circumferential thickening without proximal dilatation. There is no pleural or pericardial effusion and no focal lytic or sclerotic bone lesion is seen. Several scattered calcified granulomas in the liver as before.
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Interpretation of Outside Films CT Chest Clinical Information: 61-year-old with provided history of abnormal chest x-ray. Spec Inst: Abnormal CT - CT Chest from NWMC done 12-9-21 rec 1-7-22 Study reviewed: CT of chest with contrast performed at Northwest Medical Center on 12/9/2021, The images are available in PACS. Findings: Limitations: None. Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: There is right lower lobe irregular consolidative opacities with areas of cavitation surrounding by groundglass opacities, septal thickening and bronchial wall thickening. Right upper lobe lateral scarring with focal bronchiectatic changes is also noted. There is multiple nodular and tree-in-bud opacities mainly involving the apical right upper lobe and medial right lower lobe, likely infectious/inflammatory in etiology. Moderate upper lobe predominant centrilobular emphysema with mild diffuse bronchial wall thickening. The trachea and main bronchi are patent. No pleural effusion. Thoracic inlet, heart, and mediastinum: There is enlarged right hilar and right bronchopulmonary lymph nodes. No supraclavicular lymphadenopathy within the field of view. No axillary lymphadenopathy. The esophagus appears patulous. The thoracic aorta is normal in caliber. Main pulmonary artery is normal in caliber. No central pulmonary embolism. The overall heart size normal. Small pericardial effusion. Mild coronary calcification. Bones and soft tissues: No destructive bone lesion. Chest wall is unremarkable. Upper abdomen: Postsurgical changes around the stomach. Conclusion: 1. Right lower lobe irregular consolidative opacities with areas of cavitation surrounding by groundglass opacities, septal thickening and bronchial wall thickening. This associated enlarged right hilar and right frontal pulmonary lymph nodes. These findings likely related to pneumonia, however underlying malignancy cannot be totally excluded. Attention on follow-up after one month is recommended. 2. Multiple nodular and tree-in-bud opacities mainly involving the apical right upper lobe and medial right lower lobe, likely infectious/inflammatory in etiology.
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Findings: Limitations: None. Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: There is right lower lobe irregular consolidative opacities with areas of cavitation surrounding by groundglass opacities, septal thickening and bronchial wall thickening. Right upper lobe lateral scarring with focal bronchiectatic changes is also noted. There is multiple nodular and tree-in-bud opacities mainly involving the apical right upper lobe and medial right lower lobe, likely infectious/inflammatory in etiology. Moderate upper lobe predominant centrilobular emphysema with mild diffuse bronchial wall thickening. The trachea and main bronchi are patent. No pleural effusion. Thoracic inlet, heart, and mediastinum: There is enlarged right hilar and right bronchopulmonary lymph nodes. No supraclavicular lymphadenopathy within the field of view. No axillary lymphadenopathy. The esophagus appears patulous. The thoracic aorta is normal in caliber. Main pulmonary artery is normal in caliber. No central pulmonary embolism. The overall heart size normal. Small pericardial effusion. Mild coronary calcification. Bones and soft tissues: No destructive bone lesion. Chest wall is unremarkable. Upper abdomen: Postsurgical changes around the stomach.
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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: Central airways are patent. Subtle groundglass and tiny nodular opacities in the right lower lobe (axial series 201, image 82) are unchanged compared with exam from 5/3/2016 suggesting postinflammatory scarring. No suspicious pulmonary nodule. No focal consolidation, pneumothorax or pleural effusion. Trace linear atelectasis versus scarring left lung base. HEART / VESSELS: Heart size is normal. Severe coronary artery calcification with coronary artery stent suspected. Mild atherosclerotic calcifications of the thoracic aorta. Main pulmonary artery is normal in caliber. MEDIASTINUM / ESOPHAGUS: No significant abnormality. LYMPH NODES: None enlarged. CHEST WALL: Left chest wall mass, as described below. No other significant abnormality. UPPER ABDOMEN: Left upper pole renal cysts. Atherosclerotic calcifications of the abdominal aorta and its branch vessels. MUSCULOSKELETAL: Destructive soft tissue lesion centered in the anterior left sixth rib with associated pathologic rib fracture. There is permeative destruction of the bone and expansile soft tissue partially extending into the thoracic cavity. No other focal or aggressive osseous lesion. Chronic appearing wedge deformities of the T4 superior endplate and T5 inferior endplate. Multilevel chronic degenerative changes of the visualized spine. -------------------
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Interpretation of Outside Films MR Face 1/7/2022 8:00 AM Clinical Information: Evaluation for mass adjacent to the left mandible. Comparison: Limited images from neck soft tissue ultrasound dated 11/29/2021 Technique: Multiplanar multisequence pre and postcontrast MRI images were provided of the neck soft tissues from an outside institution examination dated 12/22/2021 Findings: Bilateral parotid, submandibular salivary glands appear normal. Small left level Ib lymph node is noted superficial to the left submandibular salivary gland as seen on series 4 image 17. No pathologically enlarged lymph nodes are present. Major vascular flow voids are unremarkable. The aerodigestive tract is unremarkable. Limited visualized portions the brain show no significant abnormality. Trace fluid is noted within the mastoid air cells with minimal ethmoid air cell mucosal thickening. No acute osseous abnormality seen. Impression: No acute abnormality of the neck soft tissues. Small left level Ib lymph node is superficial to the left submandibular salivary gland and may correlate with finding of variably present palpable focus adjacent to the left mandible. As the attending 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: Bilateral parotid, submandibular salivary glands appear normal. Small left level Ib lymph node is noted superficial to the left submandibular salivary gland as seen on series 4 image 17. No pathologically enlarged lymph nodes are present. Major vascular flow voids are unremarkable. The aerodigestive tract is unremarkable. Limited visualized portions the brain show no significant abnormality. Trace fluid is noted within the mastoid air cells with minimal ethmoid air cell mucosal thickening. No acute osseous abnormality seen.
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Findings: The spinal alignment is normal. There are postsurgical changes from anterior cervical fixation of C4-C7 with anterior plate and screws and intervertebral disc spacers. There is bony fusion across these levels. There are advanced degenerative changes at C3-4 with a disc osteophyte complex and uncovertebral DJD as well as facet DJD resulting in severe bilateral foraminal narrowing. There is mild spinal canal narrowing at this level. There is uncovertebral DJD at C2-3 with moderate left and mild right foraminal narrowing. There is osteophytic ridging at C4-5 and C6-7 with mild spinal canal narrowing and moderate left foraminal narrowing. Additional degenerative changes are noted at C7-T1 with disc osteophyte complex resulting in and severe left and moderate right foraminal narrowing, that have progressed since 2018. There is no acute fracture or malalignment. The hardware is intact. Remaining findings grossly appears similar to prior cervical spine CT. Visualized neck soft tissues are grossly unremarkable within limitations of motion artifact.
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16,153 |
EXAM: Outside MR Image Interpretation CLINICAL INFORMATION: Elevated PSA COMPARISON: None. TECHNIQUE: Outside hospital MRI prostate dated 12/01/2021. The MRI acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: STRUCTURED REPORT: MRI Prostate Prostate: Measurement: 6.6 x 5.1 x 4.8 cm; estimated volume: 90 cc; Focal lesion(s): One Lesion # 1 (index lesion): - Key image: series 9; image 25; - Size: 12 x 11 mm; - Location: right; apex; posteromedial peripheral zone; - T2WI: 3 ; DWI: 3; DCE (early and focal enhancement): positive; - PI-RADS v2.1 score: 4 - High (clinically significant cancer is likely to be present); - Likelihood of extraprostatic extension: 1 - Highly unlikely; - Likelihood of seminal vesicle invasion: 1 - Highly unlikely; Diffuse abnormalities: None; Bladder: Trabeculated appearance. Adenopathy: No pathologically enlarged lymph nodes. Bones: Multilevel moderate to severe degenerative changes lumbar spine.. Other: No significant pelvic free fluid. Note: For more details about the Prostate Imaging-Reporting and Data System (PI-RADS) version 2.1, please visit: http://www.acr.org/Quality-Safety/Resources/PIRADS CONCLUSION: 1. Right apical peripheral zone lesion suggestive of PIRADS 4 lesion. 1. No enlarged lymph nodes or enhancing marrow lesions.
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FINDINGS: STRUCTURED REPORT: MRI Prostate Prostate: Measurement: 6.6 x 5.1 x 4.8 cm; estimated volume: 90 cc; Focal lesion(s): One Lesion # 1 (index lesion): - Key image: series 9; image 25; - Size: 12 x 11 mm; - Location: right; apex; posteromedial peripheral zone; - T2WI: 3 ; DWI: 3; DCE (early and focal enhancement): positive; - PI-RADS v2.1 score: 4 - High (clinically significant cancer is likely to be present); - Likelihood of extraprostatic extension: 1 - Highly unlikely; - Likelihood of seminal vesicle invasion: 1 - Highly unlikely; Diffuse abnormalities: None; Bladder: Trabeculated appearance. Adenopathy: No pathologically enlarged lymph nodes. Bones: Multilevel moderate to severe degenerative changes lumbar spine.. Other: No significant pelvic free fluid. Note: For more details about the Prostate Imaging-Reporting and Data System (PI-RADS) version 2.1, please visit: http://www.acr.org/Quality-Safety/Resources/PIRADS
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Findings: CTA neck: The top aortic arch 2brachiocephalic arteries have expected appearance. The common carotid arteries are essentially negative. There are small calcified nonstenotic plaques at the carotid bifurcations. The cervical ICAs are tortuous but otherwise normal. Both vertebral arteries are sizable, right larger than left with no apparent defect. The basilar artery and the circle of Willis have expected appearance. No defect is seen in the cervical spine. CTA Head: There is an apparent small (2.2 x 2.6 mm) left PCOM aneurysm directed inferiorly and laterally (axial series 601 #81 and sagittal series 604 #80). There is junctional dilatation of the right PCOM. The proximal ACAs, MCA's and PCAs are unremarkable. The basilar artery and its branches also have expected appearance. The precontrast scan shows normal appearance of the parenchyma. No hemorrhage is seen. Postcontrast scans show no abnormal enhancement. The precontrast scan shows no mass, hemorrhage, visible infarct or extracerebral collection. There is no abnormal enhancement. ---------------
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EXAM: Outside MR Image Interpretation CLINICAL INFORMATION: Left gluteal soft tissue mass COMPARISON: None. TECHNIQUE: Outside MR images from Helen Keller dated 12/28/2021 were submitted for interpretation. The MRI acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: There is a soft tissue mass positioned deep to the left gluteal musculature, posterior medial to the greater trochanter, and lateral to the left ischial tuberosity. The lesion measures 4.2 x 4.9 x 2.7 cm (transverse by CC by AP). The lesion is intermediate T1/high T2 signal, and it shows heterogeneous postcontrast enhancement. The lesion directly arises from the sciatic nerve although the bulk of the nerve proper runs along the deep margin of the mass. There is no surrounding soft tissue edema. Impression: Peripheral nerve sheath tumor arising from the left sciatic nerve.
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FINDINGS: There is a soft tissue mass positioned deep to the left gluteal musculature, posterior medial to the greater trochanter, and lateral to the left ischial tuberosity. The lesion measures 4.2 x 4.9 x 2.7 cm (transverse by CC by AP). The lesion is intermediate T1/high T2 signal, and it shows heterogeneous postcontrast enhancement. The lesion directly arises from the sciatic nerve although the bulk of the nerve proper runs along the deep margin of the mass. There is no surrounding soft tissue edema.
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Findings: CTA neck: The top aortic arch 2brachiocephalic arteries have expected appearance. The common carotid arteries are essentially negative. There are small calcified nonstenotic plaques at the carotid bifurcations. The cervical ICAs are tortuous but otherwise normal. Both vertebral arteries are sizable, right larger than left with no apparent defect. The basilar artery and the circle of Willis have expected appearance. No defect is seen in the cervical spine. CTA Head: There is an apparent small (2.2 x 2.6 mm) left PCOM aneurysm directed inferiorly and laterally (axial series 601 #81 and sagittal series 604 #80). There is junctional dilatation of the right PCOM. The proximal ACAs, MCA's and PCAs are unremarkable. The basilar artery and its branches also have expected appearance. The precontrast scan shows normal appearance of the parenchyma. No hemorrhage is seen. Postcontrast scans show no abnormal enhancement. The precontrast scan shows no mass, hemorrhage, visible infarct or extracerebral collection. There is no abnormal enhancement. ---------------
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Interpretation of Outside Films CT Chest Clinical Information: 73-year-old male with provided history of pancreatic mass. Spec Inst: Pancreas Mass - CT CAP from Grandview done 11-23-21 rec 1-7-22 Study reviewed: CT of chest with contrast performed at Grandview on 11/23/2021, The images are available in PACS. Findings: Limitations: None. Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: Few small (less than 6 mm) pulmonary nodules are seen, for example in the right lung base at image 124, series 2), and left lower lobe at image 105. Scattered calcified granulomas. No focal consolidation. Mild diffuse bronchial wall thickening. The trachea and main bronchi are patent. No pleural effusion. Thoracic inlet, heart, and mediastinum: No lymphadenopathy in the axillary, mediastinal, or hilar regions. The esophagus is nondilated. The thoracic aorta and main pulmonary artery are normal in caliber. The cardiac chambers are normal in size. Mild coronary artery atherosclerotic calcifications are noted, although the study is not optimized for coronary assessment. No pericardial effusion. Bones and soft tissues: No destructive bone lesion. Chest wall is unremarkable. Upper abdomen: Reported separately. Conclusion: 1. Few small (less than 6 mm) pulmonary nodules. Continued follow-up per clinical protocol is recommended giving history of malignancy. 2. No thoracic lymphadenopathy.
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Findings: Limitations: None. Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: Few small (less than 6 mm) pulmonary nodules are seen, for example in the right lung base at image 124, series 2), and left lower lobe at image 105. Scattered calcified granulomas. No focal consolidation. Mild diffuse bronchial wall thickening. The trachea and main bronchi are patent. No pleural effusion. Thoracic inlet, heart, and mediastinum: No lymphadenopathy in the axillary, mediastinal, or hilar regions. The esophagus is nondilated. The thoracic aorta and main pulmonary artery are normal in caliber. The cardiac chambers are normal in size. Mild coronary artery atherosclerotic calcifications are noted, although the study is not optimized for coronary assessment. No pericardial effusion. Bones and soft tissues: No destructive bone lesion. Chest wall is unremarkable. Upper abdomen: Reported separately.
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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: Few subcentimeter hypoattenuating renal lesions are too small to characterize but statistically cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Trace free fluid in the pelvis, likely physiologic. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No acute abnormality. Small cervical nabothian cyst. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: No significant abnormality.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Left renal mass. COMPARISON: None. TECHNIQUE: Outside CT images without and with IV contrast dated 11/11/2021 were submitted for interpretation. FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Renal Mass LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN: KIDNEYS: RENAL MASS #1 BRIEF DESCRIPTION: Small enhancing renal mass in the left kidney upper pole. LOCATION: Left Kidney. SIZE IN 3 ORTHOGONAL DIMENSIONS (cm): 1.6 x 1.5 x 1.4 cm COMPOSITION: Solid and homogeneous. BOSNIAK CLASSIFICATION: Not applicable. MARGINS: Well-defined PRESENCE OF MACROSCOPIC FAT: No. ENHANCEMENT: - Nonenhanced phase attenuation: 48 HU - Corticomedullary phase attenuation: Not available. - Nephrographic phase attenuation: 101 HU NEPHROMETRY SCORE: - Radius: =50% exophytic (1 point) - Nearness to sinus: >4 but 70%: None. - Renal vein anatomy: Single ipsilateral renal vein with conventional anatomy. - Renal vein thrombus (describe extent of tumor and bland thrombus): No. - IVC thrombus (describe anatomy and extend of tumor and bland thrombus): No. OTHER RENAL FINDINGS: Parapelvic cysts in the left kidney. ADRENALS: - Direct invasion by renal mass: No. - Adrenal nodule(s): No. - Other findings: None. LYMPH NODES: - Retroperitoneal / Pararenal lymph nodes: Not enlarged. - Other findings: Not enlarged. LIVER: Steatotic. No focal liver lesion. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis. Otherwise normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Enlarged prostate with median lobe hypertrophy. BODY WALL: Normal. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Small enhancing left renal mass, suspicious for primary renal neoplasm. No evidence of metastatic disease in the abdomen or pelvis. Incidental findings as above.
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FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Renal Mass LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN: KIDNEYS: RENAL MASS #1 BRIEF DESCRIPTION: Small enhancing renal mass in the left kidney upper pole. LOCATION: Left Kidney. SIZE IN 3 ORTHOGONAL DIMENSIONS (cm): 1.6 x 1.5 x 1.4 cm COMPOSITION: Solid and homogeneous. BOSNIAK CLASSIFICATION: Not applicable. MARGINS: Well-defined PRESENCE OF MACROSCOPIC FAT: No. ENHANCEMENT: - Nonenhanced phase attenuation: 48 HU - Corticomedullary phase attenuation: Not available. - Nephrographic phase attenuation: 101 HU NEPHROMETRY SCORE: - Radius: =50% exophytic (1 point) - Nearness to sinus: >4 but 70%: None. - Renal vein anatomy: Single ipsilateral renal vein with conventional anatomy. - Renal vein thrombus (describe extent of tumor and bland thrombus): No. - IVC thrombus (describe anatomy and extend of tumor and bland thrombus): No. OTHER RENAL FINDINGS: Parapelvic cysts in the left kidney. ADRENALS: - Direct invasion by renal mass: No. - Adrenal nodule(s): No. - Other findings: None. LYMPH NODES: - Retroperitoneal / Pararenal lymph nodes: Not enlarged. - Other findings: Not enlarged. LIVER: Steatotic. No focal liver lesion. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis. Otherwise normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Enlarged prostate with median lobe hypertrophy. BODY WALL: Normal. MUSCULOSKELETAL: No significant abnormality.
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Findings: There is a 12 x 33 mm soft tissue hematoma in the frontal scalp with no associated underlying bone fracture. No intracranial mass effect, edema, hemorrhage, or hydrocephalus is seen. No acute infarction seen. There is mild periventricular and deep white matter hypodensity likely suggestive of microangiopathic changes. There is mild cerebral volume loss. The visualized paranasal sinuses and mastoid air cells are clear. No acute osseous abnormality seen.
