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CT-MRI_metrics_validation_dataset

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16,200
EXAM: Interpretation of Outside Films CT LSPN CLINICAL INFORMATION: Female patient 69 years with Radiculopathy CT L Spine 111821 Bridgeway Diag Clinic Rec 11222 Spec Inst: Radiculopathy CT L Spine 111821 Bridgeway Diag Clinic Rec 11222 TECHNIQUE: 2.5 mm thick serial axial images were obtained through the lumbar spine without intravenous contrast. Sagittal and coronal reformatted views were also obtained. COMPARISON: None available. FINDINGS: Outside examination from Bridgeway diagnostic clinic dated 11/18/2021 is submitted for interpretation on 1/12/2022. There is mild to moderate levoscoliosis, apex of lumbar spine curvature is at L3 level. There is no loss of height of the lumbar vertebrae and no acute fracture. There is mild anterolisthesis of L4 on L5 likely on degenerative basis. There is no prevertebral soft tissue swelling. Multilevel degenerative changes will be described below. T12-L1: No significant spinal canal narrowing. There is also no significant facet arthropathy or neural foraminal narrowing. L1-L2: Broad disc bulge without significant spinal canal narrowing. There is mild right-sided facet arthropathy. There is moderate right and mild left neural foraminal narrowing. L2-L3: There is loss of disc height at this level with vacuum phenomenon. There is a broad disc bulge resulting in mild to moderate central canal narrowing. There is mild bilateral facet arthropathy. There is no left neural foraminal narrowing and there is moderate right neural foraminal narrowing. L3-L4: There is a broad disc bulge. There is severe right hypertrophic facet arthropathy. There is severe narrowing of the thecal sac. There is also moderate to severe right neural foraminal narrowing with flattening of the exiting right L3 nerve root. There is mild left neural foraminal narrowing. L4-L5: There is a broad disc bulge. There is severe right greater than left hypertrophic facet arthropathy. There is moderate central canal narrowing. There is significant narrowing of the right lateral recess secondary to combination of hypertrophic facet arthropathy and disc bulge lateralized to the right. There is also moderate to severe right neural foraminal narrowing and mild left neural foraminal narrowing. L5-S1: There is a broad disc bulge lateralized to the left. There is severe left facet arthropathy and no significant right facet arthropathy. There is mild central canal narrowing. There is severe left neural foraminal narrowing with impingement of the exiting left L5 nerve root. There is mild right neural foraminal narrowing There is no significant degenerative osteoarthrosis of the sacroiliac joints. CONCLUSION: 01. Multilevel moderate degenerative disc disease and also mild to moderate levoscoliosis. There is significant spinal canal narrowing at both L3-L4 where there is severe narrowing of the spinal canal and at L4-L5 where there is moderate narrowing but focal severe narrowing of the right lateral recess likely impinging the transiting right L5 nerve root. 02. Multilevel facet arthropathy in part related to scoliosis. There is severe facet arthropathy on the right at L3-L4 bilaterally at L4-L5 and on the left at L5-S1. There is flattening of the exiting right L3 nerve root at L3-L4 and also involving the right L4 nerve root at L4-L5 and the exiting left L5 nerve root at L5-S1.
FINDINGS: Outside examination from Bridgeway diagnostic clinic dated 11/18/2021 is submitted for interpretation on 1/12/2022. There is mild to moderate levoscoliosis, apex of lumbar spine curvature is at L3 level. There is no loss of height of the lumbar vertebrae and no acute fracture. There is mild anterolisthesis of L4 on L5 likely on degenerative basis. There is no prevertebral soft tissue swelling. Multilevel degenerative changes will be described below. T12-L1: No significant spinal canal narrowing. There is also no significant facet arthropathy or neural foraminal narrowing. L1-L2: Broad disc bulge without significant spinal canal narrowing. There is mild right-sided facet arthropathy. There is moderate right and mild left neural foraminal narrowing. L2-L3: There is loss of disc height at this level with vacuum phenomenon. There is a broad disc bulge resulting in mild to moderate central canal narrowing. There is mild bilateral facet arthropathy. There is no left neural foraminal narrowing and there is moderate right neural foraminal narrowing. L3-L4: There is a broad disc bulge. There is severe right hypertrophic facet arthropathy. There is severe narrowing of the thecal sac. There is also moderate to severe right neural foraminal narrowing with flattening of the exiting right L3 nerve root. There is mild left neural foraminal narrowing. L4-L5: There is a broad disc bulge. There is severe right greater than left hypertrophic facet arthropathy. There is moderate central canal narrowing. There is significant narrowing of the right lateral recess secondary to combination of hypertrophic facet arthropathy and disc bulge lateralized to the right. There is also moderate to severe right neural foraminal narrowing and mild left neural foraminal narrowing. L5-S1: There is a broad disc bulge lateralized to the left. There is severe left facet arthropathy and no significant right facet arthropathy. There is mild central canal narrowing. There is severe left neural foraminal narrowing with impingement of the exiting left L5 nerve root. There is mild right neural foraminal narrowing There is no significant degenerative osteoarthrosis of the sacroiliac joints.
FINDINGS: Scouts: No additional findings. Lower neck and Mediastinum: The right Port-A-Cath tip terminates within the right atrium, without associated significant thrombi. Right posterior thyroid lobe nodule is similar to prior. Mild diffuse patulous esophagus is also similar. No new focal esophageal wall abnormalities. Lymph nodes: Multiple enlarged right axillary lymph nodes are overall slightly larger by eyeballing technique. Multiple mildly enlarged mediastinal and hilar lymph nodes are similar or slightly smaller when compared to prior. No newly enlarged left axillary lymph nodes could be identified. Heart and great arteries: Cardiac chambers are normal in size. No pericardial effusion. Mediastinal great arteries are normal in caliber. Redemonstrated post arterial switch operation with redemonstrated LeCompte maneuver. Airways: Trachea and central bronchi are patent and clear. Mild diffuse bronchial wall thickening as well as subsegmental bronchial obstructing secretions within the left lower lobe are noted, which could be seen with bronchitis. Lungs : Mild diffuse bilateral mosaic attenuation is again noted. Lungs are otherwise clear bilaterally without evidence of new focal pulmonary opacities or suspicious pulmonary nodules or masses. Pleural: No pleural effusion or pneumothorax. Mild left anterior diaphragmatic pleural calcifications versus surgical sutures are again noted. Upper abdomen: The CT of the abdomen and pelvis will be reported separately. Bones and soft tissues: Mild bilateral asymmetric, right greater than the left, gynecomastia is similar to prior. The chest wall soft tissues are otherwise unremarkable. No aggressive or destructive intrathoracic osseous lesions.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: 37-year-old female with kidney stone. COMPARISON: CT 4/5/2019. TECHNIQUE: Outside CT images of the abdomen and pelvis without intravenous contrast from Riverview Regional Medical Center dated 12/27/2021 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: A 5 mm semisolid left lingular pulmonary nodule is not included on the prior study. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: A 10 mm cystic lesion at the anterior surface of the pancreatic neck (image 66 series 2) is unchanged since 2019. No new lesions or ductal dilatation. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: There is a cluster of stones in the left interpolar region, the largest measuring 10 mm. A punctate left upper pole renal stone is present. No ureteral stones or right renal stones are identified. There is no hydronephrosis or perinephric stranding. No focal renal lesion is identified within the limitations of unenhanced technique LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Normal appendix. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. Bilateral tubal ligation clips are present. BODY WALL: Small umbilical hernia contains fat. No significant abnormality. MUSCULOSKELETAL: Small lumbar vertebral bone islands are unchanged. No significant abnormality. CONCLUSION: 1. Focal semisolid left pulmonary nodule. Completion chest CT is recommended to evaluate for additional lesions. 2. Left nephrolithiasis without ureteral stones or hydronephrosis. Findings were notified to Dr. Assimos by Dr. Lockhart at 12:30 p.m. on 1/12/2022.
FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: A 5 mm semisolid left lingular pulmonary nodule is not included on the prior study. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: A 10 mm cystic lesion at the anterior surface of the pancreatic neck (image 66 series 2) is unchanged since 2019. No new lesions or ductal dilatation. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: There is a cluster of stones in the left interpolar region, the largest measuring 10 mm. A punctate left upper pole renal stone is present. No ureteral stones or right renal stones are identified. There is no hydronephrosis or perinephric stranding. No focal renal lesion is identified within the limitations of unenhanced technique LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Normal appendix. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. Bilateral tubal ligation clips are present. BODY WALL: Small umbilical hernia contains fat. No significant abnormality. MUSCULOSKELETAL: Small lumbar vertebral bone islands are unchanged. No significant abnormality.
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: Nonobstructing 4 mm right lower pole renal stone. No hydronephrosis or additional urinary tract stones identified. Specifically, previously visualized mild right hydronephrosis has resolved The kidneys are otherwise normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Normal. Few noninflamed cecal diverticula. Otherwise normal. PERITONEUM / MESENTERY: No free fluid or free air. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Mildly distended but otherwise normal REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Tiny fat-containing periumbilical hernia. MUSCULOSKELETAL: No acute fracture or destructive osseous lesion. Partial ankylosis of the right SI joint, nonspecific but possibly related to prior sacroiliitis.
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Interpretation of Outside Films MR LSPN 1/12/2022 10:35 AM Clinical Information: Back pain Comparison: Lumbar spine MRI without and with contrast from outside institution examination dated 4/27/2021 Technique: Multiplanar multisequence unenhanced images of the lumbar spine were provided from an outside institution examination dated 11/15/2021 Findings: Straightening of usual lumbar lordotic curvature, grade 1 anterolisthesis of L2 over L3. Redemonstration of chronic compression fracture of the L1 vertebral body with approximately 50% anterior height loss. T1 and T2 hyperintense signal is present throughout this vertebral body which may represent superimposition of an intraosseous hemangioma. Diffuse Modic type II degenerative changes are seen throughout the lumbar spine which appear most pronounced at L2-L3 The conus terminates at L1 and is unremarkable. The cauda equina is traverses areas of narrowing described below. Degenerative changes of the lumbar spine are described on a level by level basis below: T12-L1: Mild disc bulge and facet arthropathy, otherwise unremarkable L1-L2: Mild disc bulge with moderate facet arthropathy, left-sided facet effusion and slight ligament flavum thickening. This is causing mild bilateral neuroforaminal narrowing L2-L3: Advanced facet arthropathy is present with right-sided predominant osseous hypertrophy. Grade 1 anterolisthesis with slight bulge of uncovered disc. This is causing moderate right and mild left neuroforaminal narrowing. There is mild spinal canal stenosis. L3-L4: Mild facet arthropathy and ligamentum flavum thickening with prominent epidural lipomatosis, mild disc bulge. This is causing advanced bilateral neuroforaminal narrowing and mild lumbar spinal canal narrowing. L4-L5: Advanced facet arthropathy with focal ligamentum flavum thickening, prominent epidural lipomatosis, mild disc bulge. This is causing moderate bilateral left greater than right neuroforaminal narrowing and moderate lumbar spinal canal narrowing L5-S1: Mild facet arthropathy, otherwise unremarkable The visualized prevertebral and paravertebral soft tissues are unremarkable. Prominent epidural adipose tissue in dorsal aspect of thecal sac is seen from L3 to L5 in favor of epidural lipomatosis, unchanged. Impression: 1. Stable interval appearance of moderate multilevel degenerative changes of the lumbar spine most pronounced at L3-L4 where there is advanced bilateral neuroforaminal narrowing and mild lumbar spinal canal narrowing and at L4-L5 with moderate spinal canal stenosis. 2. Chronic L1 vertebral body compression deformity with approximately 50% anterior height loss. 3. Stable appearance of diffuse Modic type II degenerative changes are redemonstrated throughout the lumbar spine most pronounced at L2-L3. 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.
Findings: Straightening of usual lumbar lordotic curvature, grade 1 anterolisthesis of L2 over L3. Redemonstration of chronic compression fracture of the L1 vertebral body with approximately 50% anterior height loss. T1 and T2 hyperintense signal is present throughout this vertebral body which may represent superimposition of an intraosseous hemangioma. Diffuse Modic type II degenerative changes are seen throughout the lumbar spine which appear most pronounced at L2-L3 The conus terminates at L1 and is unremarkable. The cauda equina is traverses areas of narrowing described below. Degenerative changes of the lumbar spine are described on a level by level basis below: T12-L1: Mild disc bulge and facet arthropathy, otherwise unremarkable L1-L2: Mild disc bulge with moderate facet arthropathy, left-sided facet effusion and slight ligament flavum thickening. This is causing mild bilateral neuroforaminal narrowing L2-L3: Advanced facet arthropathy is present with right-sided predominant osseous hypertrophy. Grade 1 anterolisthesis with slight bulge of uncovered disc. This is causing moderate right and mild left neuroforaminal narrowing. There is mild spinal canal stenosis. L3-L4: Mild facet arthropathy and ligamentum flavum thickening with prominent epidural lipomatosis, mild disc bulge. This is causing advanced bilateral neuroforaminal narrowing and mild lumbar spinal canal narrowing. L4-L5: Advanced facet arthropathy with focal ligamentum flavum thickening, prominent epidural lipomatosis, mild disc bulge. This is causing moderate bilateral left greater than right neuroforaminal narrowing and moderate lumbar spinal canal narrowing L5-S1: Mild facet arthropathy, otherwise unremarkable The visualized prevertebral and paravertebral soft tissues are unremarkable. Prominent epidural adipose tissue in dorsal aspect of thecal sac is seen from L3 to L5 in favor of epidural lipomatosis, unchanged.
Findings: Stable positioning of right frontal approach ventriculostomy catheter and shunted ventricular volumes. Frontal horns are decompressed. The remaining images of the brain demonstrate 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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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: 52-year-old male with renal cell cancer. COMPARISON: CT 10/27/2021. TECHNIQUE: Outside CT images of the abdomen and pelvis with intravenous contrast and delayed images from South Baldwin Regional Medical Center dated 11/28/2021 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: Dense consolidation in the right lower lobe has developed since prior study with adjacent tree-in-bud opacities. Two left lung base solid nodules are grossly unchanged. Nodularity along the posterior diaphragm is worsened. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Subcentimeter hypodensities in the anterior segment and medial segment are unchanged. No definite hepatic metastases. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Heterogeneous left adrenal mass measures 7.9 x 5.9 cm (image 21 series 4), previously 7.2 x 5.8 cm (image 33 series 2) there is markedly increased stranding around the adrenal mass since prior study. KIDNEYS: Heterogeneous enhancing left renal tumor measures 11.8 x 7.5 cm (image 31 series 4), previously 11.7 x 7.0 cm (image 51 series 2). The mass directly abuts renal calyces and the renal sinus fat, and there are nodular lesions involving Gerota's fascia and the left abdominal wall. Enhancing right renal capsular mass is unchanged on image 37 series 4. Mild bilateral perinephric stranding is present. There is no hydronephrosis. LYMPH NODES: Left periaortic nodal metastasis (image 39 series 4) is larger. Aortocaval nodal mass is unchanged. Multiple mesenteric nodal masses are grossly unchanged, the largest on image 39 series 4. Left iliac and obturator adenopathy with areas of necrosis are grossly unchanged from prior study. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Normal appendix. PERITONEUM / MESENTERY: Peritoneal mass adjacent to the ascending colon measures 3.9 x 2.8 cm (image 44 series 4), previously 2.6 x 2.2 cm (image 75 series 2). RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Multiple lytic pelvic osseous metastases are grossly unchanged. No new osseous lesions. CONCLUSION: 1. Heterogeneous enhancing large left renal mass is consistent with primary renal tumor. Metastatic disease involves the lung bases, peritoneum, mesentery, retroperitoneum, left adrenal gland, and bones. The anterior peritoneal lesion and left para-aortic adenopathy have increased size since recent prior study.
FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Dense consolidation in the right lower lobe has developed since prior study with adjacent tree-in-bud opacities. Two left lung base solid nodules are grossly unchanged. Nodularity along the posterior diaphragm is worsened. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Subcentimeter hypodensities in the anterior segment and medial segment are unchanged. No definite hepatic metastases. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Heterogeneous left adrenal mass measures 7.9 x 5.9 cm (image 21 series 4), previously 7.2 x 5.8 cm (image 33 series 2) there is markedly increased stranding around the adrenal mass since prior study. KIDNEYS: Heterogeneous enhancing left renal tumor measures 11.8 x 7.5 cm (image 31 series 4), previously 11.7 x 7.0 cm (image 51 series 2). The mass directly abuts renal calyces and the renal sinus fat, and there are nodular lesions involving Gerota's fascia and the left abdominal wall. Enhancing right renal capsular mass is unchanged on image 37 series 4. Mild bilateral perinephric stranding is present. There is no hydronephrosis. LYMPH NODES: Left periaortic nodal metastasis (image 39 series 4) is larger. Aortocaval nodal mass is unchanged. Multiple mesenteric nodal masses are grossly unchanged, the largest on image 39 series 4. Left iliac and obturator adenopathy with areas of necrosis are grossly unchanged from prior study. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Normal appendix. PERITONEUM / MESENTERY: Peritoneal mass adjacent to the ascending colon measures 3.9 x 2.8 cm (image 44 series 4), previously 2.6 x 2.2 cm (image 75 series 2). RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Multiple lytic pelvic osseous metastases are grossly unchanged. No new osseous lesions.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Lungs are clear aside from subcentimeter parenchymal cyst in the right lung base. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Mildly steatotic but otherwise normal. BILIARY TRACT: Normal. GALLBLADDER: Uncomplicated cholelithiasis PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Small renal cyst and additional subcentimeter hypoattenuating lesions which are too small to characterize but likely also cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Prior appendectomy. Otherwise normal. PERITONEUM / MESENTERY: Fluid or free air. RETROPERITONEUM: Normal. VESSELS: Mild aortoiliac atherosclerotic disease without aneurysm or flow-limiting stenosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Fibroid uterus. No acute abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute fracture or destructive osseous lesion. Small bone island in the right posterior ilium.