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EXAM: Outside MR Image Interpretation CLINICAL INFORMATION: Prostate cancer COMPARISON: None. TECHNIQUE: Outside hospital MRI prostate dated 11/19/2021. The MRI acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: STRUCTURED REPORT: MRI Prostate Prostate: Measurement: 4.4 x 3.7 x 4.2 cm; estimated volume: 40 cc; Focal lesion(s): Lesion # 1 (index lesion): - Key image: series 601; image 17; - Size: 16 x 14 mm; - Location: right; mid; anterior central gland; - T2WI: 4 ; DWI: 5; DCE (early and focal enhancement): positive; - PI-RADS v2.1 score: 4 - High (clinically significant cancer is likely to be present); - Likelihood of extraprostatic extension: 5 - Highly likely; - Likelihood of seminal vesicle invasion: 5 - Highly likely; Diffuse abnormalities: Diffusely striated appearance of the peripheral zone on T2WI with abnormal contrast kinetics may reflect prostatitis; Bladder: Trabeculated appearance. Adenopathy: No pathologically enlarged lymph nodes. Bones: No suspicious enhancing marrow lesions. Small hemangioma in the posterior right iliac blade.. Other: No significant pelvic free fluid. Note: For more details about the Prostate Imaging-Reporting and Data System (PI-RADS) version 2.1, please visit: http://www.acr.org/Quality-Safety/Resources/PIRADS CONCLUSION: 1. A 1.6 cm PIRADS 4 lesion in the right central gland. No enlarged pelvic lymph nodes or suspicious enhancing marrow lesions. There is typographical mistake in the original report. Correction is as follows. - Likelihood of extraprostatic extension: 1 - Highly unlikely; - Likelihood of seminal vesicle invasion: 1 - Highly unlikely;
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FINDINGS: STRUCTURED REPORT: MRI Prostate Prostate: Measurement: 4.4 x 3.7 x 4.2 cm; estimated volume: 40 cc; Focal lesion(s): Lesion # 1 (index lesion): - Key image: series 601; image 17; - Size: 16 x 14 mm; - Location: right; mid; anterior central gland; - T2WI: 4 ; DWI: 5; DCE (early and focal enhancement): positive; - PI-RADS v2.1 score: 4 - High (clinically significant cancer is likely to be present); - Likelihood of extraprostatic extension: 5 - Highly likely; - Likelihood of seminal vesicle invasion: 5 - Highly likely; Diffuse abnormalities: Diffusely striated appearance of the peripheral zone on T2WI with abnormal contrast kinetics may reflect prostatitis; Bladder: Trabeculated appearance. Adenopathy: No pathologically enlarged lymph nodes. Bones: No suspicious enhancing marrow lesions. Small hemangioma in the posterior right iliac blade.. Other: No significant pelvic free fluid. Note: For more details about the Prostate Imaging-Reporting and Data System (PI-RADS) version 2.1, please visit: http://www.acr.org/Quality-Safety/Resources/PIRADS
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FINDINGS: 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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Interpretation of Outside Films CT Chest Clinical Information: 63-year-old female with provided history concerning for pulmonary embolism. Spec Inst: PE - CTA Chest from Cullman done 12-30-21 rec 1-7-22 Study reviewed: CTA of chest for PE performed at Cullman Regional Medical Center on 12/30/2021, The images are available in PACS. Findings: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Severely suboptimal quality with incomplete evaluation of lobar, segmental and subsegmental pulmonary arteries. There is poor opacification of the pulmonary arteries and motion artifact. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Tiny peripheral pulmonary nodules, for example in the right upper lobe at image 13, series 3) are seen. No focal consolidation. The trachea and main bronchi are patent. No pleural effusion. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Reported separately. MUSCULOSKELETAL: No significant abnormality. Conclusion: Severely suboptimal quality with incomplete evaluation of lobar, segmental and subsegmental pulmonary arteries. No evidence of acute central pulmonary embolism.
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Findings: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Severely suboptimal quality with incomplete evaluation of lobar, segmental and subsegmental pulmonary arteries. There is poor opacification of the pulmonary arteries and motion artifact. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Tiny peripheral pulmonary nodules, for example in the right upper lobe at image 13, series 3) are seen. No focal consolidation. The trachea and main bronchi are patent. No pleural effusion. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Reported separately. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. Prior sternotomy and CABG noted. There is no pericardial effusion. Mild aortic valvular calcification is seen. The thoracic aorta is normal in caliber. Main pulmonary artery is enlarged measuring 3.4 cm, previously 3.2 cm. There are shotty symmetric mediastinal and hilar nodes seen without adenopathy by CT size criteria. new small bilateral pleural effusions are noted. Limited imaging through the upper abdomen demonstrates cholelithiasis and extensive atherosclerotic vascular calcification. Fundoplication changes appear similar. The left lower lobe mass adjacent to the fiducial markers currently measures 4.4 x 2.9 cm (image 97 series 2), previously 4.3 x 3.1 cm (image 100 series 2). The mass is partially obscured by some atelectasis adjacent to the left pleural effusion but appears visibly stable. No convincing local recurrence is appreciated. There are new groundglass densities with multifocal peripheral and basilar areas of curvilinear lines and bands. Mild upper lobe centrilobular emphysema is present. Posterior right fifth-eighth rib fractures are new in the interval but subacute in appearance with periosteal reaction and external callus formation. No acute or aggressive osseous lesion. ------------------------------------------------------------------------------ --------------------------------------
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Interpretation of Outside Films CT Venogram Head 1/7/2022 4:04 PM Clinical Information: Spec Inst: CT VENOGRAM HEAD 123021 REC 010722 CHS Comparison: None available Technique: Axial CT venogram images of the head are provided for interpretation with coronal and sagittal reconstructions. MIP and volume rendered 3-D images are also provided. -Please note: Outside imaging is not obtained in a standardized format accepted by UAB. This may limit sensitivity and specificity of interpretation. If clinical suspicion for pathology remains, would recommend repeat imaging at this institution. Findings: Within limitations of an postcontrast exam, there is no acute hemorrhage, evidence of acute infarction or hydrocephalus. There is no edema or mass effect. There is no midline shift. There is no abnormal parenchymal or meningeal enhancement. The visualized paranasal sinuses and mastoid air cells are clear. The left transverse sinus and sigmoid sinus are dominant. There is hypoplasia of the right side with additional drainage through a prominent occipital emissary vein. The superior sagittal sinus and deep cerebral venous system are patent as well. Impression: 1. No acute dural venous sinus abnormality or acute intracranial abnormality identified. Comment: This interpretation is not intended to supersede the original interpretation and should not be relied upon exclusively for clinical decision making.
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Findings: Within limitations of an postcontrast exam, there is no acute hemorrhage, evidence of acute infarction or hydrocephalus. There is no edema or mass effect. There is no midline shift. There is no abnormal parenchymal or meningeal enhancement. The visualized paranasal sinuses and mastoid air cells are clear. The left transverse sinus and sigmoid sinus are dominant. There is hypoplasia of the right side with additional drainage through a prominent occipital emissary vein. The superior sagittal sinus and deep cerebral venous system are patent as well.
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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: Pulmonary thromboembolus within the distal right main pulmonary artery extending into right upper lobar and interlobar pulmonary arteries and subsequent subsegmental pulmonary arteries. There is also thrombus within the left upper and lower lobar and segmental pulmonary arteries. - Pulmonary Artery Diameter: Enlarged measuring 1.0 cm in diameter. LUNGS / AIRWAYS / PLEURA: Few patchy groundglass opacities within both lungs, most prominent within the anterior right upper lobe. No pneumothorax or pleural effusion. HEART / OTHER VESSELS: Heart size is normal without pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No significant abnormality.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: At least stage IIB immature teratoma on note from GYN oncology tumor board. COMPARISON: 11/18/2021 and 9/21/2021. TECHNIQUE: Outside CT images from children's of Alabama dated 12/28/2021 were submitted for interpretation. The CT acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Minimal atelectasis in the lung bases with small left pleural effusion.. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Peripheral hypodensities adjacent to the liver are increased in size and number from prior. The largest lesion adjacent to the right posterior segment medially measures at least 7.1 x 5.0 cm on image 58 series 204, previously 5.7 x 2.6 cm on image 192 series 4. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Pelvicaliectasis without hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Small ascites has increased from prior. Peritoneal masses have increased from prior, for example right upper quadrant separate from the liver and left of midline image 127 series 204. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Normal-appearing uterus is completely surrounded by complex soft tissue extending to the posterior wall of the vagina, without a fat plane between it and adjacent rectosigmoid colon. The mass extends anteriorly to the uterus to the superior pelvis, measuring grossly 13.3 x 10.1 cm on image 152 series 204, previously at least 9.5 x 9.1 cm on image 392 series 4. Ovaries are not seen separately. BODY WALL: Slight increase in multiple metastasis in the anterior abdominal wall extending into the anterior peritoneal space and subcutaneous tissues, measuring 11.36 x 6.9 cm on image 156 series 204, previously 10.7 x 5.9 cm on image 194 series 3. Increase in nodular metastasis right mid lateral abdominal wall on image 108 series 204. MUSCULOSKELETAL: No destructive osseous lesions seen. CONCLUSION: 1. Peripheral hypodensities adjacent to the liver are increased in size and number, consistent with worsened metastatic disease. Interval increase in size of the complex soft tissue extending from the posterior wall of the vagina surrounding the normal uterus and without a fat plane between it and adjacent rectosigmoid colon, also consistent with metastatic disease. Ovaries are not seen separately. 2. Slight increase in multiple metastasis in the anterior abdominal wall as above. 3. Pelvicaliectasis without hydronephrosis, likely from pelvic mass. Recommend attention on follow-up. 4. Incidental findings as detailed above.
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FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Minimal atelectasis in the lung bases with small left pleural effusion.. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Peripheral hypodensities adjacent to the liver are increased in size and number from prior. The largest lesion adjacent to the right posterior segment medially measures at least 7.1 x 5.0 cm on image 58 series 204, previously 5.7 x 2.6 cm on image 192 series 4. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Pelvicaliectasis without hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Small ascites has increased from prior. Peritoneal masses have increased from prior, for example right upper quadrant separate from the liver and left of midline image 127 series 204. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Normal-appearing uterus is completely surrounded by complex soft tissue extending to the posterior wall of the vagina, without a fat plane between it and adjacent rectosigmoid colon. The mass extends anteriorly to the uterus to the superior pelvis, measuring grossly 13.3 x 10.1 cm on image 152 series 204, previously at least 9.5 x 9.1 cm on image 392 series 4. Ovaries are not seen separately. BODY WALL: Slight increase in multiple metastasis in the anterior abdominal wall extending into the anterior peritoneal space and subcutaneous tissues, measuring 11.36 x 6.9 cm on image 156 series 204, previously 10.7 x 5.9 cm on image 194 series 3. Increase in nodular metastasis right mid lateral abdominal wall on image 108 series 204. MUSCULOSKELETAL: No destructive osseous lesions seen.
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Findings: Bilateral breast implants are present. No enlarged hilar or mediastinal nodes are present. The mediastinum is normal. Mild biapical pleural parenchymal scarring. A few tiny calcified granulomas are seen within the left lower lobe. 2 mm nodule within the anterior right upper lobe on image 82 of series 3. 2 mm subpleural nodule within the middle lobe on image 163. 2 mm left upper lobe nodule on image 56. No suspicious lung nodules. Coronary artery calcification: The visual score of calcification is 5. (Based on a publication by Kirsch et al (Detection of Coronary calcium During Standard Chest Computed Tomography Correlates With Multi-Detector Computed Tomography Coronary Artery Calcium score, Int J Cardiovasc Imaging (2012) 28:1249-1256), visual score >7 is associated with an Agatston score > 400 and independently validated increased incidence of cardiovascular mortality). The visualized liver, spleen, adrenals, and bowel are unremarkable. Bones: Healing left posterior 10th and 11th ribs fractures. No acute or aggressive osseous abnormality.
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16,161 |
EXAM: Outside MR Image Interpretation CLINICAL INFORMATION: 67-year-old male prostate cancer (grade group 5). PSA of 5.27. COMPARISON: None. TECHNIQUE: Outside MR images without and with IV contrast dated 12/1/2021 were submitted for interpretation. FINDINGS: STRUCTURED REPORT: MRI Prostate Prostate: Measurement: 4.1 x 3.1 x 3.1 cm; estimated volume: 20 cc; Focal lesion(s): Lesion # 1 (index lesion): - Key image: series 950; image 12; - Size: 15 mm; - Location: right; mid-base; posterolateral peripheral zone; - 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: 4 - Likely; - Likelihood of seminal vesicle invasion: 4 - Likely. Suspected invasion of the insertion of the right seminal vesicle on series 5, image 18) Diffuse abnormalities: None Bladder: Collapsed. There is an ectopic insertion of a dilated left ureter into the prostatic urethra (series 4, image 13). Adenopathy: No pathologically enlarged lymph nodes. Bones: No aggressive bony lesions. Other: No significant pelvic free fluid. Partially visualized left hydronephrosis and bilateral renal cysts. 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. PI-RADS v2.1 score 5 lesion measuring 15 mm centered at the right mid-base posterolateral peripheral zone. Likely extraprostatic extension and seminal vesical invasion. No evidence of pelvic metastatic disease. 2. Ectopic insertion of a dilated left ureter into the prostatic urethra. At least partially duplicated left collecting system.
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FINDINGS: STRUCTURED REPORT: MRI Prostate Prostate: Measurement: 4.1 x 3.1 x 3.1 cm; estimated volume: 20 cc; Focal lesion(s): Lesion # 1 (index lesion): - Key image: series 950; image 12; - Size: 15 mm; - Location: right; mid-base; posterolateral peripheral zone; - 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: 4 - Likely; - Likelihood of seminal vesicle invasion: 4 - Likely. Suspected invasion of the insertion of the right seminal vesicle on series 5, image 18) Diffuse abnormalities: None Bladder: Collapsed. There is an ectopic insertion of a dilated left ureter into the prostatic urethra (series 4, image 13). Adenopathy: No pathologically enlarged lymph nodes. Bones: No aggressive bony lesions. Other: No significant pelvic free fluid. Partially visualized left hydronephrosis and bilateral renal cysts. 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 LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: There are multiple hemangiomas of varying sizes scattered throughout both lobes of the liver. The largest is in the lateral segment left hepatic lobe and measures 5.3 x 3.6 cm on image 43 series 900. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Punctate nonobstructing nephrolithiasis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic calcifications of the abdominal aorta and branch vessels. Replaced left hepatic artery from the left gastric artery. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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16,162 |
EXAM: Outside MR Image Interpretation CLINICAL INFORMATION: Pancreatic mass. COMPARISON: 12/22/2021 TECHNIQUE: Outside MR images without and with IV contrast dated 12/27/2021 were submitted for interpretation. FINDINGS: STRUCTURED REPORT: MR Pancreatic Mass STUDY QUALITY: Satisfactory. LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: No liver metastases. PERITONEUM: No ascites. No peritoneal nodules. PANCREAS: Adjacent to the pancreatic head mass, there is a possible peripancreatic fluid collection that measures approximately 3.6 cm on series 9, image 175. Pancreatic mass: - Location: Head - Size: 5.5 x 5.0 cm (series 9, image 169) - Composition: Solid - Enhancement relative to pancreas: Hypoenhancing - Margins: Ill-defined with irregular margins. - Pancreatic duct: Moderate upstream pancreatic ductal dilatation. - Pancreatic atrophy: Moderate upstream pancreatic atrophy. - Biliary ducts: Not dilated - Gallbladder: No abnormality. VASCULATURE: - Arterial anatomy: Conventional. - Celiac Axis (CA): No tumor contact. - Common Hepatic Artery (CHA): Tumor contact =180 degrees or bilateral narrowing NOT exceeding the inferior border of the duodenum. - IVC and Renal Veins: No tumor contact. - Vessel thrombosis: Thrombosis of the superior mesenteric vein and portosplenic confluence with reconstitution in the hepatic hilum. - Venous collaterals: Multiple peripancreatic and perihepatic collaterals. - Other peripancreatic vessel comment: None. LYMPH NODES: None enlarged. RETROPERITONEUM: No tumor invasion. MESENTERY: No tumor invasion. ADRENALS: Normal. KIDNEYS: Tiny bilateral cysts. Otherwise normal. SPLEEN: Normal. STOMACH: No abnormality. DUODENUM: No abnormality. SMALL BOWEL: No abnormality. COLON: No abnormality. OTHER VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Suspected pancreatic head adenocarcinoma, as above, with thrombosis of the superior mesenteric vein and portosplenic confluence and additional vascular involvement as described above. No evidence of metastatic disease in the abdomen. Probable adjacent peripancreatic fluid collection may be due to superimposed pancreatitis.
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FINDINGS: STRUCTURED REPORT: MR Pancreatic Mass STUDY QUALITY: Satisfactory. LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: No liver metastases. PERITONEUM: No ascites. No peritoneal nodules. PANCREAS: Adjacent to the pancreatic head mass, there is a possible peripancreatic fluid collection that measures approximately 3.6 cm on series 9, image 175. Pancreatic mass: - Location: Head - Size: 5.5 x 5.0 cm (series 9, image 169) - Composition: Solid - Enhancement relative to pancreas: Hypoenhancing - Margins: Ill-defined with irregular margins. - Pancreatic duct: Moderate upstream pancreatic ductal dilatation. - Pancreatic atrophy: Moderate upstream pancreatic atrophy. - Biliary ducts: Not dilated - Gallbladder: No abnormality. VASCULATURE: - Arterial anatomy: Conventional. - Celiac Axis (CA): No tumor contact. - Common Hepatic Artery (CHA): Tumor contact =180 degrees or bilateral narrowing NOT exceeding the inferior border of the duodenum. - IVC and Renal Veins: No tumor contact. - Vessel thrombosis: Thrombosis of the superior mesenteric vein and portosplenic confluence with reconstitution in the hepatic hilum. - Venous collaterals: Multiple peripancreatic and perihepatic collaterals. - Other peripancreatic vessel comment: None. LYMPH NODES: None enlarged. RETROPERITONEUM: No tumor invasion. MESENTERY: No tumor invasion. ADRENALS: Normal. KIDNEYS: Tiny bilateral cysts. Otherwise normal. SPLEEN: Normal. STOMACH: No abnormality. DUODENUM: No abnormality. SMALL BOWEL: No abnormality. COLON: No abnormality. OTHER VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Segmental bibasilar lung atelectasis. No pleural effusion or consolidation. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal unenhanced appearance of liver. Stable indeterminate low-attenuation area in the inferior medial margin of the right hepatic lobe (on series 2/87). BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Interval right ureteral stent. Persistent mild to moderate proximal right hydroureteronephrosis suggesting stent dysfunction. Mid/distal ureter is not dilated. Distended ureteral stent is seen within the bladder. There is nonspecific right perinephric stranding without any discrete collection. Left kidney demonstrates normal unenhanced appearance without hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach is moderately distended. Small bowel post surgical changes. There is no abnormal dilatation of small bowel loops. COLON / APPENDIX: Surgical changes of right hemicolectomy. Residual large bowel loops are nondilated. PERITONEUM / MESENTERY: Mesenteric edema and stranding in the right hemiabdomen likely postsurgical. No discrete lobulated intraperitoneal fluid collection. RETROPERITONEUM: Right pararenal interfascial edematous thickening without any discrete fluid collection. VESSELS: No significant abnormality. URINARY BLADDER: Urinary bladder is partially distended REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Midline post surgical scarring. MUSCULOSKELETAL: No interval acute osseous findings. Unchanged L3 vertebral fracture. Lumbar vertebrae demonstrate normal height and multilevel mild degenerative changes.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Pancreatic mass. COMPARISON: None. TECHNIQUE: Outside CT images without IV contrast dated 12/22/2021 were submitted for interpretation. FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Suspected pancreatic head mass measures 5.7 x 4.6 cm on series 202, image 54. There is mild upstream pancreatic ductal dilation and pancreatic atrophy. SPLEEN: Normal for technique. ADRENALS: Right adrenal calcifications. Otherwise normal. KIDNEYS: Left parenchymal calcification and small exophytic left renal cyst. Otherwise normal for technique. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Trace pelvic free fluid. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Suspected pancreatic head mass, incompletely characterized on this noncontrast exam. See MRI abdomen report for further details.
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FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Suspected pancreatic head mass measures 5.7 x 4.6 cm on series 202, image 54. There is mild upstream pancreatic ductal dilation and pancreatic atrophy. SPLEEN: Normal for technique. ADRENALS: Right adrenal calcifications. Otherwise normal. KIDNEYS: Left parenchymal calcification and small exophytic left renal cyst. Otherwise normal for technique. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Trace pelvic free fluid. 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: No intracranial mass, mass effect, edema, hemorrhage, or hydrocephalus is seen. No acute infarction seen. The visualized paranasal sinuses and mastoid air cells are clear. No acute osseous or soft tissue abnormality seen.
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Interpretation of Outside Films CT Chest Clinical Information: Endometrial cancer Spec Inst: ENDOMETRIAL CT CHEST 122021 CLEARVIEW CANCER REC 1722 Study reviewed: CT of chest performed at Clearview cancer Institute on 12/20/2021. . The images are available in PACS. Please note the examination was performed outside of UAB protocol, monitoring and oversight. There are associated diagnostic limitations which should be considered prior to implementation of clinical decisions. Comparison:7/13/2021 Findings: Included images of the lower neck are unremarkable. Normal heart size. Mild coronary artery calcifications. Right chest port terminates near the cavoatrial junction. Small hiatal hernia. Mediastinal structures are otherwise within limits. No pathologically enlarged mediastinal or hilar lymph nodes. The central airways are patent. No pleural effusions. No suspicious pulmonary nodules or masses. A tiny 1 to 2 mm nodule in the right lower lobe (series 5; image 117) is unchanged, likely benign. Please note that the concurrently obtained CT scan of the Abdomen will be dictated separately. Soft tissues of the chest wall are unremarkable. Redemonstrated probable AVN changes in the left humeral head. No aggressive osseous lesions. Conclusion: 1. No intrathoracic metastatic disease. Please note that the concurrently obtained CT scan of the Abdomen will be dictated separately.
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Findings: Included images of the lower neck are unremarkable. Normal heart size. Mild coronary artery calcifications. Right chest port terminates near the cavoatrial junction. Small hiatal hernia. Mediastinal structures are otherwise within limits. No pathologically enlarged mediastinal or hilar lymph nodes. The central airways are patent. No pleural effusions. No suspicious pulmonary nodules or masses. A tiny 1 to 2 mm nodule in the right lower lobe (series 5; image 117) is unchanged, likely benign. Please note that the concurrently obtained CT scan of the Abdomen will be dictated separately. Soft tissues of the chest wall are unremarkable. Redemonstrated probable AVN changes in the left humeral head. No aggressive osseous lesions.
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Findings: Cervical spinal alignment is normal. There are advanced multilevel degenerative changes with loss of disc height, most prominent at C5-6 and C6-7 and to a lesser extent at C4-5 with partial fusion across the disc spaces at these levels. There is uncovertebral DJD at multiple levels again most prominent from C4 to C7 with associated moderate foraminal narrowing. There is ossification of the posterior longitudinal ligament in the mid cervical spine. There is a prominent disc bulge at C4-5 and C3-4. In combination with ligamentum flavum thickening, there is severe spinal canal narrowing at C3-4, C4-5 and C5-6 with suspected cord compression in view of the severely of the narrowing as per CT technique. The spinal canal or the cord cannot be adequately evaluated on this exam.
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16,165 |
EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Endometrial cancer. COMPARISON: 9/20/2021 TECHNIQUE: Outside CT images with IV contrast dated 12/20/2021 were submitted for interpretation. FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Bilobar hepatic metastases are noted. A representative left hepatic lobe metastasis measures 5.5 x 3.9 cm on series 2, image 132. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: Retroperitoneal adenopathy is present. A representative retroperitoneal lymph node measures 2.5 x 2.4 cm on series 2, image 166. No pelvic or mesenteric adenopathy is identified. STOMACH / SMALL BOWEL: Small hiatal hernia. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is absent. No definite vaginal cuff nodularity. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Bilobar hepatic metastatic disease with retroperitoneal lymph node metastases. No definite evidence of local recurrence in the pelvis.
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FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Bilobar hepatic metastases are noted. A representative left hepatic lobe metastasis measures 5.5 x 3.9 cm on series 2, image 132. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: Retroperitoneal adenopathy is present. A representative retroperitoneal lymph node measures 2.5 x 2.4 cm on series 2, image 166. No pelvic or mesenteric adenopathy is identified. STOMACH / SMALL BOWEL: Small hiatal hernia. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is absent. No definite vaginal cuff nodularity. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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Findings: A mildly expansile mixed sclerotic and lytic lesion of the left mandibular condyle is again noted and appears unchanged. Differentials include an osteochondroma or enchondroma and less likely a fibro-osseous lesion. There is no significant difference in the areas of cortical thinning and dehiscence. This lesion approximately measures 1.3 x 1.6 x 1 cm, unchanged. There is no change in TMJ alignment. No other maxillofacial osseous abnormalities are noted. The orbits appear unremarkable. The visualized limited intracranial structures appear unremarkable. There is no obvious enhancing soft tissue component associated with the left mandibular condyle lesion. Small left maxillary third molar periapical cyst is slightly larger. There is a mucous retention cyst in the left maxillary sinus with mild maxillary sinus mucosal thickening bilaterally. The remaining visualized paranasal sinuses, middle ear cavities and mastoid air cells are clear.
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RADIOLOGIC EXAM: Interpretation of Outside Films CT Head CLINICAL INFORMATION: Altered mental status. Generalized weakness. COMPARISON: Outside CT head 11/21/2021 TECHNIQUE: Interpretation of Outside Films CT Headexam performed at Jackson Hospital on 12/13/2021. STRUCTURED REPORT: CT Head Trauma FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. There is hydrocephalus with narrow callosal angle. There is asymmetrical left frontal atrophy left with prominent sylvian fissure. There are periventricular white matter changes. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: As above ORBITS: Normal. SINUSES: Normal. Other: Atherosclerotic disease of the bilateral intracranial ICAs. CONCLUSION: 1. Dilated ventricles suggestive of normal pressure hydrocephalus. 2. Asymmetric left frontal atrophy. Recommend MRI for further evaluation. 3. Atherosclerotic 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: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. There is hydrocephalus with narrow callosal angle. There is asymmetrical left frontal atrophy left with prominent sylvian fissure. There are periventricular white matter changes. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: As above ORBITS: Normal. SINUSES: Normal. Other: Atherosclerotic disease of the bilateral intracranial ICAs.
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Findings: There are partial small bilateral mastoid effusions There are bilateral tympanostomy tubes in place. Bilateral stapes are not clearly defined, which could be related to technique or could be due to minimal fluid. Otherwise the ossicles appear unremarkable. No ossicular erosions are noted. There is no evidence of vestibular aqueduct enlargement, IAC enlargement, labyrinthine obliteration, or of inflammatory changes or soft tissue masses within the middle ears. There is no evidence of otospongiosis. There is no evidence of semicircular canal dehiscence. There is mild mucosal thickening in bilateral maxillary sinuses and ethmoid air cells with hyperostosis. The nasal septum is deviated to the left.
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MRI brain with and without Indication: Spec Inst: MRI Brain from Jackson Hospital done 11-11-21 rec 1-8-22 [left cranial nerve third palsy Comparison: No prior studies comparison. Comparison is made to CTA head 1/6/2022 Technique: Interpretation of outside MRI brain with and without contrast with dedicated thin slice T2 images through the brainstem and internal auditory canals. Study performed at Jackson imaging Center on 11/11/2021 Findings: There is no diffusion restriction at the time of examination. Whole brain T2 and FLAIR imaging demonstrate no midline shift, mass effect, or other space-occupying lesion. There is advanced diffuse cerebral cortical volume loss, moderately more pronounced in the frontal and temporal lobes and more pronounced in the left. There are marked periventricular and deep white matter hyperintensities (Fazekas grade 3). There is ex vacuo expansion of the ventricles, otherwise the ventricular system is of normal morphology. The basal cisterns are clear. The visualized vascular flow voids appear normal. Redemonstration of 3 mm medially directed aneurysm of the left cavernous ICA. There is enhancing lesion anterior to the right temporal lobe which measures approximately 1.4 x 1 cm.. No cerebellopontine angle mass lesions are identified. The visualized cranial nerves appear normal in course and caliber. There is mild compression of the left trigeminal nerve by the vessel, likely superior cerebellar artery. The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. The paranasal sinuses and mastoid air cells are clear. Impression: 1. No acute intracranial abnormality. Advanced microangiopathic disease and cerebral cortical volume loss. 2. Moderately asymmetric frontal, temporal dominant volume loss can be seen in frontal temporal dementia. 3. Left cavernous ICA aneurysm measuring approximately 3 mm, better appreciated on recent CTA head. 4. Extra-axial enhancing mass anterior to right temporal lobe. The other enhancing masses including infiltrative lesion surrounding the right optic nerve are not seen on this MRI but was seen on the CT neck performed more recently suggesting interval appearance of these lesions. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: There is no diffusion restriction at the time of examination. Whole brain T2 and FLAIR imaging demonstrate no midline shift, mass effect, or other space-occupying lesion. There is advanced diffuse cerebral cortical volume loss, moderately more pronounced in the frontal and temporal lobes and more pronounced in the left. There are marked periventricular and deep white matter hyperintensities (Fazekas grade 3). There is ex vacuo expansion of the ventricles, otherwise the ventricular system is of normal morphology. The basal cisterns are clear. The visualized vascular flow voids appear normal. Redemonstration of 3 mm medially directed aneurysm of the left cavernous ICA. There is enhancing lesion anterior to the right temporal lobe which measures approximately 1.4 x 1 cm.. No cerebellopontine angle mass lesions are identified. The visualized cranial nerves appear normal in course and caliber. There is mild compression of the left trigeminal nerve by the vessel, likely superior cerebellar artery. The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. The paranasal sinuses and mastoid air cells are clear.
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Findings: There are partial small bilateral mastoid effusions There are bilateral tympanostomy tubes in place. Bilateral stapes are not clearly defined, which could be related to technique or could be due to minimal fluid. Otherwise the ossicles appear unremarkable. No ossicular erosions are noted. There is no evidence of vestibular aqueduct enlargement, IAC enlargement, labyrinthine obliteration, or of inflammatory changes or soft tissue masses within the middle ears. There is no evidence of otospongiosis. There is no evidence of semicircular canal dehiscence. There is mild mucosal thickening in bilateral maxillary sinuses and ethmoid air cells with hyperostosis. The nasal septum is deviated to the left.
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MRI brain with and without Indication: Spec Inst: Postural posterior headache - MRI Brain from RMC Stringfellow done 12-30-21 rec 1-8-22 Comparison: Same-day CT head Technique: Outside images of the brain with and without contrast reviewed. Findings: There is no evidence of acute infarction, hemorrhage, mass lesion, or hydrocephalus. No susceptibility artifact or diffusion restriction. There is a focal extra-axial fluid collection overlying the superior right parietal lobe. It demonstrates T1 hypointense and T2/FLAIR hyperintense signal. There is no hypointense signal on GRE and also no associated restricted diffusion. There is also small extra-axial T2 hyperintense collection overlying the frontal lobes bilaterally, right greater than left. There is diffuse smooth pachymeningeal enhancement. Additionally, there are low-lying cerebellar tonsils are borderline decreased. Interpeduncular angle which measures approximately 41 degrees. Minimal pontine distance and pontomesencephalic angle are normal. T2 vascular flow voids demonstrate distention of the sagittal and right transverse sinuses. The orbits, paranasal sinuses, and mastoid air cells are unremarkable. There is no abnormal calvarial signal. Impression: 1. Diffuse mild smooth dural enhancement with small extra-axial fluid collections overlying both cerebral hemispheres, right greater than left. 2. Enlargement of the dural venous sinuses and borderline decrease in the interpeduncular angle, as well as low-lying cerebellar tonsils. This constellation of findings can be seen with intracranial hypotension in the appropriate clinical setting. As the attending 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 no evidence of acute infarction, hemorrhage, mass lesion, or hydrocephalus. No susceptibility artifact or diffusion restriction. There is a focal extra-axial fluid collection overlying the superior right parietal lobe. It demonstrates T1 hypointense and T2/FLAIR hyperintense signal. There is no hypointense signal on GRE and also no associated restricted diffusion. There is also small extra-axial T2 hyperintense collection overlying the frontal lobes bilaterally, right greater than left. There is diffuse smooth pachymeningeal enhancement. Additionally, there are low-lying cerebellar tonsils are borderline decreased. Interpeduncular angle which measures approximately 41 degrees. Minimal pontine distance and pontomesencephalic angle are normal. T2 vascular flow voids demonstrate distention of the sagittal and right transverse sinuses. The orbits, paranasal sinuses, and mastoid air cells are unremarkable. There is no abnormal calvarial signal.
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FINDINGS: STRUCTURED REPORT: CT Abdomen LOWER CHEST: LUNG BASES / PLEURA: Small bilateral pleural effusions have increased compared to 1/5/2022. Minimal posterior basilar atelectasis is again seen. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Coronary calcifications. ABDOMEN: LIVER: Unchanged cirrhotic contour. The Ethiodol-treated TACE lesion in segment IVA (previously referred to as being in segment V) appears unchanged with no evidence of residual or recurrent hepatocellular carcinoma. The abscess in segment II today measures 3.7 x 3.1 cm (image 85 series 11-venous phase); was 6.4 x 3.3 cm (image 87 series 3-venous phase) previously. The new percutaneous drainage catheter is seen within this loculated fluid-containing portion of the abscess. The previously noted percutaneous drain in the right abscess cavity contains no residual surrounding fluid. BILIARY TRACT: Branching low-attenuation structures in segment III are compatible with worsening peripheral segmental biliary dilation. No other focal regions of irregular dilation are seen within the liver. Extra hepatic duct appears normal. No central mass is evident. GALLBLADDER: Absent. PANCREAS: Atrophic SPLEEN: None enlarged ADRENALS: Normal. KIDNEYS: Scattered calcifications bilaterally appear more likely vascular than within the collecting system and are unchanged. A simple right renal cyst appears unchanged. Excretion is symmetric on delayed images. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality in visualized portions. COLON: Scattered left colonic diverticula without evidence of inflammation at present. No abnormality in visualized portions otherwise. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Trace ascites appears new. VESSELS: Fusiform aneurysm of the upper abdominal aorta extends from the chest, measuring 3.9 cm at the hiatus and decreasing to a caliber of 2.5 cm at the left renal artery origin before becoming mildly ectatic in the infrarenal region up to an AP diameter of 2.7 cm. Diffuse calcified atherosclerotic plaque is present including at the origins of the major branches, however all appear patent at present. Moderate focal stenosis of the distal left common iliac artery is suspected. No variant hepatic arterial anatomy is noted. The hepatic and portal venous systems appear patent. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Diffuse bone demineralization and mild degenerative change.
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EXAM: Outside MR Image Interpretation CLINICAL INFORMATION: Pancreatic cystic lesion. COMPARISON: 9/28/2021 and 6/17/2021 TECHNIQUE: Outside MR images without and with IV contrast dated 11/11/2021 were submitted for interpretation. 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: Left hepatic lobe cyst. Diffuse hepatic steatosis without evidence of cirrhosis. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Evaluation of the pancreas on postcontrast images is mildly limited due to motion. The pancreatic tail, there is a cystic lesion with a thin peripheral rim of enhancement that measures approximately 2.1 x 1.8 cm on series 11, image 69. This is not significantly changed since prior exam given differences in technique. No pancreatic ductal dilation or solid pancreatic mass. 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: Cystic lesion in the pancreatic tail with peripheral rim of enhancement, better appreciated on prior CT, suspicious for a cystic degenerated pancreatic neuroendocrine tumor. Consider further evaluation with endoscopic ultrasound if not already performed.
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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: Left hepatic lobe cyst. Diffuse hepatic steatosis without evidence of cirrhosis. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Evaluation of the pancreas on postcontrast images is mildly limited due to motion. The pancreatic tail, there is a cystic lesion with a thin peripheral rim of enhancement that measures approximately 2.1 x 1.8 cm on series 11, image 69. This is not significantly changed since prior exam given differences in technique. No pancreatic ductal dilation or solid pancreatic mass. 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: 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.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Neuroendocrine tumor. COMPARISON: None. TECHNIQUE: Outside CT images without IV contrast dated 12/9/2021 were submitted for interpretation. FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Several pulmonary nodules are noted in the right lower lobe, the largest of which measures 0.8 x 0.7 cm on series 2, image 9. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Scattered multivessel coronary artery calcifications. Otherwise normal for technique. ABDOMEN and PELVIS: LIVER: Possible hepatic metastasis near the hepatic dome, incompletely characterized without intravenous contrast (series 2, image 10). Right hepatic lobe cyst. Otherwise normal for technique. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Normal for technique. ADRENALS: Left adrenal nodule measures 3.3 x 2.8 cm on series 2, image 27. Normal right adrenal gland. KIDNEYS: Possible exophytic lesion arising from the left kidney interpolar region (series 2, image 34). Otherwise normal for technique. LYMPH NODES: Multiple enlarged retroperitoneal lymph nodes are noted. A representative retroperitoneal lymph node measures 1.9 x 1.5 cm on series 2, image 40. No pelvic or mesenteric adenopathy. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerosis without aneurysm. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Enlarged prostate BODY WALL: No significant abnormality. MUSCULOSKELETAL: Scattered sclerotic lesions are noted in the left iliac bone, right acetabulum, and several thoracolumbar vertebral bodies. No destructive osseous lesion. CONCLUSION: 1. Suspected hepatic metastasis, right lower lobe pulmonary metastasis, retroperitoneal lymph node metastases, and osseous metastases. However, evaluation is incomplete given noncontrast technique. 2. Indeterminate exophytic left renal lesion. Correlations with prior exams would be useful. Otherwise, recommend renal ultrasound for further evaluation. 3. Left adrenal nodule, not definitely an adenoma. This can be further evaluated with adrenal protocol CT as indicated.
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FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Several pulmonary nodules are noted in the right lower lobe, the largest of which measures 0.8 x 0.7 cm on series 2, image 9. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Scattered multivessel coronary artery calcifications. Otherwise normal for technique. ABDOMEN and PELVIS: LIVER: Possible hepatic metastasis near the hepatic dome, incompletely characterized without intravenous contrast (series 2, image 10). Right hepatic lobe cyst. Otherwise normal for technique. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Normal for technique. ADRENALS: Left adrenal nodule measures 3.3 x 2.8 cm on series 2, image 27. Normal right adrenal gland. KIDNEYS: Possible exophytic lesion arising from the left kidney interpolar region (series 2, image 34). Otherwise normal for technique. LYMPH NODES: Multiple enlarged retroperitoneal lymph nodes are noted. A representative retroperitoneal lymph node measures 1.9 x 1.5 cm on series 2, image 40. No pelvic or mesenteric adenopathy. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerosis without aneurysm. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Enlarged prostate BODY WALL: No significant abnormality. MUSCULOSKELETAL: Scattered sclerotic lesions are noted in the left iliac bone, right acetabulum, and several thoracolumbar vertebral bodies. No destructive osseous lesion.