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Interpretation of Outside Films CT Chest Clinical Information: Spec Inst: LUNG CANCER CT CHEST ABD-PEL 113021 REC 11222 COOL SPRINGS IMAGING Study reviewed: CT of chest performed at Cool Springs imaging on 11/30/2021. . 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:9/7/2021 Findings: Enlarged right cervical nodes measuring up to 1.1 cm in short axis. Normal heart size. Mild coronary artery calcifications. Mediastinal structures are within normal limits. The central airways are patent. New fiducial markers are seen near the superior segment left lower lobe mass with adjacent radiation treatment-related changes. The mass itself measures about 2.0 x 1.8 cm (series 201; image 38), previously measuring about 3.6 x 2.0 cm. Unchanged tiny ovoid nodule in the middle lobe (series 201; image 62). A left chest port terminates near the cavoatrial junction. Soft tissues of the chest wall are otherwise unremarkable. No aggressive osseous lesions. Please note that the concurrently obtained CT scan of the Abdomen will be dictated separately. Conclusion: 1. Interval decrease in size of the left lower lobe mass with surrounding radiation treatment changes. 2. Enlarged right cervical lymph nodes worrisome for metastatic disease.
Findings: Enlarged right cervical nodes measuring up to 1.1 cm in short axis. Normal heart size. Mild coronary artery calcifications. Mediastinal structures are within normal limits. The central airways are patent. New fiducial markers are seen near the superior segment left lower lobe mass with adjacent radiation treatment-related changes. The mass itself measures about 2.0 x 1.8 cm (series 201; image 38), previously measuring about 3.6 x 2.0 cm. Unchanged tiny ovoid nodule in the middle lobe (series 201; image 62). A left chest port terminates near the cavoatrial junction. Soft tissues of the chest wall are otherwise unremarkable. No aggressive osseous lesions. Please note that the concurrently obtained CT scan of the Abdomen will be dictated separately.
FINDINGS: LUMBAR SPINE: VERTEBRA: No acute fracture. No suspicious osseous lesions. Bone island in the right posterior ilium. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel lumbar facet arthropathy most prominent at L5-S1. PREVERTEBRAL SOFT TISSUES: Fibroid uterus and small renal cysts.. Soft tissues are otherwise normal. ALIGNMENT: Normal
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: 51-year-old female with lung cancer. COMPARISON: None available. TECHNIQUE: Outside CT images with IV contrast dated 11/30/2021 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 dictated same-day CT chest. ABDOMEN and PELVIS: LIVER: Noncirrhotic. No definite steatosis. There are multiple hypoattenuating, ill-defined lesions throughout the liver. For example, a large right hepatic lobe lesion measuring 4.3 x 4.0 cm (series 201 image 83). There is an additional lesion within segment V measuring 1.7 x 1.5 cm (series 201 image 99). The lesion in segment IVA measures 1.7 x 1.7 cm (series 201 image 78). BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal with small adjacent splenule. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. The appendix is not well-visualized, likely not included within the study. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild scattered atherosclerotic calcifications of the abdominal aorta which is normal in caliber. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: Partially visualized lytic lesions of the bilateral superior iliac bones, (series 203 image 74 and image 68). CONCLUSION: 1. Multiple heterogeneous, ill-defined lesions throughout the liver, the largest within the superior right hepatic lobe measures up to 4.3 cm, concerning for metastatic disease. 2. Partially visualized lytic lesions of the bilateral superior iliac bones, further evaluation with dedicated pelvic imaging is recommended. 3. Additional chronic and incidental findings as described above. 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.
FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately dictated same-day CT chest. ABDOMEN and PELVIS: LIVER: Noncirrhotic. No definite steatosis. There are multiple hypoattenuating, ill-defined lesions throughout the liver. For example, a large right hepatic lobe lesion measuring 4.3 x 4.0 cm (series 201 image 83). There is an additional lesion within segment V measuring 1.7 x 1.5 cm (series 201 image 99). The lesion in segment IVA measures 1.7 x 1.7 cm (series 201 image 78). BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal with small adjacent splenule. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. The appendix is not well-visualized, likely not included within the study. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild scattered atherosclerotic calcifications of the abdominal aorta which is normal in caliber. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: Partially visualized lytic lesions of the bilateral superior iliac bones, (series 203 image 74 and image 68).
FINDINGS: STRUCTURED REPORT: CT HCC Follow-up IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. No steatosis. A subcentimeter area of arterial phase hyperenhancement in the dome (image 31 series 5) has no correlate on portal venous or delayed phases and is likely perfusional. TREATED LIVER LESIONS: - Lesion Number: 1 - Description: Post Ethiodol TACE lesion - Location: Segment(s) V - Size of largest enhancing portion of the mass: N/A - Enhancement: None - Additional features: - Arterial phase hyperenhancement: Not present. - Washout: Not present. - Enhancement similar to pretreatment: Not present. - Vascular invasion: No - LI-RADS: TR nonviable UNTREATED OR NEW LIVER LESION(S): None - LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: None. - Other varices or collaterals: None. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: No abnormality. LYMPH NODES: None enlarged. SPLEEN: Normal size and appearance. PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Pancreas divisum ductal anatomy is present. No abnormalities otherwise. ADRENALS: Normal. KIDNEYS: Few simple appearing cysts are unchanged. Excretion is symmetric on the delayed images. STOMACH / SMALL BOWEL: No abnormality in visualized portions. COLON / APPENDIX: No abnormality in visualized portions. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: Diffuse atherosclerotic calcifications are seen throughout the normal caliber abdominal aorta, including at the origins of the major branches; all appear patent at present however. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Degenerative changes are present in the lumbar spine. No aggressive osseous lesions.
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Interpretation of Outside Films CT Chest Clinical Information: Spec Inst: RECTAL CA CT CHEST 122321 SEHMC REC 11222 Study reviewed: CT of of the chest with contrast 12/23/2021 performed at SEHMC. The images are available in PACS. Please note the examination was performed outside of UAB protocol, monitoring and oversight. Findings: No prior. Mild centrilobular emphysema. A few scattered tiny nodules are present. 4 mm middle lobe nodule image 69 series 3 could represent a small lymph node along an accessory fissure or actual parenchymal nodule. Probable lymph nodes along the minor fissure images 56 and 59. Spinal stimulator wires are partially included. Small sclerotic focus in the right posterior medial sixth rib image 42 series 3 may represent a bone island. Moderate-large hiatal hernia. Included portions of the upper abdomen show a few hypoenhancing renal lesions, possibly cysts. Please see separately reported abdominal CT. No axillary or mediastinal adenopathy. No central PTE, pleural, or pericardial effusion. Mild cardiomegaly. Moderate coronary artery atherosclerotic calcifications. Conclusion: 1. Small middle lobe nodule could represent a lymph node along an attenuated accessory fissure. Recommend attention on follow-up if there are no outside chest CTs with which to compare. 2. Other incidental findings.
Findings: No prior. Mild centrilobular emphysema. A few scattered tiny nodules are present. 4 mm middle lobe nodule image 69 series 3 could represent a small lymph node along an accessory fissure or actual parenchymal nodule. Probable lymph nodes along the minor fissure images 56 and 59. Spinal stimulator wires are partially included. Small sclerotic focus in the right posterior medial sixth rib image 42 series 3 may represent a bone island. Moderate-large hiatal hernia. Included portions of the upper abdomen show a few hypoenhancing renal lesions, possibly cysts. Please see separately reported abdominal CT. No axillary or mediastinal adenopathy. No central PTE, pleural, or pericardial effusion. Mild cardiomegaly. Moderate coronary artery atherosclerotic calcifications.
FINDINGS: STRUCTURED REPORT: CTA CAP Stent VASCULATURE: CORONARY ARTERIES: There are no atherosclerotic calcifications of the native coronary arteries. PULMONARY ARTERIES: No central pulmonary embolus. Normal size. ENDOVASCULAR STENT: Aortic arch and descending thoracic aorta endovascular stent. ENDOLEAK: No evidence of endoleak. Progressive thrombosis of the false lumen. ASCENDING THORACIC AORTA: Ascending aorta replacement graft with interval decrease in size of postoperative perigraft fluid collection. AORTIC ARCH: Total arch replacement with graft and reimplantation of the brachiocephalic and left common carotid arteries. ARCH VESSELS: Persistent dissection flap in the proximal left subclavian artery. DESCENDING THORACIC AORTA: Aneurysm sac measures up to 4.7 x 4.2 cm (image 58, series 501). ABDOMINAL AORTA: No significant abnormality. CELIAC AXIS: No significant abnormality. SMA: No significant abnormality. RIGHT RENAL: Ostium at the dissection flap with narrowing of the proximal renal artery. LEFT RENAL: The dissection flap extends along the length of the left renal artery. IMA: No significant abnormality. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: The dissection flap extends into the common iliac arteries. LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: The dissection plaque extends into the common and proximal external iliac arteries. ------------------------------------------------------------- LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Diffuse bilateral pulmonary opacities, right greater than left.. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Midline chest wall incision and median sternotomy wires. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Global hypoperfusion of the right kidney. The left kidney appears normal. No hydronephrosis.. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Small left retroperitoneal hematoma, likely postsurgical. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: No significant abnormality. Mild multilevel discogenic degenerative changes of the lumbar spine with degenerative retrolisthesis of L5 on S1 and vacuum phenomenon at L4-L5 and L5-S1.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Rectal cancer COMPARISON: None. TECHNIQUE: Outside CT images with IV contrast 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 ABDOMEN and PELVIS: LIVER: Small fluid density cyst is observed in the left hepatic dome consistent with a simple cyst. An additional sub-5 mm hypoattenuating lesion is observed in the right hepatic lobe segment 5/8 (series 8 image 41), too small to characterize. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal KIDNEYS: There are small fluid intensity cysts in both kidneys. Small parenchymal calcification in the interpolar left kidney with associated cortical parenchymal scarring. Tiny parenchymal calcification in the right kidney. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Moderate-sized hiatal hernia. Small bowel loops are normal. COLON / APPENDIX: Colonic diverticulosis. There is masslike soft tissue in the rectum measuring 3.3 x 5.0 cm (series 8 image 144) is consistent with patient history of rectal cancer. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate aortobiiliac atherosclerotic disease without aneurysm URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The prostate is enlarged BODY WALL: No significant abnormality. MUSCULOSKELETAL: Multilevel degenerative changes in the lumbar spine. There is posterior fusion hardware observed at the L2-L4 level. There is severe osteoporosis of the spine. CONCLUSION: 1. Masslike soft tissue in the rectum with provided history of rectal cancer. Tiny hypodensity in the right hepatic lobe is too small to characterize. Consider liver MRI with IV Eovist for further characterization. 2. Additional, nonacute findings as detailed in the report. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Small fluid density cyst is observed in the left hepatic dome consistent with a simple cyst. An additional sub-5 mm hypoattenuating lesion is observed in the right hepatic lobe segment 5/8 (series 8 image 41), too small to characterize. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal KIDNEYS: There are small fluid intensity cysts in both kidneys. Small parenchymal calcification in the interpolar left kidney with associated cortical parenchymal scarring. Tiny parenchymal calcification in the right kidney. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Moderate-sized hiatal hernia. Small bowel loops are normal. COLON / APPENDIX: Colonic diverticulosis. There is masslike soft tissue in the rectum measuring 3.3 x 5.0 cm (series 8 image 144) is consistent with patient history of rectal cancer. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate aortobiiliac atherosclerotic disease without aneurysm URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The prostate is enlarged BODY WALL: No significant abnormality. MUSCULOSKELETAL: Multilevel degenerative changes in the lumbar spine. There is posterior fusion hardware observed at the L2-L4 level. There is severe osteoporosis of the spine.
FINDINGS: STRUCTURED REPORT: CTA CAP Stent VASCULATURE: CORONARY ARTERIES: There are no atherosclerotic calcifications of the native coronary arteries. PULMONARY ARTERIES: No central pulmonary embolus. Normal size. ENDOVASCULAR STENT: Aortic arch and descending thoracic aorta endovascular stent. ENDOLEAK: No evidence of endoleak. Progressive thrombosis of the false lumen. ASCENDING THORACIC AORTA: Ascending aorta replacement graft with interval decrease in size of postoperative perigraft fluid collection. AORTIC ARCH: Total arch replacement with graft and reimplantation of the brachiocephalic and left common carotid arteries. ARCH VESSELS: Persistent dissection flap in the proximal left subclavian artery. DESCENDING THORACIC AORTA: Aneurysm sac measures up to 4.7 x 4.2 cm (image 58, series 501). ABDOMINAL AORTA: No significant abnormality. CELIAC AXIS: No significant abnormality. SMA: No significant abnormality. RIGHT RENAL: Ostium at the dissection flap with narrowing of the proximal renal artery. LEFT RENAL: The dissection flap extends along the length of the left renal artery. IMA: No significant abnormality. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: The dissection flap extends into the common iliac arteries. LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: The dissection plaque extends into the common and proximal external iliac arteries. ------------------------------------------------------------- LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Diffuse bilateral pulmonary opacities, right greater than left.. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Midline chest wall incision and median sternotomy wires. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Global hypoperfusion of the right kidney. The left kidney appears normal. No hydronephrosis.. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Small left retroperitoneal hematoma, likely postsurgical. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: No significant abnormality. Mild multilevel discogenic degenerative changes of the lumbar spine with degenerative retrolisthesis of L5 on S1 and vacuum phenomenon at L4-L5 and L5-S1.
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Interpretation of Outside Films MR MSK CLINICAL INFORMATION: 59-year-old male with history of right shoulder arthroscopically with rotator cuff repair, subscapularis repair and biceps tenodesis on 8/16/2021 with continued limited range of motion and pain. Spec Inst: MRI RIGHT SHOULDER 122921 REC 011222 BHAM PHYSICIANS IMAGIN COMPARISON: Radiographs of the right shoulder from 9/2/2021 and right shoulder MRI 7/2/2021 TECHNIQUE:Interpretation of Outside Films MR MSK FINDINGS: BONES: Postsurgical changes of rotator cuff repair with several tenodesis screws in the greater and lesser tuberosities. There is diffuse edema within the proximal humerus. No significant edema involving the glenoid or scapula. No osteophytosis or fracture. ROTATOR CUFF: Supraspinatus and Infraspinatus: Full-thickness tear is with tendon retraction to the glenoid. Subscapularis: Complete full-thickness tear. Teres minor: Normal. LONG HEAD BICEPS TENDON: The tendon is medially dislocated without any visualized tendon within the bicipital groove or associated with the humerus. The tendon appears to course into the medial subscapular soft tissues with poor visualization of the tendon centrally. GLENOHUMERAL JOINT: Position: Normal. Articular cartilage: Diffuse degenerative chondromalacia. Ligaments/Capsule: Complete tear of the inferior glenohumeral ligament. There is small glenohumeral joint effusion with layering debris in the axillary recess. Labrum: Redemonstrated superior labral tear with anterior displacement of the superior labrum. BURSAE: Trace fluid in the subacromial and subdeltoid bursae. ACROMIAL CLAVICULAR JOINT: Osteophytes are present with capsular hypertrophy. No os acromiale. SUBACROMIAL ENCROACHMENT: None. MUSCLES: Diffuse edema and fatty infiltration of the supraspinatus, infraspinatus and subscapularis muscles. SOFT TISSUES: There is diffuse soft tissue edema about the shoulder. CONCLUSION: 1. Complex glenohumeral joint effusion (communicating with the overlying subacromial bursa) with greater than expected edema involving the proximal humerus and soft tissues and musculature. There is no appreciable osseous destruction, however, correlation for infection is recommended. 2. Postsurgical changes of recent rotator cuff repair with complete full-thickness tears of the supraspinatus, infraspinatus, and subscapularis tendons with associated muscular edema and fatty atrophy, most prominent involving the supra and infraspinatus muscles. 3. The long head biceps tendon is not is definitively visualized either secondary to tenodesis or tear with distal retraction. 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.