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FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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EXAM: Outside MR Image Interpretation CLINICAL INFORMATION: 67-year-old male with elevated PSA (most recently 6.96). COMPARISON: None. TECHNIQUE: Outside MR images without and with IV contrast dated 12/28/2021 were submitted for interpretation. The MRI acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: STRUCTURED REPORT: MRI Prostate Prostate: Measurement: 5.9 x 4.6 x 4.5 cm; estimated volume: 61 cc; PSA density: 0.11 Focal lesion(s): None. Diffuse abnormalities: Moderate BPH. Bladder: Trabeculated appearance. Adenopathy: No pathologically enlarged lymph nodes. Bones: No aggressive bony lesions. Other: No significant pelvic free fluid. Note: For more details about the Prostate Imaging-Reporting and Data System (PI-RADS) version 2.1, please visit: http://www.acr.org/Quality-Safety/Resources/PIRADS CONCLUSION: No suspicious intraprostatic lesion. Moderate BPH.
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FINDINGS: STRUCTURED REPORT: MRI Prostate Prostate: Measurement: 5.9 x 4.6 x 4.5 cm; estimated volume: 61 cc; PSA density: 0.11 Focal lesion(s): None. Diffuse abnormalities: Moderate BPH. Bladder: Trabeculated appearance. Adenopathy: No pathologically enlarged lymph nodes. Bones: No aggressive bony lesions. Other: No significant pelvic free fluid. Note: For more details about the Prostate Imaging-Reporting and Data System (PI-RADS) version 2.1, please visit: http://www.acr.org/Quality-Safety/Resources/PIRADS
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis Limited examination due to motion. LOWER CHEST: LUNG BASES / PLEURA: Left basilar consolidation. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Stranding along the pancreatic tail, unable to optimally evaluate due to motion. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Round hyperattenuating structure measuring 10 mm, unclear if this is an exophytic renal lesion or adrenal in etiology, unable to optimally evaluate due to motion.. VESSELS: Mild atherosclerosis of the aorta. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The left ovary is enlarged with multiple calcifications and two hypoattenuating lesions. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Grade 1 anterolisthesis of L4-L5 and grade 1 retrolisthesis of L5 over S1. Moderate discogenic changes lower thoracic spine.
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EXAM: Interpretation of Outside Films MR MSK CLINICAL INFORMATION: 77-year-old female with enlarging right thigh mass. COMPARISON: None available TECHNIQUE: Interpretation of Outside Films MR MSK STRUCTURED REPORT: MRI HIP/BONE PELVIS v4/13/2019 FINDINGS: BONES: No fracture, marrow replacement or aggressive osseous lesion. MUSCLES/TENDON: Large, well-defined lipomatous mass arising within the posterior muscular compartment of the right thigh, within the adductor magnus musculature, with follows fat signal on all sequences. There are internal T1 hypointense, T2 hyperintense septations with thickened septations along the posterior lateral margin of the mass which do not demonstrate significant enhancement on postcontrast imaging. There is no enhancement of the soft tissue component seen on postcontrast imaging. There is interdigitation of adductor muscular fibers in the posterior medial aspect of the mass with scattered traversing veins. In it's largest cross-sectional dimension, the mass measures approximately 9.5 x 13.0 x 19.9 cm AP by TR by CC (axial T1 series 5, image 21 and coronal T1 series 3, image 15). VESSELS:No significant disease. The superficial femoral artery and vein closely approximate the mass with preserved intervening fat plane (series 5, image 14). NERVES: Normal. The sciatic nerve is normal in size without close proximity to the underlying CONCLUSION: 1. Large lipomatous mass arising within the adductor musculature in the posterior right thigh with thickened posterior lateral septations raising suspicion for liposarcoma. As the attending 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. MUSCLES/TENDON: Large, well-defined lipomatous mass arising within the posterior muscular compartment of the right thigh, within the adductor magnus musculature, with follows fat signal on all sequences. There are internal T1 hypointense, T2 hyperintense septations with thickened septations along the posterior lateral margin of the mass which do not demonstrate significant enhancement on postcontrast imaging. There is no enhancement of the soft tissue component seen on postcontrast imaging. There is interdigitation of adductor muscular fibers in the posterior medial aspect of the mass with scattered traversing veins. In it's largest cross-sectional dimension, the mass measures approximately 9.5 x 13.0 x 19.9 cm AP by TR by CC (axial T1 series 5, image 21 and coronal T1 series 3, image 15). VESSELS:No significant disease. The superficial femoral artery and vein closely approximate the mass with preserved intervening fat plane (series 5, image 14). NERVES: Normal. The sciatic nerve is normal in size without close proximity to the underlying
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FINDINGS: BONES/JOINTS: There is a mildly displaced fracture extending through the intertrochanteric region. No other fracture is identified. The femoral heads are well-seated within the acetabula.. The pubic symphysis and sacroiliac joints are normally positioned. SOFT TISSUES: There is mild soft tissue swelling/hemorrhage anterior to the proximal left femur. No large hematoma or fluid collection. There are several surgical clips within the inferior left hemipelvis.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Pancreatic mass. COMPARISON: None. TECHNIQUE: Outside CT images with IV contrast dated 12/27/2021 were submitted for interpretation. FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Pancreatic Mass FINDINGS: STUDY QUALITY: Satisfactory. LOWER CHEST: LUNG BASES / PLEURA: Scattered subpleural pulmonary nodules in the left lower lobe, the largest of which measures 5 mm on series 2, image 17. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: No liver metastases. Suspected enhancing hemangioma in the right hepatic lobe (series 2, image 43). PERITONEUM: No ascites. No peritoneal nodules. PANCREAS: Pancreatic mass: - Location: Uncinate - Size: 3.0 x 2.9 cm (series 2, image 64) - Composition: Solid - Enhancement relative to pancreas: Hypoenhancing - Margins: Ill-defined with irregular margins. - Pancreatic duct: Not dilated - Pancreatic atrophy: No pancreatic atrophy. - Biliary ducts: Not dilated - Gallbladder: No abnormality. VASCULATURE: - Arterial anatomy: Conventional. - Celiac Axis (CA): No tumor contact. - Common Hepatic Artery (CHA): No tumor contact. - Superior Mesenteric Artery (SMA): Tumor contact
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FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Pancreatic Mass FINDINGS: STUDY QUALITY: Satisfactory. LOWER CHEST: LUNG BASES / PLEURA: Scattered subpleural pulmonary nodules in the left lower lobe, the largest of which measures 5 mm on series 2, image 17. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: No liver metastases. Suspected enhancing hemangioma in the right hepatic lobe (series 2, image 43). PERITONEUM: No ascites. No peritoneal nodules. PANCREAS: Pancreatic mass: - Location: Uncinate - Size: 3.0 x 2.9 cm (series 2, image 64) - Composition: Solid - Enhancement relative to pancreas: Hypoenhancing - Margins: Ill-defined with irregular margins. - Pancreatic duct: Not dilated - Pancreatic atrophy: No pancreatic atrophy. - Biliary ducts: Not dilated - Gallbladder: No abnormality. VASCULATURE: - Arterial anatomy: Conventional. - Celiac Axis (CA): No tumor contact. - Common Hepatic Artery (CHA): No tumor contact. - Superior Mesenteric Artery (SMA): Tumor contact
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Findings: No enlarged hilar or mediastinal nodes are present. The mediastinum is normal. Moderate upper lobe predominant centrilobular emphysema with biapical pleural parenchymal scarring. 3 mm right lower lobe nodule on image 129 of series 2. 3 mm left apical nodule on image 36. Tiny calcified granulomas bilaterally. No suspicious lung nodules. The trachea and main bronchi are patent with some secretions in the lower trachea and right main bronchus. No pleural effusion or pleural thickening. Coronary artery calcification: The visual score of calcification is 1. (Based on a publication by Kirsch et al (Detection of Coronary calcium During Standard Chest Computed Tomography Correlates With Multi-Detector Computed Tomography Coronary Artery Calcium score, Int J Cardiovasc Imaging (2012) 28:1249-1256), visual score >7 is associated with an Agatston score > 400 and independently validated increased incidence of cardiovascular mortality). The visualized liver, spleen, adrenals, and bowel are unremarkable. Bones: Unremarkable.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Hepatic metastases. Colorectal cancer. COMPARISON: Outside PET MR dated 12/6/2021. TECHNIQUE: Outside CT images with IV contrast dated 12/10/2021 were submitted for interpretation. FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: There are extensive posttreatment changes of the liver which are difficult to completely evaluate given lack of remote exams. At least one hepatic metastasis is viable based on the findings on recent PET/MRI and is within the right hepatic lobe that measures 2.5 x 1.5 cm on axial image 27. There are changes from prior portal vein embolization in the right portal vein. There are changes from partial hepatic resection near the hepatic dome. There are also multiple ablation defects in the liver. BILIARY TRACT: There is left hepatic biliary ductal dilation, terminating at the posttreatment changes at the hepatic dome. Otherwise nondilated. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Postsurgical changes from prior partial small bowel resection. Otherwise normal. COLON / APPENDIX: Postsurgical changes from prior low anterior resection. Adjacent to the ascending colon and the inferior tip of the right hepatic lobe, there is a suspected 2.1 x 2.0 cm soft tissue nodule along the serosal surface of the colon (axial image 51) that appeared to be markedly hypermetabolic on PET/MRI. PERITONEUM / MESENTERY: No additional peritoneal nodularity or ascites. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Collapsed. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Extensive posttreatment changes of the liver are difficult to completely characterize on this single exam without remote priors. At least one viable hepatic metastasis based on findings on recent PET/MRI. Correlation with remote priors would be useful. 2. Suspected serosal mass along the surface of the descending colon adjacent to the inferior tip of the right hepatic lobe which appear to be hypermetabolic on PET/MRI. 3. No additional evidence of metastatic disease in the abdomen or pelvis.
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FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: There are extensive posttreatment changes of the liver which are difficult to completely evaluate given lack of remote exams. At least one hepatic metastasis is viable based on the findings on recent PET/MRI and is within the right hepatic lobe that measures 2.5 x 1.5 cm on axial image 27. There are changes from prior portal vein embolization in the right portal vein. There are changes from partial hepatic resection near the hepatic dome. There are also multiple ablation defects in the liver. BILIARY TRACT: There is left hepatic biliary ductal dilation, terminating at the posttreatment changes at the hepatic dome. Otherwise nondilated. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Postsurgical changes from prior partial small bowel resection. Otherwise normal. COLON / APPENDIX: Postsurgical changes from prior low anterior resection. Adjacent to the ascending colon and the inferior tip of the right hepatic lobe, there is a suspected 2.1 x 2.0 cm soft tissue nodule along the serosal surface of the colon (axial image 51) that appeared to be markedly hypermetabolic on PET/MRI. PERITONEUM / MESENTERY: No additional peritoneal nodularity or ascites. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Collapsed. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: A small ill-defined nodular density is noted in the right lower lobe in axial image 39, series 2 as before. The previously noted left lower lobe subpleural nodularity has resolved. Diffuse increased peribronchial thickening is noted along with patchy ill-defined groundglass parenchymal opacities new since prior study. No mediastinal, hilar or axillary adenopathy is noted. There is no pleural or pericardial effusion and visualized bones are unremarkable. A small right mid lateral chest wall intramuscular lipoma.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Chronic pancreatitis. COMPARISON: 10/8/2021 TECHNIQUE: Outside CT images with IV contrast dated 12/5/2021 were submitted for interpretation. FINDINGS: IMAGE QUALITY: Satisfactory. 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: Mild intrahepatic biliary ductal dilation. Metallic common bile duct stent in place. No pneumobilia is identified. GALLBLADDER: Absent. PANCREAS: Diffuse pancreatic parenchymal calcifications and irregular pancreatic ductal dilation. No focal pancreatic mass. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is absent. Otherwise normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerosis without aneurysm. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Changes consistent with chronic pancreatitis. No evidence of acute pancreatitis. 2. Mild intrahepatic biliary ductal dilation. No pneumobilia is identified. Findings are concerning for metallic common bile duct stent malfunction. Correlate with serum bilirubin.
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FINDINGS: IMAGE QUALITY: Satisfactory. 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: Mild intrahepatic biliary ductal dilation. Metallic common bile duct stent in place. No pneumobilia is identified. GALLBLADDER: Absent. PANCREAS: Diffuse pancreatic parenchymal calcifications and irregular pancreatic ductal dilation. No focal pancreatic mass. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is absent. Otherwise normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerosis without aneurysm. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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Findings: Stable positioning of right frontal approach ventriculostomy catheter with slight interval decrease in shunted ventricular volume. Remaining images the brain demonstrate no intracranial mass, mass effect, edema, hemorrhage or evidence of acute infarction. The visualized paranasal sinuses and mastoid air cells are unremarkable. No acute osseous or soft tissue abnormality seen. Mildly enlarged lymph nodes in the parotid spaces are likely reactive changes.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Renal mass COMPARISON: CT 8/17/2008 TECHNIQUE: Outside CT images with IV contrast dated 12/27/2021 were submitted for interpretation. The CT acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Two small noncalcified right lower lobe pulmonary nodules measuring up to 5 mm (image one, series 2); these were not seen on the prior examination 8/17/2008, possibly related to field of view. DISTAL ESOPHAGUS: Small hiatal hernia HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Mild intra and extrahepatic biliary dilatation, slightly more prominent compared to the remote prior exam in 2008. Common bile duct maximum diameter measures about 9 mm. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: There is a 2.0 x 2.0 cm rounded partially exophytic lesion in the superior pole right kidney (series 2 image 91) which is indeterminate based on density on this single phase examination. This lesion has appeared in the interval since 2008 and does not extend to involve the renal hilum or right renal vein. There is an additional lesion in the superior pole right kidney with density compatible with a simple cyst. This cyst is slightly increased in size since the prior examination in 2008. There is duplication of the renal collecting systems bilaterally. There are small calcifications in the inferior pole right kidney favored to reflect parenchymal calcifications with adjacent cortical parenchymal scarring. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Surgical changes from partial colectomy. Fluid is observed throughout the colon. There is mild diffuse colon wall thickening without pericolonic fat stranding. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is surgically absent BODY WALL: Small fat-containing superior abdominal and small umbilical hernia MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. 2 cm indeterminate partially exophytic lesion in the superior pole right kidney appearing since prior CT examination 8/17/2008, as detailed. Correlation with renal sonogram and further evaluation with dedicated renal mass protocol CT or MRI is recommended, if not recently performed. 2. Mild intra and extrahepatic biliary dilatation, slightly progressed compared to the remote prior examination and favored to be sequela of prior cholecystectomy. Correlation with liver function tests as to need for additional workup is recommended. 3. Fluid in the colon and mild diffuse colon wall thickening, suggestive of colitis. 4. Two small noncalcified right lower lobe pulmonary nodules, which were not appreciated on prior CT examination, possibly secondary to field-of-view. Consider dedicated chest CT for further evaluation, if not recently performed. As the attending 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: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Two small noncalcified right lower lobe pulmonary nodules measuring up to 5 mm (image one, series 2); these were not seen on the prior examination 8/17/2008, possibly related to field of view. DISTAL ESOPHAGUS: Small hiatal hernia HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Mild intra and extrahepatic biliary dilatation, slightly more prominent compared to the remote prior exam in 2008. Common bile duct maximum diameter measures about 9 mm. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: There is a 2.0 x 2.0 cm rounded partially exophytic lesion in the superior pole right kidney (series 2 image 91) which is indeterminate based on density on this single phase examination. This lesion has appeared in the interval since 2008 and does not extend to involve the renal hilum or right renal vein. There is an additional lesion in the superior pole right kidney with density compatible with a simple cyst. This cyst is slightly increased in size since the prior examination in 2008. There is duplication of the renal collecting systems bilaterally. There are small calcifications in the inferior pole right kidney favored to reflect parenchymal calcifications with adjacent cortical parenchymal scarring. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Surgical changes from partial colectomy. Fluid is observed throughout the colon. There is mild diffuse colon wall thickening without pericolonic fat stranding. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is surgically absent BODY WALL: Small fat-containing superior abdominal and small umbilical hernia MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Small right hemopneumothorax with evolving lacerations and contusions of the right middle and lower lobes. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Irregular, stellate liver laceration in the right hepatic dome appears overall unchanged compared to most recent prior exam. Liver laceration results in thrombosis of segmental branch of the right hepatic artery. Patchy perfusion related hyperenhancement throughout the right hepatic parenchyma. No evidence of active arterial contrast extravasation or pseudoaneurysm in the laceration however centimeter minimal branches of hepatic artery and portal vein are seen in close vicinity of laceration in small suboptimally evaluated metallic streak artifacts. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Right adrenal gland injury with associated hematoma. KIDNEYS: Small amount of right perinephric fluid/fat stranding without discrete injury. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Decreased size of the perihepatic fluid collection. Similar volume pneumoperitoneum. Scattered small volume hemoperitoneum. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Subcutaneous gas in the right abdominal wall. MUSCULOSKELETAL: Ballistic fragment within the spinal canal at the level of the L2-L3 disc space. Similar fractures of L1
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16,177 |
EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: 72-year-old male with history of resected colon cancer presents with new enlarged mesenteric node. COMPARISON: CT 8/26/2021. TECHNIQUE: Outside CT images abdomen and pelvis with intravenous contrast from Carmichael Imaging dated 11/11/2021 were submitted for interpretation. Coronal and sagittal reconstructions were also reviewed. The CT acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal size and configuration. Linear hypodense lesion in the lateral hepatic segment measures 1.5 x 0.6 cm (image 21 series 2), unchanged. No new hepatic lesions or cirrhotic morphology. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Scattered calcified granulomas. Otherwise normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: A nodal mass inferior to the pancreatic body contains a small cluster of central calcifications. This nodule measures 2.3 x 1.9 cm (image 46 series 2), previously 2.5 x 2.0 cm (image 134 series 2). No other adenopathy is identified. STOMACH / SMALL BOWEL: A loop of small bowel projects into a broad-based right periumbilical hernia without wall thickening or obstruction. Otherwise normal. COLON / APPENDIX: Colonic anastomosis has normal appearance without soft tissue thickening or mass. The remaining colon is unremarkable. Normal appendix. PERITONEUM / MESENTERY: No ascites or peritoneal nodularity RETROPERITONEUM: No retroperitoneal adenopathy. VESSELS: Right common iliac venous stent appears patent. No other vascular abnormalities identified. URINARY BLADDER: Collapsed. Concentric wall thickening, unchanged. REPRODUCTIVE ORGANS: Severe prostatomegaly, unchanged. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Nodal mass adjacent to the pancreas with irregular calcifications is highly suspicious for metastatic disease. This correlates with area of metabolic tracer uptake on subsequent PET study. 2. No other abdominal or pelvic metastases are identified. Small linear hepatic hypodensity is unchanged from prior study, and indeterminate. 3. Severe prostatomegaly. Urinary bladder wall thickening may be secondary to chronic bladder outlet obstruction. 4. Periumbilical hernia contains a short segment of nonobstructed small bowel.
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FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal size and configuration. Linear hypodense lesion in the lateral hepatic segment measures 1.5 x 0.6 cm (image 21 series 2), unchanged. No new hepatic lesions or cirrhotic morphology. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Scattered calcified granulomas. Otherwise normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: A nodal mass inferior to the pancreatic body contains a small cluster of central calcifications. This nodule measures 2.3 x 1.9 cm (image 46 series 2), previously 2.5 x 2.0 cm (image 134 series 2). No other adenopathy is identified. STOMACH / SMALL BOWEL: A loop of small bowel projects into a broad-based right periumbilical hernia without wall thickening or obstruction. Otherwise normal. COLON / APPENDIX: Colonic anastomosis has normal appearance without soft tissue thickening or mass. The remaining colon is unremarkable. Normal appendix. PERITONEUM / MESENTERY: No ascites or peritoneal nodularity RETROPERITONEUM: No retroperitoneal adenopathy. VESSELS: Right common iliac venous stent appears patent. No other vascular abnormalities identified. URINARY BLADDER: Collapsed. Concentric wall thickening, unchanged. REPRODUCTIVE ORGANS: Severe prostatomegaly, unchanged. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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Findings: CTA of the neck: The top aortic arch and the brachiocephalic arteries have expected appearance with minor diffuse atherosclerotic changes but no significant stenosis. The common carotid arteries and bifurcations are essentially negative. The cervical ICAs are normal. The left vertebral artery is large and the right is smaller. Both have antegrade flow with no apparent defect. CTA head: The coiled basilar tip aneurysm appears larger than on prior scans and 2016 and 2015, now measuring 2.0 x 2.2 x 2.9 cm (axial MIP series 408 #64 and sagittal MIP series 410 #69). The inferior aspect of the aneurysm is obscured by coils in the aneurysm. No filling of the aneurysm is seen. The circle of Willis is obscured. No defect is seen in the proximal ACAs, MCA's or PCAs. The basilar artery and visible branches are unremarkable. ----------------
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16,178 |
EXAM: Outside MR Image Interpretation CLINICAL INFORMATION: Cirrhosis with prior liver lesion presenting for follow-up. COMPARISON: 9/21/2021. TECHNIQUE: Outside MR images without and with IV contrast dated 12/7/2021 were submitted for interpretation. The MRI acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. 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. Ablation defect is redemonstrated within hepatic segment IVa, which does not demonstrate suspicious enhancement (LR-TR nonviable), unchanged. LIVER LESIONS: - Lesion Number: 1 - Location: Segment(s) 6 - Size: 1.4 x 1.4 cm (Image 39, Series 10), previously 1.2 x 1.4 cm. - 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: None. - LI-RADS: LR-3, unchanged. No new suspicious regions of arterial enhancement or delayed washout are visualized. LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: Small (
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FINDINGS: STRUCTURED REPORT: MR HCC Screening IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. No steatosis. Ablation defect is redemonstrated within hepatic segment IVa, which does not demonstrate suspicious enhancement (LR-TR nonviable), unchanged. LIVER LESIONS: - Lesion Number: 1 - Location: Segment(s) 6 - Size: 1.4 x 1.4 cm (Image 39, Series 10), previously 1.2 x 1.4 cm. - 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: None. - LI-RADS: LR-3, unchanged. No new suspicious regions of arterial enhancement or delayed washout are visualized. LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: Small (
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Findings: CTA of the neck: The top aortic arch and the brachiocephalic arteries have expected appearance with minor diffuse atherosclerotic changes but no significant stenosis. The common carotid arteries and bifurcations are essentially negative. The cervical ICAs are normal. The left vertebral artery is large and the right is smaller. Both have antegrade flow with no apparent defect. CTA head: The coiled basilar tip aneurysm appears larger than on prior scans and 2016 and 2015, now measuring 2.0 x 2.2 x 2.9 cm (axial MIP series 408 #64 and sagittal MIP series 410 #69). The inferior aspect of the aneurysm is obscured by coils in the aneurysm. No filling of the aneurysm is seen. The circle of Willis is obscured. No defect is seen in the proximal ACAs, MCA's or PCAs. The basilar artery and visible branches are unremarkable. ----------------
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16,179 |
EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Bladder cancer COMPARISON: 12/10/2021. TECHNIQUE: Outside CT images of the abdomen and pelvis with contrast dated 12/31/2021 were submitted for interpretation. The CT acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Increased interstitial opacities are again noted in the right lung base. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal in configuration. Low-attenuation lesion along the anterior aspect of the hepatic dome has cystic areas, with several internal septations. No other focal liver lesion. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Postsurgical changes from left nephrectomy. There is a 4.3 x 3.6 cm solid and cystic lesion in the mid right kidney (image 83, series 5) with the solid areas demonstrating measurable enhancement. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic calcification of the abdominal aorta and its branches without aneurysm. URINARY BLADDER: Irregular mass involving the majority of the urinary bladder, most prominent along the right lateral aspect of the bladder, but extending from the dome to the bladder base. The posterior aspect of the mass abuts the right ureterovesical junction, but no definite obstruction at this time. REPRODUCTIVE ORGANS: There appears to be extension of the bladder mass into the left lateral aspect of the prostate. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous lesion. Degenerative changes are present in the lumbar spine, most prominent at L5-S1. CONCLUSION: 1. Large heterogeneous urinary bladder mass with extension into the left aspect of the prostate. The mass abuts the right ureterovesical junction, but does not result in upstream obstruction. 2. Enhancing solid and cystic mass in the right kidney is most compatible with renal cell carcinoma. 3. Status post left nephrectomy. 4. Mildly complex cyst along dome of liver. Comparison to any prior exams would be useful to assess for stability. 5. Additional findings as above.
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FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Increased interstitial opacities are again noted in the right lung base. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal in configuration. Low-attenuation lesion along the anterior aspect of the hepatic dome has cystic areas, with several internal septations. No other focal liver lesion. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Postsurgical changes from left nephrectomy. There is a 4.3 x 3.6 cm solid and cystic lesion in the mid right kidney (image 83, series 5) with the solid areas demonstrating measurable enhancement. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic calcification of the abdominal aorta and its branches without aneurysm. URINARY BLADDER: Irregular mass involving the majority of the urinary bladder, most prominent along the right lateral aspect of the bladder, but extending from the dome to the bladder base. The posterior aspect of the mass abuts the right ureterovesical junction, but no definite obstruction at this time. REPRODUCTIVE ORGANS: There appears to be extension of the bladder mass into the left lateral aspect of the prostate. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous lesion. Degenerative changes are present in the lumbar spine, most prominent at L5-S1.
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Findings: There is a right frontal approach ventricular shunt catheter terminating in the left frontal horn. The ventricles are decompressed. There is no hydrocephalus. There is no acute hemorrhage. There is coil embolization material within the previously coiled basilar tip aneurysm. There has however been interval enlargement of the aneurysm with peripheral calcifications, now measuring up to 3.1 x 2.1 cm whereas it measured 1.7 x 1.8 cm previously. There is peripheral calcification along the aneurysm and some of the embolization material along the posterior and superior right aspect. There is extensive streak artifact resulting from the embolization material limiting evaluation. In the remaining visualized brain parenchyma, there is a suspected hypodensity in the right thalamus, which could represent an evolving infarct. The dural venous sinuses appear mildly hyperdense, which could represent hemoconcentration. The visualized paranasal sinuses and mastoid air cells are clear. ----------------
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CT head without contrast. Outside scan dated 12/29/2024 interpretation only. Clinical Information: Intractable epilepsy. CT Head from Huntsville Hospital done 12-29-21 rec 1-11-22 Comparison: None. Technique: Axial helical images of the head were obtained. Coronal and sagittal reformatted images were obtained from the axial data set. Findings: There is normal appearance of the parenchyma with no mass, hemorrhage or extracerebral collection. The ventricles are normal. There is no temporal atrophy or sclerosis. The posterior fossa contents appear normal. There is a small round metallic foreign body in the right orbit near the roof having the appearance of a BB. No defect is seen in the calvarium or skull base. --------------- Conclusion: Essentially negative cranial CT scan.
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Findings: There is normal appearance of the parenchyma with no mass, hemorrhage or extracerebral collection. The ventricles are normal. There is no temporal atrophy or sclerosis. The posterior fossa contents appear normal. There is a small round metallic foreign body in the right orbit near the roof having the appearance of a BB. No defect is seen in the calvarium or skull base. ---------------
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Findings: RAPID images demonstrate CBF less than 30% volume: 0 ml and T. Max greater than 6seconds volume: 4 mL. Mismatch volume is 4 mL. Minimal amount of elevated T-max is seen along the posterior falx and right occipital lobe, could be artifactual. There is no significant abnormal MTT, T max, CBV and CBF to suggest significant ischemia or infarction at the territory of the major intracranial arteries.
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16,181 |
Interpretation of Outside Films CT Chest Clinical Information: 65-year-old female with provided history of lung mass. Spec Inst: Lung mass - CT Chest from Dekalb Regional done 12-13-21 rec 1-11-22 Study reviewed: CT of chest without contrast performed at Dekalb Regional Medical Center on 12/13/2021, The images are available in PACS. Findings: Limitations: None. Chest: Lines, tubes, and devices: Left chest wall dual chamber ICD with transvenous lead terminates at the right atrial appendage and right ventricular apex. Lung parenchyma and pleura: There is a left upper lobe hilar mass measures 3.0 x 2.8 cm (image 48, series 4), extension to the left hilar region cannot be totally excluded for recommended post contrast study. The mass is surrounded by consolidative and tree-in-bud opacities with likely obstruction of the left upper lobe apical segmental bronchus. Additional tiny nodules are noted, for example in the anterior left upper lobe at image 63. The trachea and main bronchi are patent. No pleural effusion. Thoracic inlet, heart, and mediastinum: Left hilar lymphadenopathy is limited in this noncontrasted study. Small subcentimeter AP window lymph node, measures 7 mm (image 49). No supraclavicular lymphadenopathy within the field of view. No axillary lymphadenopathy. The esophagus is nondilated. The thoracic aorta is normal in caliber with mild calcification. Main pulmonary artery is dilated, measures 4.5 cm. The overall heart size normal. No pericardial effusion. Mild coronary calcification. Bones and soft tissues: No destructive bone lesion. Chest wall is unremarkable. Upper abdomen: Left hepatic lobe 10 mm low-attenuation nodule, too small to characterize. Conclusion: 1. Left upper lobe hilar mass with postobstructive changes, concerning for underlying malignancy. 2. Left hilar lymphadenopathy is limited in this noncontrasted study. 3. Dilated main pulmonary artery, consistent with pulmonary hypertension.
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Findings: Limitations: None. Chest: Lines, tubes, and devices: Left chest wall dual chamber ICD with transvenous lead terminates at the right atrial appendage and right ventricular apex. Lung parenchyma and pleura: There is a left upper lobe hilar mass measures 3.0 x 2.8 cm (image 48, series 4), extension to the left hilar region cannot be totally excluded for recommended post contrast study. The mass is surrounded by consolidative and tree-in-bud opacities with likely obstruction of the left upper lobe apical segmental bronchus. Additional tiny nodules are noted, for example in the anterior left upper lobe at image 63. The trachea and main bronchi are patent. No pleural effusion. Thoracic inlet, heart, and mediastinum: Left hilar lymphadenopathy is limited in this noncontrasted study. Small subcentimeter AP window lymph node, measures 7 mm (image 49). No supraclavicular lymphadenopathy within the field of view. No axillary lymphadenopathy. The esophagus is nondilated. The thoracic aorta is normal in caliber with mild calcification. Main pulmonary artery is dilated, measures 4.5 cm. The overall heart size normal. No pericardial effusion. Mild coronary calcification. Bones and soft tissues: No destructive bone lesion. Chest wall is unremarkable. Upper abdomen: Left hepatic lobe 10 mm low-attenuation nodule, too small to characterize.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: CVC tip is located within the right atrium. Otherwise normal appearance of the heart and coronary vessels. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: No hydronephrosis bilaterally. Unchanged perinephric stranding around the left kidney. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Short segment small bowel wall thickening with mechanical small bowel obstruction (image 71, series 80392). No pneumatosis or free air. COLON / APPENDIX: The colon is normal. The appendix is not visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Trace amount of free fluid within the pelvis. VESSELS: Mild scattered atherosclerotic calcifications of the abdominal aorta and its branches. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is absent. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Enlargement of the L5-S1 disc extrusion causing compression of the descending right S1 nerve root. Correlate with physical examination for radiculopathy. L5-S1 vacuum phenomenon. No suspicious osseous lesion.
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Interpretation of Outside Films CT Head 1/11/2022 5:27 PM Clinical Information: Spec Inst: TGN CT HEAD 122321 FLOWERS REC 11122 Comparison: CT head without contrast dated 12/20/2021. MRI brain with and without contrast dated 10/4/2021. Technique: Unenhanced axial brain CT. Bone and soft tissue windows were reviewed. Sagittal and coronal images were generated from the axial data. Findings: Brain parenchyma: Mild frontal age-appropriate brain parenchymal volume loss is again seen. The brain parenchyma has a normal appearance. The white-gray matter differentiation is preserved. Unchanged bilateral physiologic basal ganglia calcifications. Ventricular system: Normal configuration. No hydrocephalus. Basal cisterns: There is no significant effacement of the basilar cisterns. Extra-axial spaces: Normal appearance. No abnormal extra-axial fluid collections. Hemorrhage: No intracranial hemorrhage is identified. Midline shift: No significant midline shift is seen. Vascular system: Persistent punctate atherosclerotic calcifications of the bilateral carotid siphons. Soft tissues: Unremarkable without discrete fluid collections. Orbits: Normal appearance. Calvarium and skull base: No acute fractures or suspicious osseous lesions identified. The bilateral mastoid air cell complexes are well-developed and clear. Paranasal sinuses: Well aerated. IMPRESSION: No acute intracranial process or significant interval change identified. Outside imaging is not obtained in a standardized format accepted by UAB. This may limit sensitivity and specificity of interpretation. If clinical suspicion for pathology remains, would recommend repeat imaging at this institution.
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Findings: Brain parenchyma: Mild frontal age-appropriate brain parenchymal volume loss is again seen. The brain parenchyma has a normal appearance. The white-gray matter differentiation is preserved. Unchanged bilateral physiologic basal ganglia calcifications. Ventricular system: Normal configuration. No hydrocephalus. Basal cisterns: There is no significant effacement of the basilar cisterns. Extra-axial spaces: Normal appearance. No abnormal extra-axial fluid collections. Hemorrhage: No intracranial hemorrhage is identified. Midline shift: No significant midline shift is seen. Vascular system: Persistent punctate atherosclerotic calcifications of the bilateral carotid siphons. Soft tissues: Unremarkable without discrete fluid collections. Orbits: Normal appearance. Calvarium and skull base: No acute fractures or suspicious osseous lesions identified. The bilateral mastoid air cell complexes are well-developed and clear. Paranasal sinuses: Well aerated.
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FINDINGS: Contrast opacification of pulmonary arteries as well as aorta is good. No intraluminal filling defect is noted in the visualized pulmonary arteries and its branches. The main pulmonary artery measures 38 mm in diameter in axial image 55, series 501. The thoracic aorta is normal in its contour and caliber without aneurysmal dilatation or dissection. Multiple collaterals are present in the left chest wall and mediastinum due to left innominate vein and narrowing with an indwelling AICD leads in place. No mediastinal adenopathy is noted. Asymmetric upper lobe dominant centrilobular emphysema with minimal dependent atelectasis in both upper and lower lobes. The right hemidiaphragm is elevated causing compressive linear lower lobe atelectasis. There is no pleural or pericardial effusion and visualized bones are unremarkable for DJD changes.
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Interpretation of Outside Films MR Head 1/11/2022 6:10 PM Clinical information: 30 years Female patient with Spec Inst: MRA HEAD 122221 SEHMC REC 11122 Comparison: None. TECHNIQUE: 2-D noncontrast time-of-flight MRV of the brain was performed in the sagittal, coronal, and axial planes. Maximum intensity projection (MIP) reformatted images were generated. CONTRAST: None. FINDINGS: Superior sagittal sinus: No stenosis, occlusion, or filling defect. Inferior sagittal sinus: No stenosis, occlusion, or filling defect. Internal cerebral veins: No stenosis, occlusion, or filling defect. Straight sinus: No stenosis, occlusion, or filling defect. Transverse sinuses: No stenosis, occlusion, or filling defect. Sigmoid sinuses: No stenosis, occlusion, or filling defect. Upper jugular veins: No stenosis, occlusion, or filling defect. Dominant right dural venous sinus system. IMPRESSION: Unremarkable MRV of the brain, without definitive evidence of acute dural venous sinus thrombosis. Outside imaging is not obtained in a standardized format accepted by UAB. This may limit sensitivity and specificity of interpretation. If clinical suspicion for pathology remains, would recommend repeat imaging at this institution.
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FINDINGS: Superior sagittal sinus: No stenosis, occlusion, or filling defect. Inferior sagittal sinus: No stenosis, occlusion, or filling defect. Internal cerebral veins: No stenosis, occlusion, or filling defect. Straight sinus: No stenosis, occlusion, or filling defect. Transverse sinuses: No stenosis, occlusion, or filling defect. Sigmoid sinuses: No stenosis, occlusion, or filling defect. Upper jugular veins: No stenosis, occlusion, or filling defect. Dominant right dural venous sinus system.
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FINDINGS: The supraclavicular region is unremarkable. Central airways are patent. The main pulmonary artery is dilated measuring up to 3.3 cm, as before. There is unchanged cardiomegaly. Surgical changes of CABG, mitral valve repair and left atrial appendage clipping are again noted. Enlarged mediastinal lymph nodes are stable to slightly decreased in size from the prior examination. For example, a 14 mm short axis right lower paratracheal lymph node on image 83 of series 3 measured 16 mm previously. No new or enlarging thoracic lymph nodes. The esophagus is not dilated. The left pleural effusion is slightly increased in size. The small right pleural effusion is not significantly changed in size. Pleural calcifications along the posterior right lung are again noted associated bandlike areas of scarring/rounded atelectasis in the posterior basal right lower which appear similar to the prior examination. Linear areas is also seen within the left lower lobe, similar to the prior examination. There is mild bilateral chronic bronchial thickening with some associated centrilobular nodularity in the bilateral lower lobes, not significantly changed from the prior examination. A 5 mm nodule within the right lower lobe on image 109 is unchanged from prior examinations. No new or enlarging nodules. There is no acute or aggressive osseous abnormality. Prior median sternotomy. Mild degenerative changes of thoracic spine.