FINDINGS: BONES: Postsurgical changes of rotator cuff repair with several tenodesis screws in the greater and lesser tuberosities. There is diffuse edema within the proximal humerus. No significant edema involving the glenoid or scapula. No osteophytosis or fracture. ROTATOR CUFF: Supraspinatus and Infraspinatus: Full-thickness tear is with tendon retraction to the glenoid. Subscapularis: Complete full-thickness tear. Teres minor: Normal. LONG HEAD BICEPS TENDON: The tendon is medially dislocated without any visualized tendon within the bicipital groove or associated with the humerus. The tendon appears to course into the medial subscapular soft tissues with poor visualization of the tendon centrally. GLENOHUMERAL JOINT: Position: Normal. Articular cartilage: Diffuse degenerative chondromalacia. Ligaments/Capsule: Complete tear of the inferior glenohumeral ligament. There is small glenohumeral joint effusion with layering debris in the axillary recess. Labrum: Redemonstrated superior labral tear with anterior displacement of the superior labrum. BURSAE: Trace fluid in the subacromial and subdeltoid bursae. ACROMIAL CLAVICULAR JOINT: Osteophytes are present with capsular hypertrophy. No os acromiale. SUBACROMIAL ENCROACHMENT: None. MUSCLES: Diffuse edema and fatty infiltration of the supraspinatus, infraspinatus and subscapularis muscles. SOFT TISSUES: There is diffuse soft tissue edema about the shoulder.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Small hiatal hernia. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Unchanged single upper pole and two lower pole percutaneous nephrostomy tubes. Similar appearance of bilateral medullary nephrocalcinosis and large renal calculus burden most significant on the right. Additionally, the obstructing distal ureteral calculus measures 1.2 cm in maximum axial diameter (series 2 image 217) and appears grossly stable. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Colon is unremarkable. Normal appendix. PERITONEUM / MESENTERY: Trace pelvic fluid. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Collapsed. REPRODUCTIVE ORGANS: Uterus is present. Normal adnexa. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: Thoracolumbar discogenic degenerative changes. No aggressive osseous lesion.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Cervical cancer COMPARISON: None. TECHNIQUE: Outside CT images with IV contrast 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: 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: Normal. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Dilated periuterine collateral vessels and enlargement of the gonadal veins bilaterally. URINARY BLADDER: Displaced anteriorly by the large pelvic mass REPRODUCTIVE ORGANS: Very large, pelvic mass centered in the region of the cervix is observed measuring 12.8 x 11.7 cm (series 2 image 61 and series 601 image five). The mass is heterogeneously enhancing with internal areas of necrosis. There is obstruction of the endometrial canal by the mass with distention of the endometrial with fluid. There are a few small foci of gas within the mass. The cervical mass displaces the urinary bladder without clear signs of invasion. The mass also displaces the rectum, without clear signs of invasion. The mass contacts the bilateral pelvic sidewalls, without signs of vascular invasion. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Large cervical mass as described consistent with provided history of cervical cancer. No overt invasion of adjacent bowel or bladder although these structures are displaced by the large mass. No metastatic disease in the abdomen and pelvis. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Dilated periuterine collateral vessels and enlargement of the gonadal veins bilaterally. URINARY BLADDER: Displaced anteriorly by the large pelvic mass REPRODUCTIVE ORGANS: Very large, pelvic mass centered in the region of the cervix is observed measuring 12.8 x 11.7 cm (series 2 image 61 and series 601 image five). The mass is heterogeneously enhancing with internal areas of necrosis. There is obstruction of the endometrial canal by the mass with distention of the endometrial with fluid. There are a few small foci of gas within the mass. The cervical mass displaces the urinary bladder without clear signs of invasion. The mass also displaces the rectum, without clear signs of invasion. The mass contacts the bilateral pelvic sidewalls, without signs of vascular invasion. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
Findings: No intracranial mass, mass effect, edema, hemorrhage, or hydrocephalus is seen. No acute infarction seen. There is diffuse white matter and periventricular hypodensities suggestive of microangiopathic changes. Remote lacunar infarct in right thalamus and left pons is noted. There is diffuse cerebral volume loss secondary to atrophic changes. There is a tiny chronic left cerebellar infarct. Calcified atherosclerosis of the right vertebral artery is seen. Moderate mucosal thickening in bilateral maxillary, ethmoid and sphenoid sinuses is noted with hyperostosis indicating underlying chronicity. No acute osseous or soft tissue abnormality seen.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Anastomotic leak. COMPARISON: None. TECHNIQUE: Outside CT images without IV contrast dated 12/24/2021 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: Hepatic steatosis. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Bilateral adrenal thickening KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Prior colectomy surgical changes. There is a fistulous tract extending from the left colon at the region of the anastomosis into the left paracolic gutter along the left lateral abdominal wall into the left upper quadrant where it contacts the inferior aspect of the stomach greater curvature and spleen (Series 602 image 49). The fistula morphology is complex with an additional component extending into the central mesentery adjacent to several loops of small bowel (series 3 image 239). There is another component of the fistula which extends inferiorly into the pelvis where it contacts the rectosigmoid junction as well as the right aspect of the uterus and vagina (series 3 image 275). PERITONEUM / MESENTERY: Complex fistula described above RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Complex fistula adjacent to the right aspect of the uterus and vagina described above. BODY WALL: Prior ventral abdominal surgical changes MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Prior partial colectomy with complex abdominopelvic fistula arising from the colonic anastomosis as detailed in the report, likely due to prior anastomotic leak. No discrete intraabdominal abscess. 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.
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: Hepatic steatosis. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Bilateral adrenal thickening KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Prior colectomy surgical changes. There is a fistulous tract extending from the left colon at the region of the anastomosis into the left paracolic gutter along the left lateral abdominal wall into the left upper quadrant where it contacts the inferior aspect of the stomach greater curvature and spleen (Series 602 image 49). The fistula morphology is complex with an additional component extending into the central mesentery adjacent to several loops of small bowel (series 3 image 239). There is another component of the fistula which extends inferiorly into the pelvis where it contacts the rectosigmoid junction as well as the right aspect of the uterus and vagina (series 3 image 275). PERITONEUM / MESENTERY: Complex fistula described above RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Complex fistula adjacent to the right aspect of the uterus and vagina described above. BODY WALL: Prior ventral abdominal surgical changes MUSCULOSKELETAL: No significant abnormality.
Findings: CTA neck: The top of the aortic arch and the brachiocephalic arteries have diffuse atherosclerotic changes with calcified nonstenotic plaques. The common carotid arteries are essentially negative. There are small calcified nonstenotic plaques at the bifurcations but there is no flow-limiting stenosis. The cervical ICAs are essentially negative. Both vertebral arteries are sizable with minor atherosclerotic changes but otherwise normal appearance. There are sizable anterior bridging osteophytes in the mid and lower C-spine. CTA head: There are extensive calcifications in the cavernous ICAs with significant stenosis, estimated to be greater than 70% on the right and slightly less on the left. Supraclinoid ICAs and the proximal ACAs, MCA's and PCAs are unremarkable. There are atherosclerotic changes in the basilar artery but no flow-limiting stenosis is seen. The basilar branches are unremarkable. There is severe chronic sphenoid sinusitis and there is advanced right maxillary and bilateral severe ethmoid sinus disease. --------------
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Interpretation of Outside Films MR Face 1/13/2022 7:57 AM Clinical Information: Evaluation for cervical lymphadenopathy Comparison: Thyroid ultrasound dated 12/27/2021, CT neck 10/18/2021 Technique: Multiple multisequence pre and postcontrast MR images of the neck were provided from Vestavia hill imaging examination dated 12/28/2021. Images include axial T1, sagittal T1, coronal T1, coronal STIR, axial STIR, postcontrast axial and coronal T1. 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. This study interpretation should be correlated with outside imaging interpretation as transfer of data via media other than direct line may cause compression and degradation of imaging data. Findings: Multifocal left axillary lymphadenopathy is noted with large left level V lymph node conglomerate extending into the lower cervical neck soft tissues measuring approximately 3.4 x 3.3 x 2.6 cm on series 6 image 37. There is surrounding hazy soft tissue stranding. There is conglomerate does not appear to be adjacent to the transversing brachial plexus which is at the lower level. Images are suboptimal for the assessment of brachial plexus, however a 3.2 x 1.5 cm left retroclavicular lymph node conglomerate, abuts the transversing brachial plexus (series 9 image 43). Additional enlarged left level III/IV lymph nodes are present, this is best seen on series 6 image 32. There is no appreciable laryngeal or pharyngeal mass. The limited images of the brain are unremarkable. The parotid, submandibular salivary glands are unremarkable. Redemonstration of left thyroid lobe nodules. The remaining aerodigestive tract is unremarkable. Impression: No appreciable laryngeal or pharyngeal mass. Bulky left-sided axillary, supraclavicular and cervical lymphadenopathy, this is nonspecific however can be seen with lymphoma. Atypical reactive lymph nodes from an etiology such as Bartonellosis is a differential consideration. Recommend clinical correlation for left sided epitrochlear lymphadenopathy. Also follow-up of tissue diagnosis results. Images are suboptimal for the assessment of brachial plexus, however a left retroclavicular lymph node conglomerate, abuts the transversing brachial plexus. 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.
Findings: Multifocal left axillary lymphadenopathy is noted with large left level V lymph node conglomerate extending into the lower cervical neck soft tissues measuring approximately 3.4 x 3.3 x 2.6 cm on series 6 image 37. There is surrounding hazy soft tissue stranding. There is conglomerate does not appear to be adjacent to the transversing brachial plexus which is at the lower level. Images are suboptimal for the assessment of brachial plexus, however a 3.2 x 1.5 cm left retroclavicular lymph node conglomerate, abuts the transversing brachial plexus (series 9 image 43). Additional enlarged left level III/IV lymph nodes are present, this is best seen on series 6 image 32. There is no appreciable laryngeal or pharyngeal mass. The limited images of the brain are unremarkable. The parotid, submandibular salivary glands are unremarkable. Redemonstration of left thyroid lobe nodules. The remaining aerodigestive tract is unremarkable.
Findings: CTA neck: The top of the aortic arch and the brachiocephalic arteries have diffuse atherosclerotic changes with calcified nonstenotic plaques. The common carotid arteries are essentially negative. There are small calcified nonstenotic plaques at the bifurcations but there is no flow-limiting stenosis. The cervical ICAs are essentially negative. Both vertebral arteries are sizable with minor atherosclerotic changes but otherwise normal appearance. There are sizable anterior bridging osteophytes in the mid and lower C-spine. CTA head: There are extensive calcifications in the cavernous ICAs with significant stenosis, estimated to be greater than 70% on the right and slightly less on the left. Supraclinoid ICAs and the proximal ACAs, MCA's and PCAs are unremarkable. There are atherosclerotic changes in the basilar artery but no flow-limiting stenosis is seen. The basilar branches are unremarkable. There is severe chronic sphenoid sinusitis and there is advanced right maxillary and bilateral severe ethmoid sinus disease. --------------
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Interpretation of Outside Films CT Chest Clinical Information: 69-year-old male with cholangiocarcinoma. Comparison: None available. Technique: CT chest, abdomen and pelvis was obtained on 12/22/2021 adjacent contents Hospital. 5 mm axial, 2.5 mm axial, coronal and sagittal reformats were available at the time of interpretation. Findings: LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. Small volume right pleural effusion with adjacent atelectasis. No suspicious nodule. HEART / VESSELS: Three-vessel coronary artery calcifications. No central PE. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Mild gynecomastia. UPPER ABDOMEN: Reported separately. MUSCULOSKELETAL: No destructive osseous lesion. CONCLUSION: No evidence of intrathoracic metastasis. 2. Small volume right pleural effusion with adjacent atelectasis.
Findings: LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. Small volume right pleural effusion with adjacent atelectasis. No suspicious nodule. HEART / VESSELS: Three-vessel coronary artery calcifications. No central PE. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Mild gynecomastia. UPPER ABDOMEN: Reported separately. MUSCULOSKELETAL: No destructive osseous lesion.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: 1.8 cm rounded nodular area in the posterior segment right lobe with groundglass opacification adjacent. Additional small pleural based nodule right middle lobe on image eight series 301, smaller. DISTAL ESOPHAGUS: Small hiatal hernia ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Intrahepatic bile ducts are minimally prominent. No common bile duct dilatation. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. 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 and adnexa are unremarkable. Large clip is seen in the left adnexa. BODY WALL: Very small fat-containing anterior abdominal wall midline hernia is outlined on image 93 series 301. Peripheral to this there is a small amount of rounded linear enhancement measuring up to 3.9 cm on sagittal image 133 six series 602. MUSCULOSKELETAL: No destructive osseous lesions seen.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: 69-year-old male with cholangiocarcinoma. COMPARISON: CT abdomen pelvis 12/19/2021 TECHNIQUE: Outside CT images with IV contrast dated 12/22/2021 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. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Indeterminate subcentimeter hypodensity seen within the inferior right hepatic lobe on axial series 2, image 88. BILIARY TRACT: Common bile duct is enlarged with stent in place. Pneumobilia suggests stent patency. GALLBLADDER: Small amount of air within the gallbladder, likely introduced via the common bile duct stent. Small stone seen near the gallbladder neck on coronal series 601, image 45. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Approximately 1.4 cm left adrenal nodule, best appreciated on coronal series 601, image 58. KIDNEYS: Bilateral simple renal cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered colonic diverticuli without associated inflammation. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Normal caliber abdominal aorta. Moderate atherosclerotic disease. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Dystrophic prostatic calcifications are present. BODY WALL: Small fat-containing supraumbilical ventral abdominal wall hernia. Small fat-containing left inguinal hernia also noted. MUSCULOSKELETAL: Low density structure seen near the distal tendinous insertion of the right iliopsoas muscle, likely an enlarged bursa (axial series 2, image 130). Diffusely decreased bone mineralization. Advanced right femoroacetabular joint degenerative disease. CONCLUSION: 1. Persistent dilation of the common bile duct with common bile duct stent in place. No discrete ductal or periductal lesion identified. 2. Indeterminate subcentimeter hypodensity in the right hepatic lobe. Consider further evaluation with liver MRI if indicated. 3. Left adrenal lesion, likely an adenoma but technically indeterminate. 4. Cholelithiasis without evidence of acute cholecystitis.
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: Indeterminate subcentimeter hypodensity seen within the inferior right hepatic lobe on axial series 2, image 88. BILIARY TRACT: Common bile duct is enlarged with stent in place. Pneumobilia suggests stent patency. GALLBLADDER: Small amount of air within the gallbladder, likely introduced via the common bile duct stent. Small stone seen near the gallbladder neck on coronal series 601, image 45. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Approximately 1.4 cm left adrenal nodule, best appreciated on coronal series 601, image 58. KIDNEYS: Bilateral simple renal cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered colonic diverticuli without associated inflammation. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Normal caliber abdominal aorta. Moderate atherosclerotic disease. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Dystrophic prostatic calcifications are present. BODY WALL: Small fat-containing supraumbilical ventral abdominal wall hernia. Small fat-containing left inguinal hernia also noted. MUSCULOSKELETAL: Low density structure seen near the distal tendinous insertion of the right iliopsoas muscle, likely an enlarged bursa (axial series 2, image 130). Diffusely decreased bone mineralization. Advanced right femoroacetabular joint degenerative disease.
Findings: RAPID images demonstrate CBF less than 30% volume: 0 ml and T. Max greater than 6seconds volume: 0 ml . Mismatch volume is 0 ml. There is no abnormal MTT, T max, CBV and CBF to suggest significant ischemia or infarction at the territory of the major intracranial arteries.
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EXAM: Outside MR Image Interpretation CLINICAL INFORMATION: Foot lesion COMPARISON: None. TECHNIQUE: Outside MR images of the right foot without and with contrast dated 11/15/2021 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 the anterior ankle, there is an irregular multi-lobulated fat-containing lesion, difficult to accurately measure due to its shape but measures approximately approximately 2.2 x 4.4 x 5.0 cm in AP, transverse, and craniocaudal dimensions, respectively. Lesions mildly hypointense relative to the surrounding subcutaneous fat with several thin internal septations. On postcontrast images, there is mild heterogeneous enhancement throughout the mass. The mass extends deep to the anterior tibialis tendon and appears to surround the extensor hallucis longus and involve the extensor digitorum longus myotendinous junction. No fracture, marrow replacement, or aggressive osseous lesion. No evidence of abnormal marrow enhancement. No additional soft tissue mass identified. Visualized muscles are normal in bulk and signal intensity. No evidence of myotendinous injury. CONCLUSION: 1. Multilobulated heterogeneously enhancing fat-containing lesion in the anterior ankle as described above, concerning for atypical lipomatous tumor/well-differentiated liposarcoma. The lesion encases a short segment of the extensor hallucis 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.
FINDINGS: Within the the anterior ankle, there is an irregular multi-lobulated fat-containing lesion, difficult to accurately measure due to its shape but measures approximately approximately 2.2 x 4.4 x 5.0 cm in AP, transverse, and craniocaudal dimensions, respectively. Lesions mildly hypointense relative to the surrounding subcutaneous fat with several thin internal septations. On postcontrast images, there is mild heterogeneous enhancement throughout the mass. The mass extends deep to the anterior tibialis tendon and appears to surround the extensor hallucis longus and involve the extensor digitorum longus myotendinous junction. No fracture, marrow replacement, or aggressive osseous lesion. No evidence of abnormal marrow enhancement. No additional soft tissue mass identified. Visualized muscles are normal in bulk and signal intensity. No evidence of myotendinous injury.