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Interpretation of Outside Films MR Head 1/11/2022 6:10 PM Clinical information: 30 years Female patient with Spec Inst: MRI HEAD 122221 SEHMC REC 11122 Comparison: None available. Technique: Multiplanar, multisequence MRI of the brain was performed without the administration of intravenous contrast. FINDINGS: Cerebral parenchyma: The brain parenchyma volume is appropriate for patient's age. No intracranial mass lesion, hemorrhage, or infarction. Coronal T2/STIR images through the temporal lobes are significantly degraded by motion artifacts. Ventricular system: No hydrocephalus or midline shift. Extra axial spaces: No epidural, subdural, or subarachnoid hemorrhage. No basal cistern effacement. Vascular system: No loss of the major vascular flow voids. Visualized paranasal sinuses: Trace bilateral frontal and scattered anterior ethmoid air cell mucosal thickening. Visualized orbits: No ocular or retrobulbar pathology. Calvarium and skull base: No osseous destruction. Pituitary and Pineal Glands: No mass lesion. Soft tissues: No significant abnormality. IMPRESSION: 1. No acute intracranial pathology. 2. Coronal T2/STIR images through the temporal lobes are significantly degraded by motion artifacts. Outside imaging is not obtained in a standardized format accepted by UAB. This may limit sensitivity and specificity of interpretation. If clinical suspicion for pathology remains, would recommend repeat imaging at this institution.
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FINDINGS: Cerebral parenchyma: The brain parenchyma volume is appropriate for patient's age. No intracranial mass lesion, hemorrhage, or infarction. Coronal T2/STIR images through the temporal lobes are significantly degraded by motion artifacts. Ventricular system: No hydrocephalus or midline shift. Extra axial spaces: No epidural, subdural, or subarachnoid hemorrhage. No basal cistern effacement. Vascular system: No loss of the major vascular flow voids. Visualized paranasal sinuses: Trace bilateral frontal and scattered anterior ethmoid air cell mucosal thickening. Visualized orbits: No ocular or retrobulbar pathology. Calvarium and skull base: No osseous destruction. Pituitary and Pineal Glands: No mass lesion. Soft tissues: No significant abnormality.
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Findings: CT angiogram of the neck: There is a normal aortic arch. There is tapering of flow and abrupt occlusion in the left cervical ICA approximately 2 cm distal to the origin with complete occlusion throughout the remaining cervical portion. The right cervical ICA, bilateral common carotid arteries and vertebral arteries appear unremarkable. CT angiogram of the brain: There continues to be complete occlusion of the left intracranial ICA throughout its course. There is occlusion of the left MCA as well completely. There is filling of the ACAs bilaterally with some collaterals in the region of the distal ICA. There are patent bilateral P comms. The intracranial vertebral arteries, basilar artery and bilateral PCAs are unremarkable. There is diffuse poor flow within the left MCA distribution compared to the right.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Colon mass. COMPARISON: None. TECHNIQUE: Outside CT images with IV contrast dated 12/11/2021 were submitted for interpretation. The CT acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Scattered punctate foci observed in the right middle and right lower and left lower lobe which may reflect calcifications or possibly previously aspirated high density material. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Multivessel coronary artery calcifications ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. No wall thickening or pericholecystic fluid. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal KIDNEYS: Mild left hydronephrosis. Renal nephrograms are symmetric. There is a 1 cm indeterminate lesion in the posterior aspect of the interpolar left kidney (series 2 image 29). Right kidney is normal without hydronephrosis. LYMPH NODES: There are a few right lower quadrant mesenteric lymph nodes adjacent to the cecum measuring up to about 9 mm in size. STOMACH / SMALL BOWEL: No abnormality. Small bowel loops are nondilated. COLON / APPENDIX: There is marked irregular wall thickening of the cecum and proximal ascending colon with inflammatory stranding in the adjacent mesocolon highly concerning for malignancy. Colonic diverticulosis. PERITONEUM / MESENTERY: Small amount of free fluid in the pelvis. No free intraperitoneal air. RETROPERITONEUM: Normal. VESSELS: Moderate aortobiiliac atherosclerotic disease without aneurysm URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostate is normal. Penile prosthesis is partially visualized. BODY WALL: Subcutaneous foci of gas within the anterior abdominal wall, likely sequela of prior injections. MUSCULOSKELETAL: Multilevel degenerative changes in the lumbar spine. Posterior fusion hardware at L4-L5. No aggressive osseous lesions. CONCLUSION: 1. Marked irregular wall thickening of the cecum and proximal colon highly concerning for malignancy. There are prominent adjacent mesenteric lymph nodes. No distant metastatic disease identified. 2. Additional, nonacute findings as detailed in the report. Please see separately dictated report for dedicated chest findings. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report. ADDITIONAL FINDINGS: 3. Mild left hydroureteronephrosis without radiopaque urinary tract calculus or significant mass effect on the distal left ureter.
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FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Scattered punctate foci observed in the right middle and right lower and left lower lobe which may reflect calcifications or possibly previously aspirated high density material. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Multivessel coronary artery calcifications ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. No wall thickening or pericholecystic fluid. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal KIDNEYS: Mild left hydronephrosis. Renal nephrograms are symmetric. There is a 1 cm indeterminate lesion in the posterior aspect of the interpolar left kidney (series 2 image 29). Right kidney is normal without hydronephrosis. LYMPH NODES: There are a few right lower quadrant mesenteric lymph nodes adjacent to the cecum measuring up to about 9 mm in size. STOMACH / SMALL BOWEL: No abnormality. Small bowel loops are nondilated. COLON / APPENDIX: There is marked irregular wall thickening of the cecum and proximal ascending colon with inflammatory stranding in the adjacent mesocolon highly concerning for malignancy. Colonic diverticulosis. PERITONEUM / MESENTERY: Small amount of free fluid in the pelvis. No free intraperitoneal air. RETROPERITONEUM: Normal. VESSELS: Moderate aortobiiliac atherosclerotic disease without aneurysm URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostate is normal. Penile prosthesis is partially visualized. BODY WALL: Subcutaneous foci of gas within the anterior abdominal wall, likely sequela of prior injections. MUSCULOSKELETAL: Multilevel degenerative changes in the lumbar spine. Posterior fusion hardware at L4-L5. No aggressive osseous lesions.
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Findings: CT angiogram of the neck: There is a normal aortic arch. There is tapering of flow and abrupt occlusion in the left cervical ICA approximately 2 cm distal to the origin with complete occlusion throughout the remaining cervical portion. The right cervical ICA, bilateral common carotid arteries and vertebral arteries appear unremarkable. CT angiogram of the brain: There continues to be complete occlusion of the left intracranial ICA throughout its course. There is occlusion of the left MCA as well completely. There is filling of the ACAs bilaterally with some collaterals in the region of the distal ICA. There are patent bilateral P comms. The intracranial vertebral arteries, basilar artery and bilateral PCAs are unremarkable. There is diffuse poor flow within the left MCA distribution compared to the right.
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Interpretation of Outside Films CT Chest Clinical Information: 77-year-old male with provided history of colon mass. Spec Inst: COLON MASS CT CHEST 121121 OUTSIDE REC 11122 Study reviewed: CT of chest without contrast performed at Elmore community Hospital on 12/11/2021, The images are available in PACS. Findings: Limitations: None. Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: Few small (less than 4 mm) pulmonary nodules are noted, for example a 2 mm left upper lobe subpleural nodule (image 26, series 2). Additional multiple scattered clustered calcifications seen in the right middle lobe and both lower lobes are also noted. Additional tree-in-bud opacities in the posterior segmental lower lobes are also noted with mild bronchiectatic changes. Right lower lobe subsegmental atelectasis/scarring. The trachea and main bronchi are patent. No pleural effusion. Thoracic inlet, heart, and mediastinum: No supraclavicular lymphadenopathy within the field of view. No axillary lymphadenopathy. No mediastinal or hilar lymphadenopathy. The esophagus is nondilated. The thoracic aorta is normal in caliber with mild calcification. Main pulmonary artery is dilated, measures 3.3 cm. The overall heart size normal. No pericardial effusion. Scattered three-vessel coronary calcification. Blood appears hypodense relative to the interventricular septum, a finding which could be seen with anemia. Bones and soft tissues: No destructive bone lesion. Chest wall is unremarkable. Upper abdomen: Reported separately. Conclusion: 1. Few small (less than 4 mm) noncalcified pulmonary nodules. Attention follow-up is recommended giving history of malignancy. 2. No thoracic lymphadenopathy. 3. Multiple scattered clustered calcifications mainly involving the right middle lobe and both lower lobes, likely related to dendritic pulmonary ossification. 4. Other findings as described.
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Findings: Limitations: None. Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: Few small (less than 4 mm) pulmonary nodules are noted, for example a 2 mm left upper lobe subpleural nodule (image 26, series 2). Additional multiple scattered clustered calcifications seen in the right middle lobe and both lower lobes are also noted. Additional tree-in-bud opacities in the posterior segmental lower lobes are also noted with mild bronchiectatic changes. Right lower lobe subsegmental atelectasis/scarring. The trachea and main bronchi are patent. No pleural effusion. Thoracic inlet, heart, and mediastinum: No supraclavicular lymphadenopathy within the field of view. No axillary lymphadenopathy. No mediastinal or hilar lymphadenopathy. The esophagus is nondilated. The thoracic aorta is normal in caliber with mild calcification. Main pulmonary artery is dilated, measures 3.3 cm. The overall heart size normal. No pericardial effusion. Scattered three-vessel coronary calcification. Blood appears hypodense relative to the interventricular septum, a finding which could be seen with anemia. Bones and soft tissues: No destructive bone lesion. Chest wall is unremarkable. Upper abdomen: Reported separately.
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Findings: There is a hyperdense left ICA and MCA extending into the distal branches. There is diffuse subtle decrease in density involving the basal ganglia, insular region, left frontal and temporal lobes. There is no superimposed hemorrhage. There is mild asymmetry of the lateral ventricles, which could be congenital and/or from evolving mass effect. There is no midline shift. No significant superimposed hemorrhagic transformation is noted. The visualized paranasal sinuses and mastoid air cells are clear. There is no acute osseous abnormality.
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16,187 |
EXAM: Outside MR Image Interpretation CLINICAL INFORMATION: 82-year-old male with incidental sacral mass identified on outside MRI, during workup for hip pain. COMPARISON: None. TECHNIQUE: Outside noncontrast MR images of the pelvis dated 12/17/2021 were submitted for interpretation. The MRI acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: There is a fairly well-circumscribed, lobulated, exophytic mass arising from the distal sacrum and extending into the presacral space that measures 6.3 x 7.5 x 8.3 cm (series 6 image 16, series 9 image 31, AP x trans x CC). The mass is heterogeneously T2/PD hyperintense, with an heterogeneously T1 hypointense. There is no significant surrounding marrow or soft tissue edema. The anterior margin of the mass abuts the posterior colon. There is advanced left hip degenerative arthrosis, with chronic appearing collapse of the femoral head and remodeling of the femoral head and acetabulum, with reactive subchondral cystlike changes and edema. Appearance suggests sequela of previous inflammatory insult or potentially crystal deposition disease. Small joint effusion is present. Mild edema also present in the adjacent gluteus minimus with associated gluteus medius minimus tendinosis and a superior paralabral cyst. Advanced degenerative changes in the right hip, but to a lesser degree than that seen on the left, with superior paralabral labral cyst. There is a fatty ventral wall hernia, with postsurgical changes also partially seen along the anterior abdominal wall. Intrapelvic contents otherwise unremarkable. Levoscoliosis and advanced degenerative changes in the partially imaged lower lumbar spine. Horizontal linear low T1 signal and hyperintense T2 signal in the L3 and L4 vertebral bodies, centered around the disc space, suspicious for subacute insufficiency fractures. CONCLUSION: 1. Large lobulated mass arising from the distal sacrum and extending into the presacral space, appearance and location concerning for chordoma. Other etiologies such as giant cell tumor and chondrosarcoma not completely excluded. Biopsy recommended. 2. Severely advanced left hip degenerative arthrosis with and chronic appearing femoral head collapse and remodeling of the acetabulum, as above. 3. Moderately advanced right hip degenerative arthrosis, as above. 4. Partially imaged advanced degenerative changes in the lower lumbar spine, with findings concerning for subacute L3-L4 insufficiency fractures. 5. Edema and atrophy within the left gluteus minimus, likely related to the advanced left hip degenerative arthrosis.
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FINDINGS: There is a fairly well-circumscribed, lobulated, exophytic mass arising from the distal sacrum and extending into the presacral space that measures 6.3 x 7.5 x 8.3 cm (series 6 image 16, series 9 image 31, AP x trans x CC). The mass is heterogeneously T2/PD hyperintense, with an heterogeneously T1 hypointense. There is no significant surrounding marrow or soft tissue edema. The anterior margin of the mass abuts the posterior colon. There is advanced left hip degenerative arthrosis, with chronic appearing collapse of the femoral head and remodeling of the femoral head and acetabulum, with reactive subchondral cystlike changes and edema. Appearance suggests sequela of previous inflammatory insult or potentially crystal deposition disease. Small joint effusion is present. Mild edema also present in the adjacent gluteus minimus with associated gluteus medius minimus tendinosis and a superior paralabral cyst. Advanced degenerative changes in the right hip, but to a lesser degree than that seen on the left, with superior paralabral labral cyst. There is a fatty ventral wall hernia, with postsurgical changes also partially seen along the anterior abdominal wall. Intrapelvic contents otherwise unremarkable. Levoscoliosis and advanced degenerative changes in the partially imaged lower lumbar spine. Horizontal linear low T1 signal and hyperintense T2 signal in the L3 and L4 vertebral bodies, centered around the disc space, suspicious for subacute insufficiency fractures.
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Findings: RAPID images demonstrate CBF less than 30% volume: 88 mL and T. Max greater than 6seconds volume: 201 mL. Mismatch volume is 113 mL. There is a large area of reduced CBF in the left MCA distribution with slightly larger area of surrounding elevated T-max in the left cerebral hemisphere.
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16,188 |
EXAM: Outside MR Image Interpretation CLINICAL INFORMATION: Renal mass COMPARISON: CT abdomen 10/22/2021 with contrast TECHNIQUE: Outside MR images with IV contrast dated 10/22/2021 were submitted for interpretation. The MRI acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: Wedge-shaped medial right lower lobe pulmonary nodule, indeterminate, favoring atelectasis seen on CT 10/22/2021. No pleural effusion. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: The liver is normal in size and morphology and incompletely imaged on all sequences. BILIARY TRACT: Normal as imaged. GALLBLADDER: Normal as imaged. PANCREAS: No main pancreatic ductal dilation. SPLEEN: Normal in size. ADRENALS: Normal in size. Slice thickness moderately limits evaluation for adrenal nodules. KIDNEYS: Small T2 hyperintense presumed renal cysts bilaterally. T2 hypointense right medial upper pole solid mass that is approximately 50% exophytic. This mass measures approximately 4.0 x 3.6 cm. No involvement of the right renal arteries or vein seen. No hydronephrosis bilaterally. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality as imaged. COLON: Normal in caliber as imaged. PERITONEUM / MESENTERY: No ascites. RETROPERITONEUM: No other abnormality. VESSELS: No significant abnormality. BODY WALL: No significant abnormality as imaged. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Right medial upper pole solid 4.0 cm mass highly suspicious for renal cell carcinoma. Evaluation is limited by protocol for intralesional fat and additional characteristics. No definite renal artery or right renal vein involvement by this mass. 2. No lymphadenopathy seen.
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FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: Wedge-shaped medial right lower lobe pulmonary nodule, indeterminate, favoring atelectasis seen on CT 10/22/2021. No pleural effusion. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: The liver is normal in size and morphology and incompletely imaged on all sequences. BILIARY TRACT: Normal as imaged. GALLBLADDER: Normal as imaged. PANCREAS: No main pancreatic ductal dilation. SPLEEN: Normal in size. ADRENALS: Normal in size. Slice thickness moderately limits evaluation for adrenal nodules. KIDNEYS: Small T2 hyperintense presumed renal cysts bilaterally. T2 hypointense right medial upper pole solid mass that is approximately 50% exophytic. This mass measures approximately 4.0 x 3.6 cm. No involvement of the right renal arteries or vein seen. No hydronephrosis bilaterally. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality as imaged. COLON: Normal in caliber as imaged. PERITONEUM / MESENTERY: No ascites. RETROPERITONEUM: No other abnormality. VESSELS: No significant abnormality. BODY WALL: No significant abnormality as imaged. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: No splenomegaly. Few scattered granulomata. ADRENALS: Normal. KIDNEYS: Mildly lobular contour, unchanged with few subcentimeter cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: 2.6 cm type one hiatal hernia, unchanged. COLON / APPENDIX: A left mid abdominal colostomy and sigmoid resection have been performed in the interval. The previously noted acute diverticulitis involving the proximal sigmoid colon has been resected. There are no residual inflammatory changes in the left lower quadrant. The Hartmann pouch extends to the mid sigmoid level. PERITONEUM / MESENTERY: Previously noted free peritoneal air has resolved. Moderate stranding is seen in the midline and left mid abdominal mesentery, with a few visible unchanged prominent lymph nodes (for example image 187 series 2) none of which have corresponding FDG avidity on the prior PET/CT. No new pelvic logic adenopathy is seen in the abdomen or pelvis. RETROPERITONEUM: Normal. VESSELS: A few scattered calcifications are seen within the normal caliber abdominal aorta. All major branches appear patent. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Small uterine fundal fibroid. BODY WALL: A subcentimeter soft tissue nodule in the right lower anterior abdominal wall (image 302 series 301) appears smaller than on 4/5/2021 and had a ring appearance suggesting fat necrosis rather than lymphoma, though this area did have high FDG ability on the PET/CT from 5/4/2021. Left lower quadrant end colostomy has been performed in the interval, with small parastomal herniation of omental fat. Midline rectus diastases and shallow fat-containing hernia in the supraumbilical region with abdominal wall defect measuring 2.9 cm (image 147 series 2). MUSCULOSKELETAL: Diffuse lumbar facet degenerative change. No aggressive osseous lesions.
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EXAM: Interpretation of Outside Films CT Chest CLINICAL INFORMATION: History of right renal mass. COMPARISON: CT abdomen and pelvis 10/22/2021 and MR abdomen 12/3/2021 TECHNIQUE: Interpretation of Outside Films CT Chest. Outside CT images from 12/1/2021 were submitted for interpretation. FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. Mild bilateral dependent atelectasis. No suspicious nodules or masses. No pleural effusion. HEART / VESSELS: The heart is normal in size without pericardial effusion. Mild coronary artery atherosclerotic calcifications of the thoracic aorta and main pulmonary artery are normal in caliber. Common origin of the innominate and left common carotid arteries. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Enhancing right upper pole, exophytic renal mass is again seen. MUSCULOSKELETAL: No aggressive osseous lesion. Moderate multilevel degenerative changes of the thoracic spine. CONCLUSION: 1. No evidence of intrathoracic metastatic disease. 2. Enhancing right upper pole renal mass is highly concerning for renal cell carcinoma and is best characterized on more recent MR 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: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. Mild bilateral dependent atelectasis. No suspicious nodules or masses. No pleural effusion. HEART / VESSELS: The heart is normal in size without pericardial effusion. Mild coronary artery atherosclerotic calcifications of the thoracic aorta and main pulmonary artery are normal in caliber. Common origin of the innominate and left common carotid arteries. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Enhancing right upper pole, exophytic renal mass is again seen. MUSCULOSKELETAL: No aggressive osseous lesion. Moderate multilevel degenerative changes of the thoracic spine.