FINDINGS: The thyroid gland is unremarkable. Central airways are widely patent. The thoracic aorta is nonaneurysmal. The pulmonary arteries are not dilated. The heart is not enlarged. There is no pericardial effusion. No enlarged clavicular axillary lymph nodes are identified. Mediastinal lymph nodes are similar in size including a millimeters short axis subcarinal lymph node on image 91 of series 10 and a 9 mm AP window lymph node on image 91. The esophagus is not dilated. Multiple new peripherally enhancing, centrally hypodense lesions are seen within the left pleural surface. This includes an 11 mm nodule at the left lung apex on image 27, a 15 mm nodule within the anteromedial pleural surface image 84 and a 2.7 cm nodule near the AP window. There is also a 16 mm nodule on image 158. An 8mm nodule on image 160, pulse adjacent to the left hemidiaphragm. Small right pleural effusion is similar in size some associated pleural thickening. There is peripheral reticulation within the lingula and left lower lobe have increased from the prior examination and may be due to evolving radiation fibrosis. There is a new 8 x 7 mm subpleural nodule within the medial aspect of the left upper lobe on image 57. A 4 mm perifissural nodule adjacent to the minor fissure on image 101 unchanged in size. No other new or enlarging lung nodules are identified. No pleural effusion or pleural thickening. The CT of the abdomen and pelvis will be dictated separately. Surgical changes are seen in the left lateral chest wall with surgical mesh present. There is borderline soft tissue stranding which appear similar to the prior examination. No definite residual pleural masses seen in the surgical bed.
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EXAM: Interpretation of Outside Films CT MSK CLINICAL INFORMATION: Ankle fracture fixation. COMPARISON: Radiograph 1/12/2022. TECHNIQUE: Outside CT images without IV contrast dated 11/24/2021 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. STRUCTURED REPORT: CT Bone vDec2021 FINDINGS: BONES/JOINTS: No acute fracture or malalignment. Intact medial malleolus fixation screws. Intact plate screw fixation involving the lateral malleolus extending to the distal fibular diaphysis. The talar dome is intact. No widening of the syndesmosis or medial clear space. SOFT TISSUES: No large hematoma or fluid collection. Ovoid skin nodule noted along the anterior medial ankle measuring approximately 1.0 x 0.5 x 1.3 cm, favored to represent a sebaceous cyst/epidermal occlusion cyst. CONCLUSION: No acute fracture with intact fixation hardware. 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.
FINDINGS: BONES/JOINTS: No acute fracture or malalignment. Intact medial malleolus fixation screws. Intact plate screw fixation involving the lateral malleolus extending to the distal fibular diaphysis. The talar dome is intact. No widening of the syndesmosis or medial clear space. SOFT TISSUES: No large hematoma or fluid collection. Ovoid skin nodule noted along the anterior medial ankle measuring approximately 1.0 x 0.5 x 1.3 cm, favored to represent a sebaceous cyst/epidermal occlusion cyst.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Mildly nodular consistent with cirrhosis BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Small right renal cyst is stable. Left renal cell carcinoma measures 5.9 x 5.3 cm on image 250 series 10, previously 5.5 x 4.4 cm on image 170 series 302, larger than prior. Peripheral scarring/calcification in the lower pole again noted. LYMPH NODES: Enlarged left external iliac node measures 2.1 x 1.5 cm on image 375 series 10. Shotty and mildly enlarged pelvic nodes seen. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Mildly thickened REPRODUCTIVE ORGANS: Prostate is mildly enlarged BODY WALL: Fat-containing umbilical hernia. Small right inguinal hernia, fat-containing. Fluid attenuation lesion in the left buttock soft tissues measuring 4.9 x 2.8 cm on image 464 series 10, previously 4.8 x 3.0 cm, partially imaged. MUSCULOSKELETAL: No destructive osseous lesions seen.
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Cervical MRI without contrast Clinical indication: Spec Inst: Eval for spinal cord compression - MRI C-Spine from Cullman Regional done 11-12-21 rec 1-13-22. Request for interpretation of outside imaging. Technique: Outside noncontrast MRI cervical spine performed at Cullman Regional Medical Center on 11/12/2021 were submitted for interpretation. Images include noncontrast sagittal T1, sagittal T2, sagittal STIR, axial T2*weighted MRI images of the cervical spine. Comparison: MRI cervical spine dated 11/12/2021 and 11/8/2016. Findings: There is congenital segmentation anomaly involving the C2-C3 vertebrae. Also partial anterior ankylosis of T1 and T2 due to also congenital. Trace anterolisthesis of C3 over C4 and trace anterolisthesis of C4-C5. Chronic wedging of the cervical vertebral bodies. There are multilevel disc the changes, most notably moderate disc height loss at There is no abnormal marrow signal. There is no abnormal cord signal. Degenerative disease of the cervical spine is described below. C2-3: No significant spinal canal or neuroforaminal stenosis. C3-C4: Disc osteophyte complex, uncovertebral and facet hypertrophy and ligamentum flavum hypertrophy result in moderate to severe spinal canal narrowing with indentation of the spinal cord and effacement of CSF along the ventral and posterior spinal cord. Images are motion degraded, however appears to be at least bilateral moderate neuroforaminal stenosis. C4-C5: Disc osteophyte complex and uncovertebral hypertrophy result in mild spinal canal and mild bilateral neuroforaminal narrowing. C4-5: Right greater than left uncovertebral facet hypertrophy results in moderate right and mild left neuroforaminal narrowing. No significant spinal canal narrowing. C5-6: Left greater than right uncovertebral facet hypertrophy results in worsening left greater than right moderate neuroforaminal stenosis. No significant spinal canal stenosis. C6-7: Combination of uncovertebral and facet hypertrophy results in severe right and moderate left neuroforaminal stenosis. No significant spinal canal stenosis. C7-T1: Combination of right greater than left uncovertebral facet hypertrophy results in moderate to severe right and moderate left neuroforaminal stenosis. No significant spinal canal stenosis. Posterior fossa cystic lesion is grossly unchanged in size measuring up to 4.5 x 2.9 cm (series 2, image seven) compared to 4.6 x 2.9 cm on prior. The remaining visualized portions of the skull base, brain stem, posterior fossa structures, and craniocervical junction appear normal. There is no prevertebral soft tissue swelling. The paraspinal muscles and visualized soft tissues are unremarkable. Impression: 1. Congenital segmentation anomaly involving C2-C3. 2. Moderate to severe spinal canal stenosis at C3-C4 with indentation of the cord however no appreciable abnormal cord signal. This is relatively unchanged since 2016. 3. Multilevel neuroforaminal stenosis appear worse over the last six years with multilevel advanced neuroforaminal stenosis as described above. There is severe left foraminal stenosis at right C6-C7. 4. Stable cystic lesion in the posterior fossa likely representing an arachnoid cyst given stability over time. 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.
Findings: There is congenital segmentation anomaly involving the C2-C3 vertebrae. Also partial anterior ankylosis of T1 and T2 due to also congenital. Trace anterolisthesis of C3 over C4 and trace anterolisthesis of C4-C5. Chronic wedging of the cervical vertebral bodies. There are multilevel disc the changes, most notably moderate disc height loss at There is no abnormal marrow signal. There is no abnormal cord signal. Degenerative disease of the cervical spine is described below. C2-3: No significant spinal canal or neuroforaminal stenosis. C3-C4: Disc osteophyte complex, uncovertebral and facet hypertrophy and ligamentum flavum hypertrophy result in moderate to severe spinal canal narrowing with indentation of the spinal cord and effacement of CSF along the ventral and posterior spinal cord. Images are motion degraded, however appears to be at least bilateral moderate neuroforaminal stenosis. C4-C5: Disc osteophyte complex and uncovertebral hypertrophy result in mild spinal canal and mild bilateral neuroforaminal narrowing. C4-5: Right greater than left uncovertebral facet hypertrophy results in moderate right and mild left neuroforaminal narrowing. No significant spinal canal narrowing. C5-6: Left greater than right uncovertebral facet hypertrophy results in worsening left greater than right moderate neuroforaminal stenosis. No significant spinal canal stenosis. C6-7: Combination of uncovertebral and facet hypertrophy results in severe right and moderate left neuroforaminal stenosis. No significant spinal canal stenosis. C7-T1: Combination of right greater than left uncovertebral facet hypertrophy results in moderate to severe right and moderate left neuroforaminal stenosis. No significant spinal canal stenosis. Posterior fossa cystic lesion is grossly unchanged in size measuring up to 4.5 x 2.9 cm (series 2, image seven) compared to 4.6 x 2.9 cm on prior. The remaining visualized portions of the skull base, brain stem, posterior fossa structures, and craniocervical junction appear normal. There is no prevertebral soft tissue swelling. The paraspinal muscles and visualized soft tissues are unremarkable.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Bibasilar atelectasis. Scattered hazy airspace opacities in the visualized lower lobes DISTAL ESOPHAGUS: Small hiatal hernia. HEART / VESSELS: Calcific coronary atherosclerosis. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Distended with small amount of layering sludge. No acute cholecystitis. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Mild bilateral renal atrophy with small bilateral renal sinus cyst and prominent renal vascular calcifications. Nonspecific perinephric stranding bilaterally. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Nondilated and normal in appearance. COLON / APPENDIX: Noninflamed colonic diverticula. The appendix is normal. PERITONEUM / MESENTERY: No free fluid or free air. RETROPERITONEUM: Normal. VESSELS: Aortoiliac atherosclerotic disease without aneurysm. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is surgically absent. BODY WALL: Small fat containing umbilical hernia. MUSCULOSKELETAL: No acute fracture or dislocation. Healed fixated left femoral fracture without hardware complication
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CT scan of the soft tissues of the neck with contrast. Outside scan dated 11/12/2021 for interpretation only Findings: There are bilateral homogeneous dense sharply marginated masses in the parotid glands measuring 2.7 x 2.7 cm the left and 1.6 x 2.3 cm on the right. The features are benign and consistent with the biopsy of the left parotid lesion showing Warthin's tumor. The nasopharynx is unremarkable and the oral cavity and tongue base appear normal. There are shotty cervical chain nodes but 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. -------------- Conclusion: Bilateral parotid gland tumors having similar appearance. Known Warthin's tumor on the left
Findings: There are bilateral homogeneous dense sharply marginated masses in the parotid glands measuring 2.7 x 2.7 cm the left and 1.6 x 2.3 cm on the right. The features are benign and consistent with the biopsy of the left parotid lesion showing Warthin's tumor. The nasopharynx is unremarkable and the oral cavity and tongue base appear normal. There are shotty cervical chain nodes but 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. --------------
FINDINGS: VERTEBRA: No acute fracture or vertebral body compression deformities. No suspicious osseous lesions. DISC SPACES AND FACET JOINTS: No acute injury. Moderate discogenic degenerative changes at L5-S1 with small broad-based disc bulge. Multilevel lumbar facet arthropathy most prominent in the lower lumbar spine. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Mild degenerative retrolisthesis of L5. Lumbar posterior vertebral alignment is otherwise normal.
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Interpretation of Outside Films MR LSPN 1/13/2022 12:54 PM Clinical Information: Concern for infertility Comparison: None available Technique: Axial and sagittal T1, axial and sagittal T2, and sagittal STIR sequences were acquired of the lumbar spine without the use of intravenous contrast. Findings: Trace retrolisthesis of L5 over S1 with slight straightening of usual lumbar lordotic curvature. The bone marrow is of normal signal intensity. The conus terminates approximately at L1 and is unremarkable. Mild Congenital narrowing of the lumbar spinal canal is noted from L2-L4. Degenerative changes of the lumbar spine are described on a level by level basis below: T12-L1: Unremarkable L1-L2: Mild facet arthropathy, otherwise unremarkable L2-L3: Mild facet arthropathy, mild narrowing of the lumbar spinal canal is present. L3-L4: Mild facet arthropathy, ligamentum flavum thickening. There is a central disc protrusion with mass effect over the ventral aspect of thecal sac. This is causing moderate narrowing of the lumbar spinal canal. L4-L5: Mild ligament flavum thickening, disc desiccation with trace bulge. This is causing mild lumbar spinal canal narrowing L5-S1: Mild disc bulging with a superimposed left paracentral shallow protrusion which abuts the left S1 root within the left lateral recess. No obvious compression over the thecal sac or neural foraminal narrowing. The visualized prevertebral and paravertebral soft tissues are unremarkable. Impression: Mild developmental spinal canal stenosis in mid lumbar spine which is accentuated by degenerative changes including: 1. Small central disc protrusion is present at L3-L4, in the setting of congenital narrowing of the lumbar spinal canal extending from L2-L4 this is causing moderate lumbar spinal canal narrowing. 2. A shallow left paracentral disc protrusion at L5-S1 which abuts the left S1 root. 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.
Findings: Trace retrolisthesis of L5 over S1 with slight straightening of usual lumbar lordotic curvature. The bone marrow is of normal signal intensity. The conus terminates approximately at L1 and is unremarkable. Mild Congenital narrowing of the lumbar spinal canal is noted from L2-L4. Degenerative changes of the lumbar spine are described on a level by level basis below: T12-L1: Unremarkable L1-L2: Mild facet arthropathy, otherwise unremarkable L2-L3: Mild facet arthropathy, mild narrowing of the lumbar spinal canal is present. L3-L4: Mild facet arthropathy, ligamentum flavum thickening. There is a central disc protrusion with mass effect over the ventral aspect of thecal sac. This is causing moderate narrowing of the lumbar spinal canal. L4-L5: Mild ligament flavum thickening, disc desiccation with trace bulge. This is causing mild lumbar spinal canal narrowing L5-S1: Mild disc bulging with a superimposed left paracentral shallow protrusion which abuts the left S1 root within the left lateral recess. No obvious compression over the thecal sac or neural foraminal narrowing. The visualized prevertebral and paravertebral soft tissues are unremarkable.
FINDINGS: BONES/JOINTS: Redemonstration of a left femoral intramedullary nail with a femoral neck fixation screw fixating intertrochanteric fracture.. Fracture is not well seen and may be radiographically healed. No evidence of hardware failure or loosening. The proximal intramedullary nail extends approximately 1.3 cm beyond the greater trochanter cortex into the adjacent soft tissues. The bilateral femoral heads are well-seated within the acetabula. The sacroiliac joints are symmetric without abnormal widening. No pubic symphysis diastasis. Multilevel discogenic degenerative changes of the lower lumbar spine with moderate degenerative disc disease at L5-S1 and mild retrolisthesis of L5 on S1. SOFT TISSUES: No large hematoma or fluid collection. Diffuse advanced atherosclerotic calcifications.
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Interpretation of Outside Films MR MSK Clinical information: 16 year-old volleyball player with left ankle pain following an injury in September. Persistent pain in the lateral ankle. Technique: Coronal T1, coronal PD, axial PD, axial oblique T2 fat sat, and sagittal STIR images were provided of the left ankle without contrast. Images were acquired at Carmichael Imaging Center on 12/15/2021 and imported into UAB PACS on 1/14/2022 for interpretation. Comparison: Bilateral ankle radiographs 1/5/22 Findings: 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. Nonosseous syndesmotic coalition of the talocalcaneal joint with subchondral cystic changes and mild edema of the sustentaculum and middle talar facet. No marrow contusion or fracture. No cartilage defect or osteochondral lesion. No joint effusion. The deltoid ligament is intact. There is mild thickening and increased signal of the anterior talofibular ligament, likely representing chronic sprain. Attenuation and increased signal of the fibular attachment of the calcaneofibular ligament, representing chronic sprain. Posterior talofibular ligament is intact. The anterior and posterior tibiofibular ligaments are intact. No abnormal edema within the syndesmosis. Flexor and extensor tendons are intact without tenosynovitis. The Lisfranc ligament is intact. Achilles tendon and plantar fascia are intact. There is soft tissue edema over the medial malleolus and lateral distal foreleg. No drainable fluid collection. Small ganglion cyst along the lateral flexor hallucis longus myotendinous junction. Conclusion: 1. Nonosseous talocalcaneal coalition with degenerative changes across the synchondrosis. 2. Chronic sprains of the anterior talofibular ligament and calcaneofibular ligament.
Findings: 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. Nonosseous syndesmotic coalition of the talocalcaneal joint with subchondral cystic changes and mild edema of the sustentaculum and middle talar facet. No marrow contusion or fracture. No cartilage defect or osteochondral lesion. No joint effusion. The deltoid ligament is intact. There is mild thickening and increased signal of the anterior talofibular ligament, likely representing chronic sprain. Attenuation and increased signal of the fibular attachment of the calcaneofibular ligament, representing chronic sprain. Posterior talofibular ligament is intact. The anterior and posterior tibiofibular ligaments are intact. No abnormal edema within the syndesmosis. Flexor and extensor tendons are intact without tenosynovitis. The Lisfranc ligament is intact. Achilles tendon and plantar fascia are intact. There is soft tissue edema over the medial malleolus and lateral distal foreleg. No drainable fluid collection. Small ganglion cyst along the lateral flexor hallucis longus myotendinous junction.
FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The trachea and central airways are patent. Scattered patchy regions of consolidation and groundglass with an apical predominance. Focal region of dense consolidation with air bronchograms in the superior aspect of the right lower lobe. Platelike atelectasis at the left base. Small right pleural effusion. On expiratory phase imaging, there is no significant air trapping. HEART / VESSELS: The heart is enlarged. The main pulmonary artery is dilated. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. LYMPH NODES: Prominent anterior mediastinal lymph nodes. CHEST WALL: Scattered body wall edema. UPPER ABDOMEN: Redemonstrated cirrhotic morphology of the transplant liver. MUSCULOSKELETAL: Mild multilevel discogenic degenerative change.
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EXAM: Interpretation of Outside Films CT MSK CLINICAL INFORMATION: Fracture. COMPARISON: Radiograph 1/13/2020. TECHNIQUE: Outside CT images without IV contrast dated 12/24/2021 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. STRUCTURED REPORT: CT Bone vDec2021 FINDINGS: BONES/JOINTS: Low-grade cartilaginous lesion within the proximal humeral metaphysis with associated mildly displaced and impacted comminuted fracture involving the surgical neck. Fracture extends to involve the bicipital groove and greater tuberosity, which is depressed posteriorly. The lesser tuberosity is intact. No extension of the fractures of the articular surface. Mild pre-existing degenerative changes of the glenohumeral joint. Although the posterior and anterior humeral cortex is disrupted at the level of the cartilaginous lesion, and cortical scalloping is not able to be assessed at this level, there is no discrete soft tissue component or overtly aggressive features of the lesion as visualized. SOFT TISSUES: There is soft tissue edema/hemorrhage surrounding the shoulder with small joint lipohemarthrosis. There is an intramuscular lipoma within the lateral deltoid. CONCLUSION: Comminuted fracture of the humeral neck and greater tuberosity at the level of a small cartilaginous lesion. Although the cortex is disrupted anteriorly and posteriorly by the fracture, there are no aggressive features associated with visualized portions of the lesion, and differential favors low-grade cartilaginous lesion. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: BONES/JOINTS: Low-grade cartilaginous lesion within the proximal humeral metaphysis with associated mildly displaced and impacted comminuted fracture involving the surgical neck. Fracture extends to involve the bicipital groove and greater tuberosity, which is depressed posteriorly. The lesser tuberosity is intact. No extension of the fractures of the articular surface. Mild pre-existing degenerative changes of the glenohumeral joint. Although the posterior and anterior humeral cortex is disrupted at the level of the cartilaginous lesion, and cortical scalloping is not able to be assessed at this level, there is no discrete soft tissue component or overtly aggressive features of the lesion as visualized. SOFT TISSUES: There is soft tissue edema/hemorrhage surrounding the shoulder with small joint lipohemarthrosis. There is an intramuscular lipoma within the lateral deltoid.
Findings: CT head without and with contrast: Chronic left occipitotemporal encephalomalacia. Age-appropriate cerebral volume with mild periventricular hypoattenuation suggestive of microangiopathy. No intracranial mass, mass effect, edema, hemorrhage, hydrocephalus or evidence of acute infarction is seen. No abnormal enhancement. The visualized paranasal sinuses and mastoid air cells are clear. No acute osseous or soft tissue abnormality. CTA head: Redemonstration of saccular inferiorly projecting aneurysm of the terminal right internal carotid artery measuring up to 5 x 4 mm on series 8 image 276. The left PCA is diminutive with moderate stenosis noted the P1/P2 junction, this vessel previously noted to be occluded in November 2021. Moderate atherosclerotic disease present at the carotid siphons without flow-limiting narrowing. There is mild narrowing at right P1/P2 junction. The remaining images of the intracranial arterial vasculature demonstrates no aneurysm, dissection, or malformation.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Digestive health COMPARISON: None. TECHNIQUE: Outside CT images with contrast and coronal and sagittal reformats dated 12/14/2021 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: Trace bibasilar subsegmental atelectasis. DISTAL ESOPHAGUS: Small type I hiatal hernia. HEART / VESSELS: Scattered coronary artery calcifications. Otherwise, no abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Atrophic. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: There is a large, nonobstructing stone within the right renal pelvis that measures 1.0 cm (series 2 image 68). Smaller nonobstructing stone within the left renal pelvis. Mild right-sided pelviectasis. No obstructing mass or stone. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Small colonic diverticula without surrounding inflammation. The appendix is not visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerosis involving the abdominal aorta and branching vessels. URINARY BLADDER: Mild urinary bladder wall thickening, likely due to underdistention. REPRODUCTIVE ORGANS: Borderline prostatomegaly with dystrophic prostatic calcifications. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute or aggressive osseous normality. Sclerotic focus within the right ilium, adjacent to the sacroiliac joint, likely bone island. Tiny other sclerotic foci within the pelvic bones, likely bone islands. Near complete ankylosis of the left sacroiliac joint. Mild degenerative changes involving the lumbar spine. CONCLUSION: 1. A 1.0 cm nonobstructing stone within the right renal pelvis. Smaller nonobstructing stone within left renal pelvis. No hydronephrosis. 2. Chronic/incidental findings as outlined above including small hiatal hernia and uncomplicated colonic diverticulosis 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.
FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Trace bibasilar subsegmental atelectasis. DISTAL ESOPHAGUS: Small type I hiatal hernia. HEART / VESSELS: Scattered coronary artery calcifications. Otherwise, no abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Atrophic. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: There is a large, nonobstructing stone within the right renal pelvis that measures 1.0 cm (series 2 image 68). Smaller nonobstructing stone within the left renal pelvis. Mild right-sided pelviectasis. No obstructing mass or stone. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Small colonic diverticula without surrounding inflammation. The appendix is not visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerosis involving the abdominal aorta and branching vessels. URINARY BLADDER: Mild urinary bladder wall thickening, likely due to underdistention. REPRODUCTIVE ORGANS: Borderline prostatomegaly with dystrophic prostatic calcifications. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute or aggressive osseous normality. Sclerotic focus within the right ilium, adjacent to the sacroiliac joint, likely bone island. Tiny other sclerotic foci within the pelvic bones, likely bone islands. Near complete ankylosis of the left sacroiliac joint. Mild degenerative changes involving the lumbar spine.
Findings: There has been interval evolution of postsurgical changes and bifrontal regions from prior tumor resection. There has been improvement in the previously seen multicompartment hemorrhage. There is however a persistent extra-axial collection underlying the craniotomy in the frontal region with an air-fluid level anteriorly. There is extensive bifrontal edema and anterior interhemispheric postsurgical clips. The remaining brain parenchyma demonstrates no acute hemorrhage, evidence of acute infarction, new edema or significant mass effect. There is mild increase in frontal horn size compared to the prior exam, likely due to decreased mass effect There is no hydrocephalus or midline shift. There is mild mucosal thickening in the right maxillary sinus. The remaining visualized paranasal sinuses and mastoid air cells are clear.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Pancreatic mass noted on recent abdominal CT. History of pancreatitis. COMPARISON: 12/7/2021 TECHNIQUE: Outside CT images with and without contrast with coronal and sagittal reformats 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 Pancreatic Mass FINDINGS: STUDY QUALITY: Satisfactory. LOWER CHEST: LUNG BASES / PLEURA: Trace right basilar subsegmental atelectasis. Otherwise, normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Scattered coronary artery calcifications. Otherwise, no abnormality. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. The dome of the liver is incompletely imaged on the arterial phase. However, no suspicious mass or lesion is visualized. PERITONEUM: No ascites. No peritoneal nodules. PANCREAS: Pancreatic head mass as described below. The remaining pancreas is unremarkable. Pancreatic mass: - Location: Head - Size: 2.0 x 1.5cm (series 5 image 31). - Composition: Solid - Enhancement relative to pancreas: Hypoenhancing - Margins: Well defined with lobulated margins. - Pancreatic duct: Not dilated - Pancreatic atrophy: No pancreatic atrophy. - Biliary ducts: Dilated. The common bile duct measures up to 1.2 cm. Lower insertion of the cystic duct near the pancreatic head. - Gallbladder: There is mild gallbladder distention. No wall thickening or pericholecystic inflammatory changes. VASCULATURE: - 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): No tumor contact. - IVC and Renal Veins: No tumor contact. - Vessel thrombosis: None. - Venous collaterals: None. - Other peripancreatic vessel comment: None. LYMPH NODES: Increase number of small peripancreatic lymph nodes. RETROPERITONEUM: No tumor invasion. MESENTERY: No tumor invasion. ADRENALS: Normal. KIDNEYS: Normal. SPLEEN: Normal. Small adjacent splenule. STOMACH: No abnormality. DUODENUM: No abnormality. SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. The appendix is not visualized. OTHER VESSELS: There is severe atherosclerosis involving the abdominal aorta and branching vessels with severe luminal narrowing just proximal to the iliac bifurcation, measuring 8 mm (series 5 image 36). Mild to moderate narrowing at the origins of the celiac axis and SMA. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute or aggressive osseous abnormality. Mild degenerative changes involving the visualized thoracolumbar spine. CONCLUSION: 1. Hypoenhancing pancreatic head mass most suggestive of pancreatic adenocarcinoma. No peripancreatic vascular invasion or metastatic disease. 2. Common bile duct dilation up to 1.2 cm and moderate gallbladder distention. 3. Other incidental findings Severe aortic atherosclerosis with severe luminal narrowing proximal to the iliac bifurcation, measuring 8 mm at its narrowest segment. 4. Other 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.
FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Pancreatic Mass FINDINGS: STUDY QUALITY: Satisfactory. LOWER CHEST: LUNG BASES / PLEURA: Trace right basilar subsegmental atelectasis. Otherwise, normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Scattered coronary artery calcifications. Otherwise, no abnormality. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. The dome of the liver is incompletely imaged on the arterial phase. However, no suspicious mass or lesion is visualized. PERITONEUM: No ascites. No peritoneal nodules. PANCREAS: Pancreatic head mass as described below. The remaining pancreas is unremarkable. Pancreatic mass: - Location: Head - Size: 2.0 x 1.5cm (series 5 image 31). - Composition: Solid - Enhancement relative to pancreas: Hypoenhancing - Margins: Well defined with lobulated margins. - Pancreatic duct: Not dilated - Pancreatic atrophy: No pancreatic atrophy. - Biliary ducts: Dilated. The common bile duct measures up to 1.2 cm. Lower insertion of the cystic duct near the pancreatic head. - Gallbladder: There is mild gallbladder distention. No wall thickening or pericholecystic inflammatory changes. VASCULATURE: - 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): No tumor contact. - IVC and Renal Veins: No tumor contact. - Vessel thrombosis: None. - Venous collaterals: None. - Other peripancreatic vessel comment: None. LYMPH NODES: Increase number of small peripancreatic lymph nodes. RETROPERITONEUM: No tumor invasion. MESENTERY: No tumor invasion. ADRENALS: Normal. KIDNEYS: Normal. SPLEEN: Normal. Small adjacent splenule. STOMACH: No abnormality. DUODENUM: No abnormality. SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. The appendix is not visualized. OTHER VESSELS: There is severe atherosclerosis involving the abdominal aorta and branching vessels with severe luminal narrowing just proximal to the iliac bifurcation, measuring 8 mm (series 5 image 36). Mild to moderate narrowing at the origins of the celiac axis and SMA. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute or aggressive osseous abnormality. Mild degenerative changes involving the visualized thoracolumbar spine.
Findings: There is no evidence of acute infarction, hemorrhage or hydrocephalus. There is no vasogenic edema or mass effect. There are minimal chronic microangiopathic changes. The visualized paranasal sinuses and mastoid air cells are clear of acute process. There is no acute osseous abnormality.
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EXAM: Outside MR Image Interpretation CLINICAL INFORMATION: Fibroids COMPARISON: None. TECHNIQUE: Outside MR images without and with IV contrast dated 11/19/2021 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 Pelvis LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Small cyst in the left hepatic lobe. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Small gastric hiatal hernia. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: UTERUS: Enlarged, extending approximately 8 to 9 cm above the level of the umbilicus - UTERINE SIZE: 23.5 x 9.5 x 13.5 cm - ENDOMETRIUM: Not grossly thickened, but distorted and partially obscured by large fibroids - JUNCTIONAL ZONE: Normal thickness (
FINDINGS: STRUCTURED REPORT: MRI Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Small cyst in the left hepatic lobe. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Small gastric hiatal hernia. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: UTERUS: Enlarged, extending approximately 8 to 9 cm above the level of the umbilicus - UTERINE SIZE: 23.5 x 9.5 x 13.5 cm - ENDOMETRIUM: Not grossly thickened, but distorted and partially obscured by large fibroids - JUNCTIONAL ZONE: Normal thickness (
Findings: There is right otomastoiditis with complete opacification of the right middle ear cavity and right mastoid cells. There is also extensive bone destruction involving the upper aspect left external ear canal with erosion of mastoid cells and possible extension into the right TMJ. There is a large destructive lesion involving the petrous apex, right petrous apex and posterior inferior clivus and right occipital bone, extending to the upper aspect of the right mandibular condyle. Tumor in the petrous apex and jugular fossa is suggested, possibly sarcoma. Osteomyelitis with destruction of the petrous apex is considered less likely. Metastatic tumor is not excluded. There is partial opacification of left mastoid cells and the left middle ear is completely opacified. Only a small amount of air is present in the epitympanum. The left EAC is unremarkable. --------------- Conclusion: Bilateral otomastoiditis, more severe on the right. Extensive bone destruction involving the right petrous apex, clivus and occipital bone and mastoid cells above the EAC. ----------------
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: 54-year-old female with bladder cancer COMPARISON: None available. TECHNIQUE: Outside CT images without and with IV contrast dated 11/23/2021 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 Urogram LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN AND PELVIS: KIDNEYS: There is a heterogeneously enhancing lesion within the central right renal pelvis measuring approximately 4.0 x 3.0 cm (series 6 image 60). This appears to arise from the collecting system and extend into the proximal ureter. Additional subcentimeter hypodensity within the right kidney is too small to characterize; however, statistically representing a cyst. The left kidney is unremarkable. UPPER URINARY TRACTS: - Calculi: No urothelial calculi. - Urothelium: There is thickening and enhancement of the right ureter proximally with enhancement in the visualized portion to the mid-ureter. URINARY BLADDER: No abnormal bladder wall thickening or enhancement. No bladder mass. LIVER: Scattered subcentimeter hypodensities throughout the liver are too small to characterize; however, statistically representing cysts. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal with splenule. ADRENALS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis without evidence of diverticulitis. The appendix is not well-visualized. PERITONEUM / MESENTERY: Trace pelvic fluid. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. REPRODUCTIVE ORGANS: The uterus is unremarkable. No adnexal masses. BODY WALL: Tiny umbilical fat protrusion. MUSCULOSKELETAL: Lucent area with patchy sclerosis extending along the posterior aspect of the left pelvis. CONCLUSION: 1. Heterogeneously enhancing right renal pelvis/proximal ureteral mass measuring up to 4.0 cm with thickening and enhancement extending along portions of the right ureter, concerning for urothelial carcinoma. 2. No evidence of metastatic disease within the abdomen or pelvis. 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.
FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Urogram LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN AND PELVIS: KIDNEYS: There is a heterogeneously enhancing lesion within the central right renal pelvis measuring approximately 4.0 x 3.0 cm (series 6 image 60). This appears to arise from the collecting system and extend into the proximal ureter. Additional subcentimeter hypodensity within the right kidney is too small to characterize; however, statistically representing a cyst. The left kidney is unremarkable. UPPER URINARY TRACTS: - Calculi: No urothelial calculi. - Urothelium: There is thickening and enhancement of the right ureter proximally with enhancement in the visualized portion to the mid-ureter. URINARY BLADDER: No abnormal bladder wall thickening or enhancement. No bladder mass. LIVER: Scattered subcentimeter hypodensities throughout the liver are too small to characterize; however, statistically representing cysts. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal with splenule. ADRENALS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis without evidence of diverticulitis. The appendix is not well-visualized. PERITONEUM / MESENTERY: Trace pelvic fluid. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. REPRODUCTIVE ORGANS: The uterus is unremarkable. No adnexal masses. BODY WALL: Tiny umbilical fat protrusion. MUSCULOSKELETAL: Lucent area with patchy sclerosis extending along the posterior aspect of the left pelvis.
Findings: There is right otomastoiditis with complete opacification of mastoid cells and right middle ear cavity. There is extensive destruction involving the right EAC with erosion of the mastoid bone above the EAC and possible extension into the right TMJ. There is also extensive bone destruction involving the right petrous apex extending into the clivus and occipital bone. There is extension into the carotid canal and jugular fossa. Extensive destruction suggest tumor, possibly sarcoma or metastatic tumor. There is partial opacification of left mastoid cells with the middle ear is completely opacified. The left EAC is unremarkable. ---------------
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Interpretation of Outside Films MR Head HISTORY: Evaluation for pituitary lesion TECHNIQUE: Multiplanar, multisequence MRI of the brain was performed without intravenous contrast. COMPARISON: MRI dated 11/8/2021 FINDINGS: INTRACRANIAL FINDINGS: The brain parenchyma appears normal without evidence for acute ischemia, hemorrhage, or mass lesion. The ventricles are normal in size. There is no abnormal extra-axial collection. The flow voids at the skull base are normal. The cerebellar tonsils are 12 mm below foramen of magnum most consistent with Chiari malformation type I. The pituitary gland appears prominent in size however this finding is likely physiologic given the patient's age and gender. EXTRACRANIAL FINDINGS: The orbital contents are unremarkable. The visualized paranasal sinuses and mastoid air cells are well aerated. IMPRESSION: Evidence of Chiari malformation type I. Otherwise no acute intracranial lesion. The pituitary gland appears prominent in size however this finding is likely physiologic given the patient's age and gender.
FINDINGS: INTRACRANIAL FINDINGS: The brain parenchyma appears normal without evidence for acute ischemia, hemorrhage, or mass lesion. The ventricles are normal in size. There is no abnormal extra-axial collection. The flow voids at the skull base are normal. The cerebellar tonsils are 12 mm below foramen of magnum most consistent with Chiari malformation type I. The pituitary gland appears prominent in size however this finding is likely physiologic given the patient's age and gender. EXTRACRANIAL FINDINGS: The orbital contents are unremarkable. The visualized paranasal sinuses and mastoid air cells are well aerated.