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Findings: There has been further evolution of multifocal parenchymal hemorrhages with decrease in the density and size. Mild residual hyperattenuation is seen in the left frontal parenchymal hemorrhage. There is similar appearance of evolving edema/evolving encephalomalacia in the left frontal and temporal lobes. There is decreased density of the left occipital horn intraventricular hemorrhage. There is no new hemorrhage, evidence of acute infarction or significant midline shift. There is a right frontal approach ventricular shunt catheter terminating in the right frontal horn. Ventricles are stable in size and configuration. The visualized paranasal sinuses and mastoid air cells are clear.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: 65-year-old male with recently diagnosed bladder cancer. COMPARISON: None available. TECHNIQUE: Outside CT images without IV contrast dated 12/2/2021 were submitted for interpretation. The CT acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Small left pleural effusion with adjacent atelectasis. The visualized right lung is clear. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Coronary artery calcifications. ABDOMEN and PELVIS: LIVER: Postsurgical changes consistent with prior transplant. Otherwise normal for technique. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral native kidneys are atrophied. There are punctate nonobstructing renal calculi bilaterally. There is moderate dilation of the right collecting system to the level of the ureterovesicular junction with punctate nonobstructing calculi within the mid to distal right ureter (series 2 image 117 and series 2 image 123), with dilatation distally also noted. There is a transplanted kidney within the right lower pelvis. No transplant hydronephrosis or peritransplant fluid collection is visualized. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis without evidence of diverticulitis. The appendix is not definitively visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic calcifications of the abdominal aorta which is normal in caliber. URINARY BLADDER: Partially collapsed with suspected bladder wall thickening at the insertion of the right ureter (series 2 image 144). REPRODUCTIVE ORGANS: Mild prostatomegaly with dense calcifications. BODY WALL: Fat-containing ventral abdominal wall defect measuring up to 1.7 cm (series 2 image 96). MUSCULOSKELETAL: Multilevel discogenic degenerative changes. No aggressive osseous lesions. CONCLUSION: 1. Dilation of the right renal collecting system and ureter to the level of the ureterovesicular junction with punctate, nonobstructing calculi within the mid to distal right ureter. There is asymmetric bladder wall thickening at the insertion of the right ureter, concerning for an underlying lesion. Further evaluation with cystoscopy is recommended, if clinically indicated. 2. Bilateral renal atrophy with nonobstructing renal calculi. Transplant kidney within the right lower pelvis without transplant hydronephrosis or peritransplant collection. 3. Small left pleural effusion with adjacent atelectasis. 4. Additional chronic and incidental findings as described above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Small left pleural effusion with adjacent atelectasis. The visualized right lung is clear. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Coronary artery calcifications. ABDOMEN and PELVIS: LIVER: Postsurgical changes consistent with prior transplant. Otherwise normal for technique. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral native kidneys are atrophied. There are punctate nonobstructing renal calculi bilaterally. There is moderate dilation of the right collecting system to the level of the ureterovesicular junction with punctate nonobstructing calculi within the mid to distal right ureter (series 2 image 117 and series 2 image 123), with dilatation distally also noted. There is a transplanted kidney within the right lower pelvis. No transplant hydronephrosis or peritransplant fluid collection is visualized. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis without evidence of diverticulitis. The appendix is not definitively visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic calcifications of the abdominal aorta which is normal in caliber. URINARY BLADDER: Partially collapsed with suspected bladder wall thickening at the insertion of the right ureter (series 2 image 144). REPRODUCTIVE ORGANS: Mild prostatomegaly with dense calcifications. BODY WALL: Fat-containing ventral abdominal wall defect measuring up to 1.7 cm (series 2 image 96). MUSCULOSKELETAL: Multilevel discogenic degenerative changes. No aggressive osseous lesions.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Chest CT is reported separately. ABDOMEN and PELVIS: LIVER: Several hypoattenuating hepatic metastatic lesions are redemonstrated. The dominant inferior right hepatic lobe lesion is more isodense, less prominent compared to prior CT measuring about 2.8 cm stable to marginally smaller compared to prior CT. Few other smaller adjacent hypoattenuating metastatic lesions are however more prominent/increased in size, for example on series 3/image 215. Few new lesions are identified, for example on series 3, image 179 series 3, image 211 and subcentimeter lesions in the lateral right hepatic dome. Left lobe hepatic lesion is stable to marginally prominent compared to prior CT. BILIARY TRACT: Stable bilateral adrenal nodules. GALLBLADDER: Surgically absent. PANCREAS: Normal SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Stable simple simple renal cyst. No hydronephrosis. LYMPH NODES: Several enlarged retroperitoneal, aortocaval lymph nodes identified, few of them are larger compared to prior CT, for example 2.0 x 1.6 cm left para-aortic lymph node on series 3/image 20), previously 1.3 x 0.9 cm. STOMACH / SMALL BOWEL: Stomach is partially distended. No abnormal dilatation small bowel loops. COLON / APPENDIX: Uncomplicated colonic diverticulosis. Circumferential thickening of the rectum sigmoid colon. PERITONEUM / MESENTERY: Trace pelvic free fluid. RETROPERITONEUM: Small enhancing nodules at the vaginal cuff measuring 1.9 x 1.4 cms and 1.5 x 1.1 cms not definitely identified on prior CT. VESSELS: Aorta is non aneurysmal, Mild narrowing the origin of celiac trunk origin. . URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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Interpretation of Outside Films CT Chest Clinical Information: 40-year-old female with provided history of renal mass. Spec Inst: Renal Mass - CT CAP from NMMC done 12-30-21 rec 1-12-22 Study reviewed: CT of chest with contrast performed at North Mississippi Medical Center on 12/30/2021, The images are available in PACS. Comparison: Outside CT 9/3/2021 Findings: Chest: Lines, tubes, and devices: Left subclavian port catheter with tip at the right atrium. Lung parenchyma and pleura: No consolidation. A small nodular density along the minor fissure is unchanged and likely representing a lymph node. No suspicious pulmonary nodule. No pleural effusion. Central airways are patent. Thoracic inlet, heart, and mediastinum: No lymphadenopathy in the axillary, mediastinal, or hilar regions. The esophagus is nondilated. The thoracic aorta and main pulmonary artery are normal in caliber. The cardiac chambers are normal in size. No coronary artery atherosclerotic calcifications are noted, although the study is not optimized for coronary assessment. No pericardial effusion. Redemonstrated prominent azygos vein, likely related to azygous continuation of the IVC. Bones and soft tissues: No destructive bone lesion. Chest wall is unremarkable. Upper abdomen: No abnormality in the imaged upper abdomen. Conclusion: No evidence of intrathoracic metastases.
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Findings: Chest: Lines, tubes, and devices: Left subclavian port catheter with tip at the right atrium. Lung parenchyma and pleura: No consolidation. A small nodular density along the minor fissure is unchanged and likely representing a lymph node. No suspicious pulmonary nodule. No pleural effusion. Central airways are patent. Thoracic inlet, heart, and mediastinum: No lymphadenopathy in the axillary, mediastinal, or hilar regions. The esophagus is nondilated. The thoracic aorta and main pulmonary artery are normal in caliber. The cardiac chambers are normal in size. No coronary artery atherosclerotic calcifications are noted, although the study is not optimized for coronary assessment. No pericardial effusion. Redemonstrated prominent azygos vein, likely related to azygous continuation of the IVC. Bones and soft tissues: No destructive bone lesion. Chest wall is unremarkable. Upper abdomen: No abnormality in the imaged upper abdomen.
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FINDINGS: Interval improvement in ill-defined groundglass parenchymal opacities in the lower lobe with persistent nonspecific peribronchial thickening. There are no enlarged nodes in the mediastinum, hila or either axilla. No pleural or pericardial effusion is seen. There is no focal lytic or sclerotic bone lesion. Right IJ Mediport catheter tip is in the right atrium
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Renal mass status post left nephrectomy. COMPARISON: 6/4/2021 TECHNIQUE: Outside CT images with IV contrast dated 12/30/2021 were submitted for interpretation. FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Left adrenal is absent. Normal right adrenal gland. KIDNEYS: Postsurgical changes from left nephrectomy without suspicious nodularity in the nephrectomy bed. Normal appearance of the right kidney. 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: Uterus is absent. No suspicious adnexal lesion. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Postsurgical changes from left nephrectomy without convincing evidence of locally recurrent or metastatic disease in the abdomen or pelvis.
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FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Left adrenal is absent. Normal right adrenal gland. KIDNEYS: Postsurgical changes from left nephrectomy without suspicious nodularity in the nephrectomy bed. Normal appearance of the right kidney. 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: Uterus is absent. No suspicious adnexal lesion. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: STRUCTURED REPORT: CT Abdomen LOWER CHEST: LUNG BASES / PLEURA: Subsegmental bibasilar lung atelectasis. No pleural effusion or consolidation. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Heart is enlarged in size. ABDOMEN: LIVER: A 1.3 cm posterior right hepatic lobe, is unchanged since prior MRI. No additional/new hepatic lesions. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Atrophic pancreas. Pancreatic duct is nondilated. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Kidneys demonstrates normal size and symmetric enhancement. No hydronephrosis. Excreted contrast is seen within the renal collecting system. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute osseous findings.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: 44-year-old male with fistula to the colon. COMPARISON: CT abdomen and pelvis 10/14/2021. TECHNIQUE: Outside CT images with IV contrast dated 12/8/2021 were submitted for interpretation. The CT acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Calcified nodule within the posterior right lung appears unchanged from prior. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: There has been interval removal of the cystogastrostomy stent. There is a peripherally enhancing complex collection anterior to the pancreas with thick walls and isn't adjacent fat stranding measuring approximately 3.9 x 3.8 cm (series 3 image 96), previously 4.7 x 3.7 cm when remeasured retrospectively. There is a single foci of gas within the collection. The collection extends anteriorly in close proximity to the posterior wall of the transverse colon. Additionally, a collapsed component of this collection extends superiorly along the posterior wall of the gastric body (series 3, image 87 and 84). SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: No hydronephrosis or renal calculi. Left renal cyst. No hydronephrosis bilaterally. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Thickening of the posterior wall of the stomach. The small bowel is unremarkable. COLON / APPENDIX: Bowel wall thickening and adjacent fat stranding of the posterior wall of the transverse colon in close proximity to the above-described peripancreatic collection. The appendix is normal. PERITONEUM / MESENTERY: Mesenteric edema and fat stranding surrounding the peripancreatic collection. No free fluid or air. RETROPERITONEUM: Normal. VESSELS: Small splenic and omental varices. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous lesions. CONCLUSION: 1. Interval decrease in size of the extrapancreatic walled off necrosis compared to prior. There are adjacent inflammatory changes within the transverse colon and stomach without a definite fistulous connection. 2. Additional chronic and incidental findings as described above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Calcified nodule within the posterior right lung appears unchanged from prior. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: There has been interval removal of the cystogastrostomy stent. There is a peripherally enhancing complex collection anterior to the pancreas with thick walls and isn't adjacent fat stranding measuring approximately 3.9 x 3.8 cm (series 3 image 96), previously 4.7 x 3.7 cm when remeasured retrospectively. There is a single foci of gas within the collection. The collection extends anteriorly in close proximity to the posterior wall of the transverse colon. Additionally, a collapsed component of this collection extends superiorly along the posterior wall of the gastric body (series 3, image 87 and 84). SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: No hydronephrosis or renal calculi. Left renal cyst. No hydronephrosis bilaterally. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Thickening of the posterior wall of the stomach. The small bowel is unremarkable. COLON / APPENDIX: Bowel wall thickening and adjacent fat stranding of the posterior wall of the transverse colon in close proximity to the above-described peripancreatic collection. The appendix is normal. PERITONEUM / MESENTERY: Mesenteric edema and fat stranding surrounding the peripancreatic collection. No free fluid or air. RETROPERITONEUM: Normal. VESSELS: Small splenic and omental varices. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous lesions.
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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: Moderate volume bilateral pleural effusions along with changes of bibasilar pulmonary edema.. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Heart is enlarged in size. There is moderate coronary calcifications. ABDOMEN and PELVIS: LIVER: Normal unenhanced appearance of liver. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Atrophic pancreas. Pancreatic duct is nondilated. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Atrophic kidneys containing multiple calculi. The larger right renal calculus measures 7 mm and the larger left renal calculus measures 9 mm. There is mild right proximal hydroureteronephrosis is secondary to distal ureteric compression by the pelvic hematoma as described below. There is no left-sided hydronephrosis or hydroureter. Nonspecific right perinephric stranding without any discrete fluid collection. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach is partially distended with is abnormal dilatation of small bowel loops. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: There is a large hyperdense blood clot in the anterior pelvis measuring about 10 x 9.2 cm with hemorrhage extending into the right hemiabdomen and right lateral pelvic sidewall. There is no pneumoperitoneum. RETROPERITONEUM: Right pelvic sidewall retroperitoneal hemorrhage. Mild presacral stranding. VESSELS: Tortuous abdominal aorta with moderate calcifications. Embolization coils within the right internal iliac artery aneurysm. Endovascular stent within the right common/external iliac artery. Moderate calcifications of left external iliac artery without any aneurysm. URINARY BLADDER: Partially distended and contains Foleys catheter. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Moderate diffuse body wall edema. MUSCULOSKELETAL: No vertebral demonstrate normal height and multilevel degenerative changes predominantly at L3-L4 and L4-L5
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Complex surgical history. Known enterocutaneous fistula. COMPARISON: 8/15/2021 TECHNIQUE: Outside CT images with IV contrast dated 11/22/2021 were submitted for interpretation. FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: No focal liver lesion. Unchanged chronic portal vein thrombosis with cavernous transformation. BILIARY TRACT: Stable minimal intrahepatic biliary ductal dilation. GALLBLADDER: Absent. PANCREAS: Pancreatic parenchyma appears normal without focal pancreatic mass. Unchanged appearance of ill-defined soft tissue surrounding the celiac vasculature. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stable postsurgical changes. Enterocutaneous fistula in the upper abdomen appears similar. Jejunostomy tube in expected position. No acute abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is absent. No suspicious adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Overall similar appearance of postsurgical changes of the abdomen or pelvis with no change in the appearance of the known enterocutaneous fistula in the upper abdomen. Unchanged ill-defined soft tissue surrounding the celiac vasculature.
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FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: No focal liver lesion. Unchanged chronic portal vein thrombosis with cavernous transformation. BILIARY TRACT: Stable minimal intrahepatic biliary ductal dilation. GALLBLADDER: Absent. PANCREAS: Pancreatic parenchyma appears normal without focal pancreatic mass. Unchanged appearance of ill-defined soft tissue surrounding the celiac vasculature. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stable postsurgical changes. Enterocutaneous fistula in the upper abdomen appears similar. Jejunostomy tube in expected position. No acute abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is absent. No suspicious adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: Postsurgical changes from aortic valve replacement and descending thoracic aortic graft in place. Persistent focal dilatation of the proximal descending thoracic aorta proximal to the graft measuring 43 mm in axial image 78, series 12, unchanged. Left SVG grafts to LAD is patent. Persistent distal descending thoracic aortic aneurysmal dilatation and dissection extending into the abdominal aorta. The distal descending thoracic aorta at the level of aortic diaphragmatic hiatus remains stable at 61 mm size as measured in image 202, series 12. Asymmetric enlargement of the left thyroid gland with hypodense stable lesions. Several mostly calcified nodes are present in the mediastinum, both hila as well as bronchopulmonary regions. Interval improvement in left lower lobe nodular lesion with small residual calcified nodules seen in image 113, series 12 along with unchanged other nodules in the left lower lobe along the fissure image 98 and right middle lobe image 111-118, series 12. There is a minimal dependent pleural thickening with unchanged nondependent anterior left loculated pleural effusion.
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EXAM: Interpretation of Outside Films CT Body HISTORY: 52 years old Female with Spec Inst: Abscess - CT AbdPel from Floyd Cherokee Medical Center done 12-15-21 rec 1-12-22 CT images of the [body part] were obtained with intravenous contrast at Floyd Cherokee Medical Center on 12/15/2021 and submitted to UAB for interpretation. Please note the examination was performed outside of UAB protocol, monitoring and oversight. There are associated diagnostic limitations which should be considered prior to implementation of clinical decisions. COMPARISON: CT, most recent from 11/18/2021 FINDINGS: STRUCTURED REPORT: CT Abdomen LOWER CHEST: LUNG BASES / PLEURA: Subsegmental atelectasis/scarring in the lingula and left lower lobe. DISTAL ESOPHAGUS: Post surgical changes at the GE junction. HEART / VESSELS: Normal sized cardiac chambers. No pericardial effusion. Small coronary artery calcifications. ABDOMEN: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Unchanged few small cortical cysts bilaterally. Mild urothelial thickening bilaterally. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Post surgical changes from gastrectomy are redemonstrated. No small bowel dilation. Right-sided ileostomy. Linear tract is seen at the site of prior jejunostomy tube, with surrounding soft tissue thickening. Ileostomy on the right. COLON: Postsurgical changes from prior total colectomy. PERITONEUM / MESENTERY: Redemonstration of fluid and gas collection in the left subphrenic region with surrounding soft tissue thickening. Fluid pocket cranially measures approximately 3.4 x 3.7 cm, overall unchanged. RETROPERITONEUM: Presacral soft tissue thickening is again seen.. VESSELS: Mild atherosclerotic calcifications involving the abdominal aorta, bilateral iliac arteries. REPRODUCTIVE ORGANS: Fibroid uterus. No adnexal lesion on either side. URINARY BLADDER: BODY WALL: Fat-containing parastomal hernia on the right. Calcific foci in bilateral gluteal region. MUSCULOSKELETAL: No significant abnormality. IMPRESSION: 1. Minimally decreased size of left subphrenic abscess with increased surrounding soft tissue thickening. 2. Linear tract at the site of prior jejunostomy tube likely communicating with underlying small bowel loops. Possibility of fistulous communication is not excluded. 3. Status post complete gastrectomy, total colectomy with expected postsurgical changes. Stable other findings as above
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FINDINGS: STRUCTURED REPORT: CT Abdomen LOWER CHEST: LUNG BASES / PLEURA: Subsegmental atelectasis/scarring in the lingula and left lower lobe. DISTAL ESOPHAGUS: Post surgical changes at the GE junction. HEART / VESSELS: Normal sized cardiac chambers. No pericardial effusion. Small coronary artery calcifications. ABDOMEN: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Unchanged few small cortical cysts bilaterally. Mild urothelial thickening bilaterally. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Post surgical changes from gastrectomy are redemonstrated. No small bowel dilation. Right-sided ileostomy. Linear tract is seen at the site of prior jejunostomy tube, with surrounding soft tissue thickening. Ileostomy on the right. COLON: Postsurgical changes from prior total colectomy. PERITONEUM / MESENTERY: Redemonstration of fluid and gas collection in the left subphrenic region with surrounding soft tissue thickening. Fluid pocket cranially measures approximately 3.4 x 3.7 cm, overall unchanged. RETROPERITONEUM: Presacral soft tissue thickening is again seen.. VESSELS: Mild atherosclerotic calcifications involving the abdominal aorta, bilateral iliac arteries. REPRODUCTIVE ORGANS: Fibroid uterus. No adnexal lesion on either side. URINARY BLADDER: BODY WALL: Fat-containing parastomal hernia on the right. Calcific foci in bilateral gluteal region. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: STRUCTURED REPORT: CTA Abdomen Pelvis VASCULATURE: DISTAL DESCENDING THORACIC AORTA: Please see separate CT angiogram chest report. ABDOMINAL AORTA: Unchanged appearance of the chronic thoracoabdominal aortic dissection with diffuse fusiform aneursym dilation of the abdominal aorta. The suprarenal aorta measures 5.6 x 5.3 cms at the origin of celiac trunk (Series 12/image 224) The infrarenal abdominal aorta measures 6.1 x 5.8 cm on series 9, image 295, previously 5.6 x 5.5 cms. CELIAC AXIS: Celiac trunk origin is from the true lumen. Normal origin, course and caliber of celiac and its branches. SMA: Mild diffuse ectasia of SMA without focal aneurysm. RIGHT RENAL: Right renal artery arises from the false lumen, normal in caliber and course. Left LEFT RENAL: Left renal artery is normal in course, caliber IMA: No significant abnormality. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: Mild aneurysmal dilatation of right common iliac artery, which measures about 2.7 cm (series 12/image 350), previous CT similar size. Right external, internal iliac arteries, right common femoral and imaged proximal superficial and deep femoral arteries are unremarkable. LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: Mild aneurysmal dilatation of left common femoral artery, which measures 2.6 cm (series 2/image 350), previously similar size. Left internal and external iliac arteries are normal caliber. ------------------------------------------------------------- LOWER CHEST: Please see separate CT angiogram chest report. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis PANCREAS: Atrophic pancreas. Pancreatic duct is nondilated. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Kidneys demonstrate symmetric enhancement. Stable bilateral renal cysts. Stable left peripelvic renal cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach is partially distended. There is no abnormal dilatation of small bowel loops. COLON / APPENDIX: Uncomplicated colonic diverticulosis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Stable partially calcified retroperitoneal nodule adjacent to the celiac trunk.. OTHER VESSELS: IVC and iliac veins are mildly dilated. Venous structures are not well opacified. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Stable fat-containing umbilical hernia. Small fat-containing bilateral inguinal hernia. MUSCULOSKELETAL: No acute osseous findings no vertebral demonstrate normal height and multilevel degenerative changes..