Findings: There is evidence of diffuse periventricular and deep white matter hypodensity likely due to microangiopathic changes. Again noted, multiple chronic infarcts located in bifrontal deep white matter, right insula and right thalamus, unchanged since prior study. Diffuse cerebral volume loss due to atrophic changes is is noted. Again noted is hyperdense extra-axial broad-based lesion adjacent to the left anterior temporal bone likely suggesting of a meningioma, unchanged. Hyperdensity is seen in the lateral aspect of the left orbit which is unchanged since prior study likely due to silicone injection. 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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EXAM: Outside MR Image Interpretation CLINICAL INFORMATION: Fibroids COMPARISON: None. TECHNIQUE: Outside MR images without and with IV contrast dated 11/19/2021 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 Pelvis LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Small cyst in the left hepatic lobe. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Small gastric hiatal hernia. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: UTERUS: Enlarged, extending approximately 8 to 9 cm above the level of the umbilicus - UTERINE SIZE: 23.5 x 9.5 x 13.5 cm - ENDOMETRIUM: Not grossly thickened, but distorted and partially obscured by large fibroids - JUNCTIONAL ZONE: Normal thickness (
FINDINGS: STRUCTURED REPORT: MRI Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Small cyst in the left hepatic lobe. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Small gastric hiatal hernia. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: UTERUS: Enlarged, extending approximately 8 to 9 cm above the level of the umbilicus - UTERINE SIZE: 23.5 x 9.5 x 13.5 cm - ENDOMETRIUM: Not grossly thickened, but distorted and partially obscured by large fibroids - JUNCTIONAL ZONE: Normal thickness (
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: 88-year-old female with breast cancer. Comparison: Outside PET/CT images dated 12/10/2021. Technique: CT chest, abdomen and pelvis with contrast was obtained on 12/1/2021 at Carmichael imaging Center. 1.25 mm axial, 2.5 mm axial, 3 mm coronal and sagittal reformats are available at the time of interpretation. Findings: STRUCTURED REPORT: CT Chest LOWER NECK: Heterogeneous thyroid with nodular left thyroid lobe. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. Mild lower lobe bronchiectasis. Partial atelectasis in the medial segment of the right middle lobe. No suspicious pulmonary nodule. No pleural effusion. HEART / VESSELS: Myocardial thinning with remote large infarct in the LAD territory with apical ballooning/chronic left ventricular apical aneurysm. Borderline dilated pulmonary artery. No central PE. Three-vessel coronary artery calcifications. Right ventricular defibrillator is positioned appropriately. MEDIASTINUM / ESOPHAGUS: Trace hiatal hernia. LYMPH NODES: Low-attenuation rounded density near the pulmonary veins on the right, has attenuation similar to the aortic pericardial recess likely represents a prominent pericardial sinus and less likely a true lymph node. CHEST WALL: Left chest wall battery pack. No enhancing mass in the breast. Biopsy clip in the right breast. UPPER ABDOMEN: Reported separately. MUSCULOSKELETAL: No destructive osseous lesion. Conclusion: 1. No evidence of intrathoracic metastasis. 2. Chronic large infarct in the LAD territory extending through the septum, lateral wall, left ventricular apex with left ventricular apical aneurysm, related to old LAD infarct. 3. Other incidental findings as above.
Findings: STRUCTURED REPORT: CT Chest LOWER NECK: Heterogeneous thyroid with nodular left thyroid lobe. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. Mild lower lobe bronchiectasis. Partial atelectasis in the medial segment of the right middle lobe. No suspicious pulmonary nodule. No pleural effusion. HEART / VESSELS: Myocardial thinning with remote large infarct in the LAD territory with apical ballooning/chronic left ventricular apical aneurysm. Borderline dilated pulmonary artery. No central PE. Three-vessel coronary artery calcifications. Right ventricular defibrillator is positioned appropriately. MEDIASTINUM / ESOPHAGUS: Trace hiatal hernia. LYMPH NODES: Low-attenuation rounded density near the pulmonary veins on the right, has attenuation similar to the aortic pericardial recess likely represents a prominent pericardial sinus and less likely a true lymph node. CHEST WALL: Left chest wall battery pack. No enhancing mass in the breast. Biopsy clip in the right breast. UPPER ABDOMEN: Reported separately. MUSCULOSKELETAL: No destructive osseous lesion.
Findings: There is slight diffuse atrophy and there is commensurate slight prominence of ventricles but no hydrocephalus per se. There is no mass, hemorrhage, visible infarct or extracerebral collection. There is preservation of gray-white margins. No significant hypodensity is seen in the white matter. The posterior fossa contents are unremarkable. No defect is seen in the calvarium or skull base. There is been exenteration of the nasal passages and marsupialization of the sinuses and nasal passages. There is a wall up right mastoidectomy and air fills the mastoidectomy bowl, continuous with the middle ear cavity. ---------------
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Newly diagnosed right breast cancer. COMPARISON: None. TECHNIQUE: Outside CT images with contrast dated 12/1/2021 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: Small, well-circumscribed hypoenhancing lesions adjacent to falciform ligament, the hepatic segment of the IVC, and near the hepatic dome, too small to accurately characterize but likely hepatic cysts. Otherwise, no abnormality. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: A 1.3 x 0.8 cm cyst in the pancreatic head (series 2/119. There is a hypoenhancing lesion within the tail of pancreas measures 1.0 x 0.9 cm (series 2 image 110). Its density measures near simple fluid. The main pancreatic duct is normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Postsurgical changes from prior left total nephrectomy. Several right-sided simple renal cysts. Prominent right-sided pelviectasis. No obstructing mass or stone. Calcified right renal artery aneurysm measuring 1.2 cm in the renal hilum (series 2/114). Additional probable small calcified aneurysm is seen. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Sigmoid diverticulosis. No surrounding inflammation. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild aortoiliac atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Fundal uterine fibroid. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: No acute or aggressive osseous abnormality. There is ankylosis of the left SI joint. Mild to moderate degenerative changes involving the bilateral hip joints, right sacroiliac joint, and lumbar spine. CONCLUSION: 1. No metastatic disease within the abdomen/pelvis. 2. Small hypoattenuating pancreatic head and tail lesions probably side branch IPMN. Recommend close attention on follow-up exam. 3. Other chronic/incidental findings as outlined above. Please see separately reported chest CT. 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.
FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately reported chest CT. ABDOMEN and PELVIS: LIVER: Small, well-circumscribed hypoenhancing lesions adjacent to falciform ligament, the hepatic segment of the IVC, and near the hepatic dome, too small to accurately characterize but likely hepatic cysts. Otherwise, no abnormality. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: A 1.3 x 0.8 cm cyst in the pancreatic head (series 2/119. There is a hypoenhancing lesion within the tail of pancreas measures 1.0 x 0.9 cm (series 2 image 110). Its density measures near simple fluid. The main pancreatic duct is normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Postsurgical changes from prior left total nephrectomy. Several right-sided simple renal cysts. Prominent right-sided pelviectasis. No obstructing mass or stone. Calcified right renal artery aneurysm measuring 1.2 cm in the renal hilum (series 2/114). Additional probable small calcified aneurysm is seen. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Sigmoid diverticulosis. No surrounding inflammation. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild aortoiliac atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Fundal uterine fibroid. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: No acute or aggressive osseous abnormality. There is ankylosis of the left SI joint. Mild to moderate degenerative changes involving the bilateral hip joints, right sacroiliac joint, and lumbar spine.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Stable trace right pleural effusion. Persistent multifocal groundglass opacities and dependent bibasilar atelectasis. DISTAL ESOPHAGUS: Esophagogastric tube in place. HEART / VESSELS: Partially visualized central venous catheter terminates at the superior cavoatrial junction. Stable pulmonary artery dilation. ABDOMEN and PELVIS: LIVER: Stable subcentimeter simple hepatic cysts. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Innumerable bilateral simple renal cysts. Scattered bilateral well-circumscribed hyperattenuating lesions likely represent hemorrhagic cysts. No renal calculi or hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube tip terminates in the gastric antrum. Multiple mildly dilated small bowel loops with air-fluid levels are again seen. No definite transition point. COLON / APPENDIX: Mildly dilated colon with air-fluid levels. Rectal tube with inflated balloon in place. PERITONEUM / MESENTERY: No free intraperitoneal air. Redemonstration of small volume perihepatic ascites tracking along the mesentery and paracolic gutter. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Decompressed bladder with Foley catheter. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing periumbilical hernia. Bilateral flank soft tissue stranding. MUSCULOSKELETAL: Mild multilevel spinal degenerative changes. No acute osseous lesion.
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Interpretation of Outside Films CT Chest Clinical Information: Spec Inst: CT A CHEST 121321 REC 011422 BROOKWOOD HOSPITAL Comparison: None. Findings: Please note the outside report is not available. STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Positive for pulmonary embolus. - Pulmonary Embolus Distribution: Right middle lobe segmental branches with nonocclusive appearance - Pulmonary Artery Diameter: Normal. - Ascending Aortic Diameter: Normal. - RV:LV Ratio: Normal. - Interventricular Septum: Normal. - Contrast reflux into IVC: No significant abnormality. LUNGS / AIRWAYS / PLEURA: Small bilateral pleural effusions and dependent atelectatic changes. Minimal paraseptal emphysema changes at the right upper lobe. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Postsurgical changes at the left renal fossa are partially visualized and the left kidney is not identified to advantage. MUSCULOSKELETAL: Right middle lobe nonobstructive pulmonary emboli. Bilateral small pleural effusions and atelectasis.
Findings: Please note the outside report is not available. STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Positive for pulmonary embolus. - Pulmonary Embolus Distribution: Right middle lobe segmental branches with nonocclusive appearance - Pulmonary Artery Diameter: Normal. - Ascending Aortic Diameter: Normal. - RV:LV Ratio: Normal. - Interventricular Septum: Normal. - Contrast reflux into IVC: No significant abnormality. LUNGS / AIRWAYS / PLEURA: Small bilateral pleural effusions and dependent atelectatic changes. Minimal paraseptal emphysema changes at the right upper lobe. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Postsurgical changes at the left renal fossa are partially visualized and the left kidney is not identified to advantage. MUSCULOSKELETAL: Right middle lobe nonobstructive pulmonary emboli. Bilateral small pleural effusions and atelectasis.
FINDINGS: STRUCTURED REPORT: CTA Abdomen Pelvis VASCULATURE: DISTAL DESCENDING THORACIC AORTA: No significant abnormality. ABDOMINAL AORTA: No significant abnormality. CELIAC AXIS: No significant abnormality. SMA: No significant abnormality. RIGHT RENAL: No significant abnormality. LEFT RENAL: No significant abnormality. IMA: No significant abnormality. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. ------------------------------------------------------------- LOWER CHEST: LUNG BASES / PLEURA: Scattered linear subsegmental atelectasis. Tiny calcified right lung base granuloma. No focal lung consolidation or pleural effusion or pneumothorax. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Subcentimeter hypoattenuating foci in the liver, too small to characterize probably represent simple cysts are stable in size compared to prior CT from 2020 BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Kidneys demonstrate symmetric enhancement. Stable subcentimeter bilateral renal cortical hypoattenuating lesions, likely simple cysts. Stable two tiny right lower pole renal calculi. No hydronephrosis or hydroureter. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach and duodenum partially distended. Small hiatal hernia. There is no abnormal dilatation small bowel loops. COLON / APPENDIX: Large bowel loops are not distended. No abnormal large bowel wall thickening or enhancement. No pericolonic stranding or collection. PERITONEUM / MESENTERY: No intraperitoneal fluid collection. No pneumoperitoneum. RETROPERITONEUM: Normal. OTHER VESSELS: Venous structures are not opacified. URINARY BLADDER: Partially distended urinary bladder. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: No acute osseous findings. Lumbar vertebrae demonstrate normal height.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: 44-year-old female with a history of a history of pelvic mass. COMPARISON: Pelvic ultrasound 1/12/2022 TECHNIQUE: Outside CT images with IV contrast dated 12/14/2021 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: Subcentimeter hypoattenuating lesion near the hepatic dome is likely a cyst, but technically indeterminate. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No free intraperitoneal air. Trace free pelvic fluid, likely physiologic in a patient of this age.. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Collapsed, limiting evaluation. REPRODUCTIVE ORGANS: Solid mass in the pelvis which appears contiguous with the uterine fundus measuring approximately 7.9 x 6.6 x 7.2 cm (series 2 image 65 and series 602 image 83). The bilateral ovaries appear unremarkable. IUD is seen in appropriate positioning within the endometrial cavity. BODY WALL: Rectus diastases. Otherwise unremarkable. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Solid mass pelvic mass which appears contiguous with the uterus (likely a large uterine fundal fibroid). Given indeterminate appearance on recent pelvic ultrasound, this could be confirmed with contrast-enhanced pelvic MRI 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.
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: Subcentimeter hypoattenuating lesion near the hepatic dome is likely a cyst, but technically indeterminate. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No free intraperitoneal air. Trace free pelvic fluid, likely physiologic in a patient of this age.. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Collapsed, limiting evaluation. REPRODUCTIVE ORGANS: Solid mass in the pelvis which appears contiguous with the uterine fundus measuring approximately 7.9 x 6.6 x 7.2 cm (series 2 image 65 and series 602 image 83). The bilateral ovaries appear unremarkable. IUD is seen in appropriate positioning within the endometrial cavity. BODY WALL: Rectus diastases. Otherwise unremarkable. MUSCULOSKELETAL: No significant abnormality.
FINDINGS: LOWER CHEST: Please see separately dictated CT chest. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. 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: Noninflamed colonic diverticula. Appendix is not confidently seen. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus and ovaries are absent. BODY WALL: Rectus muscle diastasis. MUSCULOSKELETAL: Unchanged L4 vertebral body metastasis. No new osseous metastases. Similar multilevel degenerative changes of the spine most pronounced in the lower lumbar spine.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: 60-year-old male with a history of pancreatic cancer. COMPARISON: Outside CT abdomen pelvis with contrast 9/19/2021. TECHNIQUE: Outside CT images with IV contrast dated 12/17/2021 were submitted for interpretation. FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Pancreatic Mass FINDINGS: STUDY QUALITY: Satisfactory. ABDOMEN and PELVIS: LIVER: No liver metastases. PERITONEUM: No ascites. Suspected small peritoneal nodule along the anterior abdominal wall (series 3, image 98), new since prior exam. Additional small new nodule along the anterior peritoneum on series 3, image 75. PANCREAS: Pancreatic mass: - Location: Body - Size: 5.2 x 4.2 cm (series 2 image 53) - Composition: Solid - Enhancement relative to pancreas: Hypoenhancing - Margins: Ill-defined with irregular margins. - Pancreatic duct: Mild upstream pancreatic ductal dilatation. - Pancreatic atrophy: Severe upstream pancreatic atrophy. - Biliary ducts: Not dilated - Gallbladder: Collapsed. VASCULATURE: - Arterial anatomy: Conventional. - Celiac Axis (CA): Tumor contact with vessel deformity and/or involvement >=180 degrees - Common Hepatic Artery (CHA): Tumor contact with extension to proper hepatic artery or celiac axis and/or involvement >=180 degrees. - Superior Mesenteric Artery (SMA): Tumor contact =180 degrees of the superior mesenteric vein NOT exceeding the inferior border of the duodenum. There is moderate compression of the SMV and portal splenic confluence. [BORDERLINE RESECTABLE - PORTAL VENOUS] - IVC and Renal Veins: No tumor contact. - Vessel thrombosis: None. - Venous collaterals: The splenic vein is occluded with prominent perisplenic and upper abdominal collaterals. - Other peripancreatic vessel comment: None. LYMPH NODES: Mildly enlarged peripancreatic lymph node measuring 1.4 x 1.1 cm (series 2 image 48). Several mildly prominent peripancreatic lymph nodes are seen slightly more inferiorly (for example series 3 images 57, 70, 76, 85). RETROPERITONEUM: No tumor invasion. Nodularity in the right paracolic gutter (series 3, image 85). MESENTERY: Tumor invades the mesentery. ADRENALS: Normal. KIDNEYS: Bilateral extrarenal pelvises. Otherwise unremarkable. SPLEEN: Normal. STOMACH: Distended with oral contrast. Stomach and small bowel are otherwise unremarkable. DUODENUM: No abnormality. SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. OTHER VESSELS: Moderate atherosclerotic calcifications of the infrarenal abdominal aorta and iliac vessels without distention.. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous lesion or acute fracture. CONCLUSION: Locally advanced pancreatic adenocarcinoma, as above, with suspected peritoneal carcinomatosis. 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.
FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Pancreatic Mass FINDINGS: STUDY QUALITY: Satisfactory. ABDOMEN and PELVIS: LIVER: No liver metastases. PERITONEUM: No ascites. Suspected small peritoneal nodule along the anterior abdominal wall (series 3, image 98), new since prior exam. Additional small new nodule along the anterior peritoneum on series 3, image 75. PANCREAS: Pancreatic mass: - Location: Body - Size: 5.2 x 4.2 cm (series 2 image 53) - Composition: Solid - Enhancement relative to pancreas: Hypoenhancing - Margins: Ill-defined with irregular margins. - Pancreatic duct: Mild upstream pancreatic ductal dilatation. - Pancreatic atrophy: Severe upstream pancreatic atrophy. - Biliary ducts: Not dilated - Gallbladder: Collapsed. VASCULATURE: - Arterial anatomy: Conventional. - Celiac Axis (CA): Tumor contact with vessel deformity and/or involvement >=180 degrees - Common Hepatic Artery (CHA): Tumor contact with extension to proper hepatic artery or celiac axis and/or involvement >=180 degrees. - Superior Mesenteric Artery (SMA): Tumor contact =180 degrees of the superior mesenteric vein NOT exceeding the inferior border of the duodenum. There is moderate compression of the SMV and portal splenic confluence. [BORDERLINE RESECTABLE - PORTAL VENOUS] - IVC and Renal Veins: No tumor contact. - Vessel thrombosis: None. - Venous collaterals: The splenic vein is occluded with prominent perisplenic and upper abdominal collaterals. - Other peripancreatic vessel comment: None. LYMPH NODES: Mildly enlarged peripancreatic lymph node measuring 1.4 x 1.1 cm (series 2 image 48). Several mildly prominent peripancreatic lymph nodes are seen slightly more inferiorly (for example series 3 images 57, 70, 76, 85). RETROPERITONEUM: No tumor invasion. Nodularity in the right paracolic gutter (series 3, image 85). MESENTERY: Tumor invades the mesentery. ADRENALS: Normal. KIDNEYS: Bilateral extrarenal pelvises. Otherwise unremarkable. SPLEEN: Normal. STOMACH: Distended with oral contrast. Stomach and small bowel are otherwise unremarkable. DUODENUM: No abnormality. SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. OTHER VESSELS: Moderate atherosclerotic calcifications of the infrarenal abdominal aorta and iliac vessels without distention.. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous lesion or acute fracture.
FINDINGS: Limitations: The study is limited by multiple beam hardening/streak artifacts from the ICD lead within the upper chest and mediastinum. Scouts: No additional findings. Lower neck and Mediastinum: The left subclavian approach ICD is in stable position. Mildly prominent thyroid gland appear similar to prior. Diffuse mildly patulous esophagus, predominantly the inferior segment, is also similar, without associated new focal esophageal wall abnormalities. Lymph nodes: No new pathologically enlarged supraclavicular, mediastinal, axillary or hilar lymph nodes. Heart and great arteries: Cardiac chambers are mildly dilated, similar to prior. No pericardial effusion. Mediastinal great arteries are normal in caliber. Airways: The trachea and central bronchi are patent and clear. Lungs : Tiny biapical pulmonary nodules are unchanged. The lungs are otherwise clear without evidence of new focal pulmonary opacities or suspicious pulmonary nodules or masses. Pleura: No pleural effusion or pneumothorax. Upper abdomen: The CT of the abdomen and pelvis will be reported separately. Bones and soft tissues: Chest wall soft tissues are unremarkable. Mild degenerative bony changes are again noted. No aggressive or destructive intrathoracic osseous lesions.
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EXAM: Outside MR Image Interpretation CLINICAL INFORMATION: Left humerus lesions COMPARISON: Outside nuclear medicine bone scan 10/8/2021, CT left humerus 10/7/2021, MR left shoulder 9/27/2021 TECHNIQUE: Outside MR images of the left humerus without and with 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: Please note that the provided outside MRI images appear to be of the left humerus although images on multiple sequences are labeled right humerus. Multiple round well-circumscribed intraosseous lesions are identified throughout the left humeral diaphysis measuring up to 1 cm in diameter. These lesions demonstrate hyperintense signal on fluid sensitive sequences and are isointense to muscle on T1-weighted images. On postcontrast images, there is equivocal enhancement of several lesions, particularly the inferior most lesion. These appear unchanged when compared to the prior MRI dated 9/27/2021. No evidence of endosteal scalloping, cortical destruction, periosteal reaction or extraosseous soft tissue components. There is no fracture or abnormal marrow enhancement. Moderate AC joint and glenohumeral joint osteoarthritis. Moderate volume fluid in the subacromial/subdeltoid bursa noted compatible with bursitis. No left axillary adenopathy is identified. Left subpectoral breast implant is noted. CONCLUSION: Multiple intraosseous lesions within the left humeral diaphysis as described above without aggressive features. These appear stable compared to the previous MR shoulder with no suspicious features seen on the outside CT and no appreciable uptake on nuclear medicine bone scan, favoring these to be of benign etiology. There is however equivocal faint enhancement of several of the lesions. Differential includes fibro-osseous lesions or multiple cystic lesions containing proteinaceous material. However, metastases cannot be excluded. Repeat examination with gadolinium with fat suppressed sequences may be helpful for further evaluation. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: Please note that the provided outside MRI images appear to be of the left humerus although images on multiple sequences are labeled right humerus. Multiple round well-circumscribed intraosseous lesions are identified throughout the left humeral diaphysis measuring up to 1 cm in diameter. These lesions demonstrate hyperintense signal on fluid sensitive sequences and are isointense to muscle on T1-weighted images. On postcontrast images, there is equivocal enhancement of several lesions, particularly the inferior most lesion. These appear unchanged when compared to the prior MRI dated 9/27/2021. No evidence of endosteal scalloping, cortical destruction, periosteal reaction or extraosseous soft tissue components. There is no fracture or abnormal marrow enhancement. Moderate AC joint and glenohumeral joint osteoarthritis. Moderate volume fluid in the subacromial/subdeltoid bursa noted compatible with bursitis. No left axillary adenopathy is identified. Left subpectoral breast implant is noted.
FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Trace mucoid secretions in the upper trachea and left mainstem bronchus. Otherwise patent central airways with mild bibasilar bronchiectasis. Moderate bilateral peripheral subpleural reticulations and scattered groundglass opacities involving lung apices and bases. Moderate paraseptal emphysema. Mild right upper and lower lobe air trapping, likely physiologic. No suspicious pulmonary nodule. Unchanged small right pleural effusion with pleural thickening and calcifications. No pleural effusion or calcifications on the left. No pneumothorax. HEART / VESSELS: Cardiomegaly without pericardial effusion. Left apical aneurysm with associated myocardial calcifications, likely secondary to prior infarct. Ascending thoracic aortic aneurysm is not well assessed measures up to 4.7 cm, similar to the prior examination where it measured 4.6 cm. Post CABG changes. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Prominent right lower paratracheal node measuring 1.1 cm in short axis, series 4 image 69. CHEST WALL: Healed median sternotomy. UPPER ABDOMEN: Cholelithiasis. MUSCULOSKELETAL: No aggressive osseous lesion.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: 69-year-old male with a history of melanoma. Evaluation for staging COMPARISON: Outside FDG PET/CT of 1/3/2022. TECHNIQUE: Outside CT images with IV contrast dated 12/16/2021 were submitted for interpretation. FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Small sliding 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: The left kidney is surgically absent. There is a small hypoattenuating nodule at the left nephrectomy bed adjacent to the remnant left renal vein measuring approximately 1.3 x 1.1 cm) series 2 image 43). A second nodule seen more inferiorly with similar appearance (series 2 image 56). Punctate nonobstructive calculus of the right kidney measuring 5 mm. Right kidney is otherwise unremarkable. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No free intraperitoneal fluid or air. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Postsurgical changes of left inguinal hernia repair and midline incision. MUSCULOSKELETAL: No acute fracture or aggressive osseous lesion. There is a chronic compression fracture of the T12 vertebral body. Bony ankylosis of the inferior thoracic spine posterior elements, suggestive of prior fixation hardware. Severe right and moderate left degenerative changes of hip joints CONCLUSION: 1. No evidence of metastatic disease in the abdomen or pelvis. 2. Small bilateral hypoattenuating nodules along the left nephrectomy bed. These does not have FDG activity on recent outside PET/CT of 1/3/2022, favoring postsurgical changes. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Small sliding 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: The left kidney is surgically absent. There is a small hypoattenuating nodule at the left nephrectomy bed adjacent to the remnant left renal vein measuring approximately 1.3 x 1.1 cm) series 2 image 43). A second nodule seen more inferiorly with similar appearance (series 2 image 56). Punctate nonobstructive calculus of the right kidney measuring 5 mm. Right kidney is otherwise unremarkable. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No free intraperitoneal fluid or air. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Postsurgical changes of left inguinal hernia repair and midline incision. MUSCULOSKELETAL: No acute fracture or aggressive osseous lesion. There is a chronic compression fracture of the T12 vertebral body. Bony ankylosis of the inferior thoracic spine posterior elements, suggestive of prior fixation hardware. Severe right and moderate left degenerative changes of hip joints
Findings: CT head: BRAIN PARENCHYMA: No acute intracranial hemorrhage, mass, large territory infarct, or edema. Small chronic lacunar infarct within the inguinal sheath right caudate. Subcortical and periventricular hypodensities that likely represent chronic microangiopathic changes. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No acute fracture. No aggressive osseous lesion. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Mild mucosal thickening of bilateral maxillary sinuses with frothy secretions in the right. Mild mucosal thickening also seen in the left ethmoid air cells. The remaining visualized paranasal sinuses and mastoid air cells are clear.
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EXAM: Outside MR Image Interpretation CLINICAL INFORMATION: 51-year-old male with elevated PSA. Most recent PSA of 11.0 on 10/29/2021. History of negative prior biopsy x1. COMPARISON: None. TECHNIQUE: Outside MR images without and with IV contrast dated 11/19/2021 were submitted for interpretation. FINDINGS: STRUCTURED REPORT: MRI Prostate Prostate: Measurement: 4.5 x 3.4 x 4.5 cm; estimated volume: 34 cc; PSA density: 0.32 Focal lesion(s): Lesion # 1 (index lesion): - Key image: series 9; image 14; - Size: 15 x 11 mm; - Location: left; mid; anterior central gland; - T2WI: 5; DWI: 5; DCE (early and focal enhancement): positive; - PI-RADS v2.1 score: 5 - Very high (clinically significant cancer is highly likely to be present); - Likelihood of extraprostatic extension: 1 - Highly unlikely; - Likelihood of seminal vesicle invasion: 1 - Highly unlikely; Diffuse abnormalities: Diffusely striated appearance of the peripheral zone on T2WI may reflect prostatitis. Bladder: Within normal limits. 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: 1. PI-RADS 5 lesion in the left mid anterior central gland, measuring up to 15 mm and directly abutting the prostatic urethra. No evidence of extraprostatic extension, seminal vesical invasion, or pelvic metastatic disease. 2. Diffuse T2 hyperintensity within the peripheral zone of the prostate, may reflect sequela of prior prostatitis.
FINDINGS: STRUCTURED REPORT: MRI Prostate Prostate: Measurement: 4.5 x 3.4 x 4.5 cm; estimated volume: 34 cc; PSA density: 0.32 Focal lesion(s): Lesion # 1 (index lesion): - Key image: series 9; image 14; - Size: 15 x 11 mm; - Location: left; mid; anterior central gland; - T2WI: 5; DWI: 5; DCE (early and focal enhancement): positive; - PI-RADS v2.1 score: 5 - Very high (clinically significant cancer is highly likely to be present); - Likelihood of extraprostatic extension: 1 - Highly unlikely; - Likelihood of seminal vesicle invasion: 1 - Highly unlikely; Diffuse abnormalities: Diffusely striated appearance of the peripheral zone on T2WI may reflect prostatitis. Bladder: Within normal limits. 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
FINDINGS: There is a tiny subdural hemorrhage in posterior portion of the falx cerebri without mass effect and new since prior CT. Also there is a tiny subdural hemorrhage in anterior aspect of the right middle cranial fossa. There is mild diffuse cerebral volume loss. White matter hypodensity suggestive for microvascular angiopathy. The brain parenchyma appears normal without evidence for acute territorial infarct, mass lesion, mass effect, or recent hemorrhage. The ventricles are normal in size. The calvarium is intact. The visualized paranasal sinuses and mastoid air cells are well aerated. The orbits are normal.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: 81-year-old male with a history of renal mass COMPARISON: FDG PET/CT of 2/11/2021 TECHNIQUE: Outside CT images without and with IV contrast dated 12/29/2021 were submitted for interpretation. FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Renal Mass LOWER CHEST: LUNG BASES / PLEURA: Calcified granuloma the lateral segment middle lobe. Lung bases otherwise clear. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Partially imaged LAD calcifications. ABDOMEN: KIDNEYS: RENAL MASS #1 BRIEF DESCRIPTION: Avidly arterially hyperenhancing solid mass of the posterior right lower pole. LOCATION: Right kidney. SIZE IN 3 ORTHOGONAL DIMENSIONS (cm): 1.8 x 1.7 x 2.0 (series 4 image 64 and series 9 image 64). COMPOSITION: Solid and homogeneous. BOSNIAK CLASSIFICATION: Not applicable. MARGINS: Well-defined PRESENCE OF MACROSCOPIC FAT: No. ENHANCEMENT: - Nonenhanced phase attenuation: 17 HU - Corticomedullary phase attenuation: 106 HU - Nephrographic phase attenuation: 56 HU NEPHROMETRY SCORE: - Radius: 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: Simple cyst of the posterior left left lower pole. Bilateral renal hypodensities are too small to adequately characterize, but statistically represent simple cysts. 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: Small 7 mm focus hyperenhancement of the right hepatic dome, with initial enhancement on arterial phase with filling in on venous phase (series 4 image 14 and 7 image 48, respectively). Ill-defined enhancement of the mid right hepatic lobe, with preserved arterial phase imaging which resolves on portal venous and delayed phase imaging, likely perfusional (series 4 image 36). BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Sigmoid diverticulosis without surrounding inflammation. Colon is otherwise. Appendix is normal. PERITONEUM / MESENTERY: No free intraperitoneal air or fluid. RETROPERITONEUM: Normal. OTHER VESSELS: Advanced atherosclerotic calcifications of the infrarenal abdominal aorta and iliac vasculature without aneurysmal dilatation. URINARY BLADDER: Circumferential bladder wall thickening. REPRODUCTIVE ORGANS: Prostatomegaly. Partially imaged bilateral hydroceles. BODY WALL: Right fat-containing right inguinal hernia. Postoperative changes from repair of left inguinal hernia. MUSCULOSKELETAL: No evidence of aggressive osseous lesion or acute fracture. Chronic bilateral L3 pars defects without spondylolisthesis. Chronic bilateral L5 pars defects with grade 1 spondylolisthesis. Chronic appearing right L5 pedicle fracture (for example sagittal series 8 image 54). CONCLUSION: Hyperenhancing solid renal mass of the posterior right lower pole, concerning for RCC. No convincing evidence of abdominopelvic metastatic disease. Flash filling hemangioma of the right hepatic dome. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Renal Mass LOWER CHEST: LUNG BASES / PLEURA: Calcified granuloma the lateral segment middle lobe. Lung bases otherwise clear. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Partially imaged LAD calcifications. ABDOMEN: KIDNEYS: RENAL MASS #1 BRIEF DESCRIPTION: Avidly arterially hyperenhancing solid mass of the posterior right lower pole. LOCATION: Right kidney. SIZE IN 3 ORTHOGONAL DIMENSIONS (cm): 1.8 x 1.7 x 2.0 (series 4 image 64 and series 9 image 64). COMPOSITION: Solid and homogeneous. BOSNIAK CLASSIFICATION: Not applicable. MARGINS: Well-defined PRESENCE OF MACROSCOPIC FAT: No. ENHANCEMENT: - Nonenhanced phase attenuation: 17 HU - Corticomedullary phase attenuation: 106 HU - Nephrographic phase attenuation: 56 HU NEPHROMETRY SCORE: - Radius: 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: Simple cyst of the posterior left left lower pole. Bilateral renal hypodensities are too small to adequately characterize, but statistically represent simple cysts. 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: Small 7 mm focus hyperenhancement of the right hepatic dome, with initial enhancement on arterial phase with filling in on venous phase (series 4 image 14 and 7 image 48, respectively). Ill-defined enhancement of the mid right hepatic lobe, with preserved arterial phase imaging which resolves on portal venous and delayed phase imaging, likely perfusional (series 4 image 36). BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Sigmoid diverticulosis without surrounding inflammation. Colon is otherwise. Appendix is normal. PERITONEUM / MESENTERY: No free intraperitoneal air or fluid. RETROPERITONEUM: Normal. OTHER VESSELS: Advanced atherosclerotic calcifications of the infrarenal abdominal aorta and iliac vasculature without aneurysmal dilatation. URINARY BLADDER: Circumferential bladder wall thickening. REPRODUCTIVE ORGANS: Prostatomegaly. Partially imaged bilateral hydroceles. BODY WALL: Right fat-containing right inguinal hernia. Postoperative changes from repair of left inguinal hernia. MUSCULOSKELETAL: No evidence of aggressive osseous lesion or acute fracture. Chronic bilateral L3 pars defects without spondylolisthesis. Chronic bilateral L5 pars defects with grade 1 spondylolisthesis. Chronic appearing right L5 pedicle fracture (for example sagittal series 8 image 54).