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Bladder cancer COMPARISON: None. TECHNIQUE: Outside hospital CT study of abdomen and pelvis dated 12/03/2021. The CT acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Subsegmental bibasilar lung atelectasis. No pleural effusion. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Moderate coronary calcifications. Heart is normal in size. Is no pericardial effusion. ABDOMEN and PELVIS: LIVER: Severe hepatic steatosis. Focal areas of fatty sparing in the inferior and peripheral right hepatic lobe. No suspicious focal hepatic lesions BILIARY TRACT: Normal GALLBLADDER: Surgically absent PANCREAS: Multiple punctate pancreatic parenchymal calcifications. No pancreatic duct dilatation. No peripancreatic collection. SPLEEN: Tiny calcified splenic granulomas. ADRENALS: Normal. KIDNEYS: There is moderate to severe left hydroureteronephrosis. Ureters dilated along its entire course up to the left ureterovesical junction. Hypoenhancement of left kidney secondary to obstruction. Right kidney demonstrates normal appearance. No suspicious enhancing renal cortical lesions. No perinephric collection. LYMPH NODES: Small bilateral pelvic sidewall lymph nodes measuring 1.3 x 1.0 cm on the right and 1.5 x 1.2 cm on left (series 5, 112 and measuring 118). STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Uncomplicated colonic diverticulosis. PERITONEUM / MESENTERY: No ascites or pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: Mild infrarenal abdominal aortic aneurysm, which measures about 3.2 x 2.8 cm. There is severe aortic and bilateral iliac artery calcifications. URINARY BLADDER: There is large hyperenhancing bladder mass on the left lateral aspect extending into the bladder neck. Extravesical fat invasion is present along the left lateral aspect REPRODUCTIVE ORGANS: No abnormality BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: Lumbar vertebrae demonstrate normal height. No suspicious destructive osseous lesions. CONCLUSION: 1. Large hyperenhancing urinary bladder neoplasm on the left lateral aspect extending into the bladder neck with likely invasion of the left extravesical fat. 2. Obstruction of distal left ureter by the mass at the ureterovesical junction with moderate to severe hydroureteronephrosis. 3. Small bilateral pelvic sidewall lymph nodes most concerning for metastasis. 4. No distant metastasis in abdomen. Other incidental/chronic findings as described above.
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FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Subsegmental bibasilar lung atelectasis. No pleural effusion. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Moderate coronary calcifications. Heart is normal in size. Is no pericardial effusion. ABDOMEN and PELVIS: LIVER: Severe hepatic steatosis. Focal areas of fatty sparing in the inferior and peripheral right hepatic lobe. No suspicious focal hepatic lesions BILIARY TRACT: Normal GALLBLADDER: Surgically absent PANCREAS: Multiple punctate pancreatic parenchymal calcifications. No pancreatic duct dilatation. No peripancreatic collection. SPLEEN: Tiny calcified splenic granulomas. ADRENALS: Normal. KIDNEYS: There is moderate to severe left hydroureteronephrosis. Ureters dilated along its entire course up to the left ureterovesical junction. Hypoenhancement of left kidney secondary to obstruction. Right kidney demonstrates normal appearance. No suspicious enhancing renal cortical lesions. No perinephric collection. LYMPH NODES: Small bilateral pelvic sidewall lymph nodes measuring 1.3 x 1.0 cm on the right and 1.5 x 1.2 cm on left (series 5, 112 and measuring 118). STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Uncomplicated colonic diverticulosis. PERITONEUM / MESENTERY: No ascites or pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: Mild infrarenal abdominal aortic aneurysm, which measures about 3.2 x 2.8 cm. There is severe aortic and bilateral iliac artery calcifications. URINARY BLADDER: There is large hyperenhancing bladder mass on the left lateral aspect extending into the bladder neck. Extravesical fat invasion is present along the left lateral aspect REPRODUCTIVE ORGANS: No abnormality BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: Lumbar vertebrae demonstrate normal height. No suspicious destructive osseous lesions.
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FINDINGS: Scouts: No additional findings. Lower neck and Mediastinum: Evaluation of the mediastinum is limited in such a noncontrast study. Thyroid gland is unremarkable. Within the limits of the noncontrast scan, no evidence of focal esophageal wall abnormalities. Lymph nodes: Within the limits of the noncontrast scan, no evidence of new pathologically enlarged mediastinal, supraclavicular or hilar lymph nodes. Heart and great arteries: Cardiac chambers are normal in size. No pericardial effusion. Severe atherosclerotic calcification of the thoracic aorta and coronary arteries are again noted, with redemonstrated status post CABG. Stable mild fusiform aneurysmal dilatation of the ascending thoracic aorta measuring up to 4.1 cm, together with distal aortic arch small inferior saccular aneurysm. The main and central branch pulmonary arteries are normal in caliber. Airways: The trachea and central bronchi are patent and clear. Lungs and pleura: Interval increase in the hypoattenuating left pleural effusion, now seen as moderate, with increased associated subsegmental atelectasis within the left lower lobe. Interval new soft tissue nodule within the superior segment of the lingula measuring up to 23 x 27 mm, and abutting the anterior costal as well as the medial mediastinal pleura (series 3, image 53). Interval new pulmonary nodule/nodular opacity is also noted within the posterior basal segment of the right lower lobe, measuring up to 18 x 23 mm (series 3, image 87). Interval increased interlobular septal thickening with associated tree-in-bud nodular opacities within the bilateral upper lobe, right middle lobe and left lower lobe. Upper abdomen: Limited noncontrast visualization of the upper abdomen redemonstrates splenic calcifications and partially visualized hypoattenuating right renal cyst, as well as cholelithiasis, without evidence of acute upper abdominal abnormalities. Bones and soft tissues: Interval minimal increase in size of the previously seen left anterior chest wall mass, which is ill-defined due to lack of IV contrast administration, however, roughly now measures up to 13.4 cm (series 3, image 48) in the AP diameter, previously measured up to 12.6 cm. The mass component seen slightly more anteroinferiorly with multilobulated appearance now measures up to 5.2 x 9.3 cm (series 3, image 68), largely unchanged from prior, where it measured up to 5 x 9.8 cm. The rounded hypoattenuating component involving the left pectoralis muscles is unchanged by eyeballing. Redemonstrated associated left anterior osseous destruction, predominantly noted within the left anterior fourth and fifth ribs. Interval increase in the left anterior chest wall subcutaneous fat stranding and mild skin thickening. No new destructive osseous lesions.
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16,197 |
EXAM: Outside MR Image Interpretation CLINICAL INFORMATION: Adrenal nodule COMPARISON: None. TECHNIQUE: Outside MR images without and with IV contrast dated 11/29/2021 were submitted for interpretation. The MRI acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. 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: Normal. SPLEEN: Normal. ADRENALS: Right adrenal mass measuring approximately 2.9 x 3.5 cm with T2 hyperintense signal. No intralesional fat is identified on the opposed phase sequences. This lesion demonstrates heterogeneous avid postcontrast enhancement. Left adrenal gland is unremarkable. KIDNEYS: No hydronephrosis. Left 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: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: T2 hyperintense right adrenal mass, with avid enhancement overall most suspicious for pheochromocytoma. Correlate with metanephrines. As the attending 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: Normal. SPLEEN: Normal. ADRENALS: Right adrenal mass measuring approximately 2.9 x 3.5 cm with T2 hyperintense signal. No intralesional fat is identified on the opposed phase sequences. This lesion demonstrates heterogeneous avid postcontrast enhancement. Left adrenal gland is unremarkable. KIDNEYS: No hydronephrosis. Left 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: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: 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. No hydronephrosis. LYMPH NODES: Mildly enlarged, rounded left inguinal lymph node which measures 1.4 x 1.7 cm (image 272, series 201), likely reactive. STOMACH / SMALL BOWEL: No abnormality. Small bowel is nondilated. COLON / APPENDIX: Scattered colonic diverticula without evidence of diverticulitis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is absent. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: No aggressive osseous lesion. Sclerosis of the symphysis pubis, degenerative.
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16,198 |
Cervical MRI with and without contrast Clinical indication: 66-year-old male with history of squamous cell carcinoma status post CRT and glossolaryngectomy with right ALT FF reconstruction with subsequent recurrence, prostate cancer, and double hit lymphoma. Need to be certain that vertebral diseasePet avidity is not malignant MR C Spine 122721 Rec 11222 Spec Inst: Need to be certain that vertebral diseasePet avidity is not malignant MR C Spine 122721 Rec 11222. Request for interpretation of outside imaging. Technique: Multiple T1 and T2 weighted MR sequence images of the cervical spine were obtained in the axial and sagittal plane with and without the use of intravenous contrast per outside facility. Comparison: PET/CT dated 2/11/2021.. Findings: The visualized portions of the skull base, brain stem, posterior fossa structures, and craniocervical junction appear normal. There is postsurgical changes status post glossectomy and laryngectomy with fatty replacement in the surgical bed.. Nonspecific mucosal thickening at the level of C2-C3 retropharyngeal soft tissues and uvula likely representing posttreatment changes. No spondylolisthesis. There is disc space narrowing, endplate irregularity and bone marrow edema involving the C6 and C7 vertebral bodies. After contrast injection there is enhancement at the C6-C7 endplate and within the disc interspace. There is no other abnormal cord signal. Degenerative disease of the cervical spine is described below. C2-3: Disc osteophyte complex results in mild spinal canal narrowing. C3-4: Disc osteophyte complex results in mild spinal canal narrowing. C4-5: Disc osteophyte complex results in mild spinal canal narrowing. C5-6: Disc osteophyte complex results in mild spinal canal narrowing with effacement of CSF along the ventral spinal cord. No significant neuroforaminal narrowing. C6-7: No significant neuroforaminal or spinal canal stenosis. C7-T1: No significant neuroforaminal or spinal canal stenosis. Fluid in the left mastoid air cells.The vertebral arteries demonstrate normal flow voids. There is no prevertebral soft tissue swelling. The paraspinal muscles and visualized soft tissues are unremarkable. A 23 mm well-defined subcutaneous structure in the occipital region at midline is likely a sebaceous cyst. Impression: 1. Disc space narrowing, endplate edema and enhancement at C6-C7 level. This finding may represent sequela of treated infection. Metastasis is considered to be less likely because metastasis usually does not demonstrate prominent disc space involvement. However if presentation is concerning for neoplastic lesion at this location follow-up MRI after few months for evaluation of the interval development of soft tissue tumoral component is recommended. 2. Mild cervical spondylosis, postsurgical and posttreatment changes of the neck, and other incidental findings 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: The visualized portions of the skull base, brain stem, posterior fossa structures, and craniocervical junction appear normal. There is postsurgical changes status post glossectomy and laryngectomy with fatty replacement in the surgical bed.. Nonspecific mucosal thickening at the level of C2-C3 retropharyngeal soft tissues and uvula likely representing posttreatment changes. No spondylolisthesis. There is disc space narrowing, endplate irregularity and bone marrow edema involving the C6 and C7 vertebral bodies. After contrast injection there is enhancement at the C6-C7 endplate and within the disc interspace. There is no other abnormal cord signal. Degenerative disease of the cervical spine is described below. C2-3: Disc osteophyte complex results in mild spinal canal narrowing. C3-4: Disc osteophyte complex results in mild spinal canal narrowing. C4-5: Disc osteophyte complex results in mild spinal canal narrowing. C5-6: Disc osteophyte complex results in mild spinal canal narrowing with effacement of CSF along the ventral spinal cord. No significant neuroforaminal narrowing. C6-7: No significant neuroforaminal or spinal canal stenosis. C7-T1: No significant neuroforaminal or spinal canal stenosis. Fluid in the left mastoid air cells.The vertebral arteries demonstrate normal flow voids. There is no prevertebral soft tissue swelling. The paraspinal muscles and visualized soft tissues are unremarkable. A 23 mm well-defined subcutaneous structure in the occipital region at midline is likely a sebaceous cyst.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Chest CT is reported separately. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Hypoattenuating splenic lesions are vaguely seen on current CT. Persistent mild splenomegaly.. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: Interval enlargement of several bilateral iliac/pelvic lymph nodes, with several new lymph nodes. Also seen are a few small periaortic and mesenteric lymph nodes. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: No discrete retroperitoneal fluid collection. VESSELS: Aorta is nonaneurysmal. Aorta, IVC, portal, splenic and superior mesenteric veins and hepatic veins are patent. Iliac veins are not well opacified. URINARY BLADDER: Partially distended REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute osseous findings. Patchy sclerotic lesions is visualized in the pelvic bones without any destructive changes. Sclerotic lesions in the L2, L4 and L5 vertebral body similar to prior CT
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16,199 |
EXAM: Outside MR Image Interpretation CLINICAL INFORMATION: Right humeral lesion COMPARISON: None. TECHNIQUE: Outside MR images of the left shoulder without intravenous contrast dated 11/24/2021 were submitted for interpretation. The MRI acquisition was performed outside of UAB protocol, monitoring and oversight. Interpretation may have reduced accuracy, which should be considered prior to implementation of clinical decisions. FINDINGS: Within the proximal humerus, there are multiple circumscribed low T1 and high T2 signal intensity areas filling the medullary canal of the proximal humerus, with intervening areas of intermediate T1 and T2 signal, extending approximately 6.5 cm in the craniocaudal dimension. There is very subtle endosteal scalloping along the anterior posterior cortical margins on the sagittal sequences, however, this appears to be less than half cortical thickness. No significant adjacent marrow edema, extension through the cortex, or periosteal reaction is seen. No acute fracture. Small amount of marrow edema is noted at the supraspinatus and infraspinatus footplate insertion and centered around the degenerative changes of the AC joint an superior glenoid. Near full-thickness tear of the posterior fibers of the supraspinatus tendon at the critical zone. Additionally, there is tendinosis and intermediate grade articular surface tear of the anterior fibers of the supraspinatus. The infraspinatus tendon is intact and unremarkable. Low-grade partial thickness articular surface tear of the superior fibers of the subscapularis tendon. The teres minor tendon is intact and unremarkable. The long head biceps tendon is intact and unremarkable. Degenerative changes of the glenohumeral joint with subchondral cystic changes at the superior aspect of the glenoid. Degenerative signal is seen within the superior and anterior glenoid labrum. No muscular atrophy is seen. Fluid is seen within the subacromial subdeltoid spaces. Degenerative changes of the acromioclavicular joint with capsular hypertrophy. CONCLUSION: 1. Findings most consistent with low-grade chondroid lesion within the proximal humeral metadiaphysis. Subtle endosteal scalloping, no other overtly aggressive MRI features appreciated. Radiographic correlation recommended. 2. Focal near full-thickness tear of posterior supraspinatus with tendinosis and intermediate grade partial-thickness articular tear of the anterior fibers. 3. Low grade partial-thickness articular surface tear of the subscapularis tendon. 4. Degenerative changes of the glenohumeral and acromioclavicular joints. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: Within the proximal humerus, there are multiple circumscribed low T1 and high T2 signal intensity areas filling the medullary canal of the proximal humerus, with intervening areas of intermediate T1 and T2 signal, extending approximately 6.5 cm in the craniocaudal dimension. There is very subtle endosteal scalloping along the anterior posterior cortical margins on the sagittal sequences, however, this appears to be less than half cortical thickness. No significant adjacent marrow edema, extension through the cortex, or periosteal reaction is seen. No acute fracture. Small amount of marrow edema is noted at the supraspinatus and infraspinatus footplate insertion and centered around the degenerative changes of the AC joint an superior glenoid. Near full-thickness tear of the posterior fibers of the supraspinatus tendon at the critical zone. Additionally, there is tendinosis and intermediate grade articular surface tear of the anterior fibers of the supraspinatus. The infraspinatus tendon is intact and unremarkable. Low-grade partial thickness articular surface tear of the superior fibers of the subscapularis tendon. The teres minor tendon is intact and unremarkable. The long head biceps tendon is intact and unremarkable. Degenerative changes of the glenohumeral joint with subchondral cystic changes at the superior aspect of the glenoid. Degenerative signal is seen within the superior and anterior glenoid labrum. No muscular atrophy is seen. Fluid is seen within the subacromial subdeltoid spaces. Degenerative changes of the acromioclavicular joint with capsular hypertrophy.
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FINDINGS: SOFT TISSUES: Normal. LYMPH NODES: Again noted is evidence of multistationary lymphadenopathy which are more prominent in the left level two, mediastinum and in the right axillary region. AERODIGESTIVE STRUCTURES: No asymmetric contrast enhancement or asymmetric soft tissue nodularity. PAROTID GLANDS: Normal. SUBMANDIBULAR GLANDS: Normal. THYROID GLAND: There is a persistent 8 mm hypodense nodule in the right thyroid lobe. VASCULAR STRUCTURES: There is a right-sided portacatheter which ends in the SVC out of field of view. OSSEOUS STRUCTURES: No fracture, dislocation, or destructive lesion. ORBITS: Normal. PARANASAL SINUSES AND MASTOID AIR CELLS: There is a small retention cyst in the sphenoidal sinus. PARTIALLY VISUALIZED INTRACRANIAL STRUCTURES: Normal. LUNG APICES: Normal.
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