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 MR Image Interpretation CLINICAL INFORMATION: Renal mass. COMPARISON: None. TECHNIQUE: Outside MR images without and with IV contrast dated 12/7/2021 were submitted for interpretation. FINDINGS: STRUCTURED REPORT: MRI Renal Mass LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: KIDNEYS: RENAL MASS #1 BRIEF DESCRIPTION: Right interpolar renal mass LOCATION: Right kidney. SIZE IN 3 ORTHOGONAL DIMENSIONS (cm): 2.3 x 1.7 x 2.5 cm COMPOSITION: Solid and homogeneous. BOSNIAK CLASSIFICATION: Not applicable. MARGINS: Well-defined PRESENCE OF MACROSCOPIC FAT: No. PRECONTRAST SIGNAL CHARACTERISTICS: - T1 signal characteristics of the entire mass relative to renal cortex: Isointense. - Opposed-phase T1 weighted characteristics: No drop in signal on opposed phase imaging = Negative for microscopic fat. - Fat-suppressed imaging: Negative for macroscopic fat. - T2 signal characteristics of the entire mass relative to renal cortex: Hyperintense. - Diffusion-weighted signal characteristics of the entire mass relative to renal cortex: Positive for restricted diffusion. - Other: Not applicable. ENHANCEMENT: - Enhancement >=15% relative to pre-contrast imaging: Yes. - Enhancement on subtraction images: Yes. NEPHROMETRY SCORE: - Radius: =7 mm (1 point) - Polar location: >50% of the mass is central (3 points) - Axial location: Posterior. - Hilar extent: No hilar invasion. - Nephrometry Score (Points): 7 LOCAL EXTENT OF DISEASE: - Invades perirenal fat: No. - 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. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. BODY WALL: Normal. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Enhancing right renal mass, suspicious for renal cell carcinoma. No evidence of renal vein invasion or metastatic disease.
FINDINGS: STRUCTURED REPORT: MRI Renal Mass LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: KIDNEYS: RENAL MASS #1 BRIEF DESCRIPTION: Right interpolar renal mass LOCATION: Right kidney. SIZE IN 3 ORTHOGONAL DIMENSIONS (cm): 2.3 x 1.7 x 2.5 cm COMPOSITION: Solid and homogeneous. BOSNIAK CLASSIFICATION: Not applicable. MARGINS: Well-defined PRESENCE OF MACROSCOPIC FAT: No. PRECONTRAST SIGNAL CHARACTERISTICS: - T1 signal characteristics of the entire mass relative to renal cortex: Isointense. - Opposed-phase T1 weighted characteristics: No drop in signal on opposed phase imaging = Negative for microscopic fat. - Fat-suppressed imaging: Negative for macroscopic fat. - T2 signal characteristics of the entire mass relative to renal cortex: Hyperintense. - Diffusion-weighted signal characteristics of the entire mass relative to renal cortex: Positive for restricted diffusion. - Other: Not applicable. ENHANCEMENT: - Enhancement >=15% relative to pre-contrast imaging: Yes. - Enhancement on subtraction images: Yes. NEPHROMETRY SCORE: - Radius: =7 mm (1 point) - Polar location: >50% of the mass is central (3 points) - Axial location: Posterior. - Hilar extent: No hilar invasion. - Nephrometry Score (Points): 7 LOCAL EXTENT OF DISEASE: - Invades perirenal fat: No. - 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. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. BODY WALL: Normal. MUSCULOSKELETAL: No significant abnormality.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: No focal consolidations, pleural effusion or pneumothorax. Calcified granuloma seen in the right middle lobe. Central airways are patent. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Punctate nonobstructive stones in the right kidney. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild stranding along the right femoral vessels, likely related to recent instrumentation. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: Severe burst fracture of L2 with loss of approximately 40% of vertebral body height. There is significant retropulsion of bone fragments in the spinal canal causing severe spinal canal narrowing with near obliteration of the canal secondary to bone fragments. Fracture lines are extending towards the right pedicle, bilateral lamina and bilateral transverse processes. DISC SPACES AND FACET JOINTS: Mild widening of the right-sided L1-L2 facet joint concerning for ligamentous injury. PREVERTEBRAL SOFT TISSUES: Prevertebral fluid and hemorrhage at the fracture site. ALIGNMENT: Normal.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Hepatocellular carcinoma. COMPARISON: None. TECHNIQUE: Outside CT images without and with IV contrast dated 12/16/2021 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: Mildly cirrhotic. Infiltrative left hepatic lobe mass, difficult to precisely measure on this exam, but measuring at least 16.4 cm in greatest dimension on series 3, image 69. There is enhancing tumor thrombus within the left portal vein extending into the main portal vein. Hepatic veins are patent. Conventional hepatic arterial anatomy. No additional liver lesion is identified. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Mildly enlarged. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered colonic diverticula. Otherwise normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerosis without aneurysm. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No destructive osseous lesion. Chronic appearing compression fracture of the L1 vertebral body. CONCLUSION: Cirrhosis with splenomegaly. Infiltrative mass replacing most of the left hepatic lobe with associated tumor thrombus in the left portal vein (LR-TIV). Evaluation is limited given limited postcontrast images, but this probably represents hepatocellular carcinoma. No evidence of abdominal metastatic disease.
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: Mildly cirrhotic. Infiltrative left hepatic lobe mass, difficult to precisely measure on this exam, but measuring at least 16.4 cm in greatest dimension on series 3, image 69. There is enhancing tumor thrombus within the left portal vein extending into the main portal vein. Hepatic veins are patent. Conventional hepatic arterial anatomy. No additional liver lesion is identified. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Mildly enlarged. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered colonic diverticula. Otherwise normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerosis without aneurysm. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No destructive osseous lesion. Chronic appearing compression fracture of the L1 vertebral body.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: No focal consolidations, pleural effusion or pneumothorax. Calcified granuloma seen in the right middle lobe. Central airways are patent. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Punctate nonobstructive stones in the right kidney. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild stranding along the right femoral vessels, likely related to recent instrumentation. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: Severe burst fracture of L2 with loss of approximately 40% of vertebral body height. There is significant retropulsion of bone fragments in the spinal canal causing severe spinal canal narrowing with near obliteration of the canal secondary to bone fragments. Fracture lines are extending towards the right pedicle, bilateral lamina and bilateral transverse processes. DISC SPACES AND FACET JOINTS: Mild widening of the right-sided L1-L2 facet joint concerning for ligamentous injury. PREVERTEBRAL SOFT TISSUES: Prevertebral fluid and hemorrhage at the fracture site. ALIGNMENT: Normal.
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EXAM: Outside MR Image Interpretation CLINICAL INFORMATION: Cirrhosis, liver transplant workup. Medical record indicates outside imaging demonstrating multifocal liver lesions and portal vein thrombus. Patient is status post CT-guided biopsy showing likely multifocal hepatoma without further specification COMPARISON: CT 12/17/2013 and CT 1/1/2022 TECHNIQUE: Outside MR images without and with IV contrast dated 12/22/2021 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 Exam findings a motion degraded LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. Heterogeneous attenuation with multiple areas of steatosis. There is heterogeneous enhancement of the liver. Evaluation of the hepatic masses is degraded by motion artifact and limited enhancement on the arterial phase. There are multiple lesions which demonstrate washout highly concerning for HCC. For reference A lesion in the left hepatic lobe segment 2 measures 4.0 cm (series 1101image 60) and a lesion within the right hepatic lobe segment 8 measures 2.5 cm (series 1101 image 66). Multiple additional ill-defined lesions are suspected as well, notably in the posterior right hepatic lobe with suspected infiltration. There is expansion and possible washout within the right portal venous system involving the anterior and posterior braches and right portal vein (for example image 40, series 1201 and image 14, series 801). These findings are suspicious for infiltrating HCC with tumor in vein, although, poorly evaluated on this exam. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Small T2 hyperintense lesions in the kidneys, likely cysts. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Small-volume abdominal ascites RETROPERITONEUM: Normal. VESSELS: There is nonocclusive thrombus within the main portal vein (series 101 image 40). There is expansion, loss of flow void and suspected enhancement and washout within the right portal venous system, highly suspicious for tumoral thrombus. Hepatic veins are poorly visualized. There are esophageal varices. Recanalized umbilical vein. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Limited examination degraded by motion artifact and suboptimal postcontrast imaging. 2. Hepatic cirrhosis with sequela of portal venous hypertension. Multiple hepatic lesions in both hepatic lobes highly suspicious for infiltrating HCC, consistent with prior biopsy results. There is expansion, loss of flow void, and suspected enhancement with washout within the right portal venous system, highly suspicious for tumor in vein (LR-TIV). 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.
FINDINGS: STRUCTURED REPORT: MRI Abdomen Exam findings a motion degraded LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. Heterogeneous attenuation with multiple areas of steatosis. There is heterogeneous enhancement of the liver. Evaluation of the hepatic masses is degraded by motion artifact and limited enhancement on the arterial phase. There are multiple lesions which demonstrate washout highly concerning for HCC. For reference A lesion in the left hepatic lobe segment 2 measures 4.0 cm (series 1101image 60) and a lesion within the right hepatic lobe segment 8 measures 2.5 cm (series 1101 image 66). Multiple additional ill-defined lesions are suspected as well, notably in the posterior right hepatic lobe with suspected infiltration. There is expansion and possible washout within the right portal venous system involving the anterior and posterior braches and right portal vein (for example image 40, series 1201 and image 14, series 801). These findings are suspicious for infiltrating HCC with tumor in vein, although, poorly evaluated on this exam. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Small T2 hyperintense lesions in the kidneys, likely cysts. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Small-volume abdominal ascites RETROPERITONEUM: Normal. VESSELS: There is nonocclusive thrombus within the main portal vein (series 101 image 40). There is expansion, loss of flow void and suspected enhancement and washout within the right portal venous system, highly suspicious for tumoral thrombus. Hepatic veins are poorly visualized. There are esophageal varices. Recanalized umbilical vein. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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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Interpretation of Outside Films CT Chest Clinical Information: 50-year-old female with provided history of lung nodules Spec Inst: PULMONARY NODULES OX CT THORAX 112921 REC 11722 RMC ANNISTON RADIOLOGY Study reviewed: CT of chest with contrast performed at RMC Anniston radiology on November 29, 2021, The images are available in PACS. Findings: Compared with an another outside chest CT dated May 12, 2021. Index lesions are measured in series 4. The contrast opacification of pulmonary vasculature is excellent although few images are degraded due to respiratory motion artifacts. The main pulmonary artery remains slightly dilated measuring 35 mm in diameter in axial image 37, series 4. No intraluminal filling defect is noted in the visualized well opacified pulmonary arteries and its branches. Slightly prominent thymic tissue in the anterior mediastinum along with few ill formed nodes especially in the lower paratracheal and bilateral hilar/bronchopulmonary regions. Several nodules are present in both lungs including few new nodules as well as a cavitating right upper lobe nodule (image 25). Few of the nodules are ill-defined in outline with subtle surrounding groundglass halo. An index nodule in the right lower lobe in image 60 measures 7 x 7 mm, unchanged. A right upper lobe subpleural nodule in image 30 is 6 x 4 mm and is new since prior study. In addition there are increased groundglass parenchymal changes especially in both lower lobes associated with mild bronchiectasis without any honeycombing. Mild upper lobe dominant centrilobular emphysema is also noted. Small pericardial effusion is noted new since prior study. There is no pleural effusion and visualized bones are unremarkable. Conclusion: 1. Indeterminate scattered predominantly solid and few cavitating lung nodules, several are new since prior study. Differential possibilities include infection (?fungal), metastasis from extrathoracic malignancy and less common vasculitis. 2. Upper lobe dominant centrilobular emphysema and bilateral lower lobe dominant chronic interstitial lung disease ?NSIP due to CTD-ILD. 3. Slightly dilated main pulmonary artery may suggest presence of pulmonary artery hypertension if there are any underlying risk factors. 4. New small pericardial effusion.
Findings: Compared with an another outside chest CT dated May 12, 2021. Index lesions are measured in series 4. The contrast opacification of pulmonary vasculature is excellent although few images are degraded due to respiratory motion artifacts. The main pulmonary artery remains slightly dilated measuring 35 mm in diameter in axial image 37, series 4. No intraluminal filling defect is noted in the visualized well opacified pulmonary arteries and its branches. Slightly prominent thymic tissue in the anterior mediastinum along with few ill formed nodes especially in the lower paratracheal and bilateral hilar/bronchopulmonary regions. Several nodules are present in both lungs including few new nodules as well as a cavitating right upper lobe nodule (image 25). Few of the nodules are ill-defined in outline with subtle surrounding groundglass halo. An index nodule in the right lower lobe in image 60 measures 7 x 7 mm, unchanged. A right upper lobe subpleural nodule in image 30 is 6 x 4 mm and is new since prior study. In addition there are increased groundglass parenchymal changes especially in both lower lobes associated with mild bronchiectasis without any honeycombing. Mild upper lobe dominant centrilobular emphysema is also noted. Small pericardial effusion is noted new since prior study. There is no pleural effusion and visualized bones are unremarkable.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: No focal consolidations, pleural effusion or pneumothorax. Calcified granuloma seen in the right middle lobe. Central airways are patent. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Punctate nonobstructive stones in the right kidney. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild stranding along the right femoral vessels, likely related to recent instrumentation. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: Severe burst fracture of L2 with loss of approximately 40% of vertebral body height. There is significant retropulsion of bone fragments in the spinal canal causing severe spinal canal narrowing with near obliteration of the canal secondary to bone fragments. Fracture lines are extending towards the right pedicle, bilateral lamina and bilateral transverse processes. DISC SPACES AND FACET JOINTS: Mild widening of the right-sided L1-L2 facet joint concerning for ligamentous injury. PREVERTEBRAL SOFT TISSUES: Prevertebral fluid and hemorrhage at the fracture site. ALIGNMENT: Normal.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Abdominal pain. COMPARISON: None. TECHNIQUE: Outside CT images with IV contrast dated 12/24/2021 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: Right lower lobe calcified granuloma. DISTAL ESOPHAGUS: Normal. ABDOMEN and PELVIS: LIVER: Scattered hypoattenuating lesions throughout the liver, many of which are too small to characterize, but likely represent cysts. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Scattered calcified granulomas. ADRENALS: Normal. KIDNEYS: Left parapelvic renal cysts. No nephrolithiasis or hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Contrast material fills the stomach. Small bowel is unremarkable. COLON / APPENDIX: Congenital malrotation of the colon with scattered noninflamed diverticula. Probable appendix is unremarkable. PERITONEUM / MESENTERY: No ascites. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Fluid distended without wall thickening. REPRODUCTIVE ORGANS: Uterus is present. Adnexa are unremarkable. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Moderate multilevel discogenic degenerative changes most prominent at L3-L4. CONCLUSION: No acute abnormality within the abdomen or pelvis with incidental findings as detailed 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.
FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Right lower lobe calcified granuloma. DISTAL ESOPHAGUS: Normal. ABDOMEN and PELVIS: LIVER: Scattered hypoattenuating lesions throughout the liver, many of which are too small to characterize, but likely represent cysts. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Scattered calcified granulomas. ADRENALS: Normal. KIDNEYS: Left parapelvic renal cysts. No nephrolithiasis or hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Contrast material fills the stomach. Small bowel is unremarkable. COLON / APPENDIX: Congenital malrotation of the colon with scattered noninflamed diverticula. Probable appendix is unremarkable. PERITONEUM / MESENTERY: No ascites. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Fluid distended without wall thickening. REPRODUCTIVE ORGANS: Uterus is present. Adnexa are unremarkable. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Moderate multilevel discogenic degenerative changes most prominent at L3-L4.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: No focal consolidations, pleural effusion or pneumothorax. Calcified granuloma seen in the right middle lobe. Central airways are patent. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Punctate nonobstructive stones in the right kidney. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild stranding along the right femoral vessels, likely related to recent instrumentation. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: Severe burst fracture of L2 with loss of approximately 40% of vertebral body height. There is significant retropulsion of bone fragments in the spinal canal causing severe spinal canal narrowing with near obliteration of the canal secondary to bone fragments. Fracture lines are extending towards the right pedicle, bilateral lamina and bilateral transverse processes. DISC SPACES AND FACET JOINTS: Mild widening of the right-sided L1-L2 facet joint concerning for ligamentous injury. PREVERTEBRAL SOFT TISSUES: Prevertebral fluid and hemorrhage at the fracture site. ALIGNMENT: Normal.
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Maxillofacial CT scan without contrast. Outside scan dated 12/22/2021 for interpretation Clinical: Chronic sinus disease. Findings: There are bilateral antrostomies and ethmoidectomies. There is extensive mucosal thickening in the right maxillary sinus and right nasal passages are partially obstructed with extensive mucosal thickening. There is extensive opacification of right frontal and sphenoid sinuses. The left maxillary sinus, ethmoid, sphenoid and frontal sinuses are relatively spared. The maxillofacial bones, orbits and orbital contents are unremarkable. No defect is seen in the anterior skull base or calvarium. --------------- Conclusion: Extensive opacification of right maxillary, ethmoid, frontal and sphenoid sinuses.
Findings: There are bilateral antrostomies and ethmoidectomies. There is extensive mucosal thickening in the right maxillary sinus and right nasal passages are partially obstructed with extensive mucosal thickening. There is extensive opacification of right frontal and sphenoid sinuses. The left maxillary sinus, ethmoid, sphenoid and frontal sinuses are relatively spared. The maxillofacial bones, orbits and orbital contents are unremarkable. No defect is seen in the anterior skull base or calvarium. ---------------
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: Pancreatic mass COMPARISON: Abdominal ultrasound dated 1/10/2021 TECHNIQUE: Outside MR images without IV 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: 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: No biliary ductal dilation. No biliary filling defects. GALLBLADDER: No abnormality. PANCREAS: Solid, well-circumscribed mass with heterogeneous signal intensity in the distal pancreatic body measures 4.1 x 3.2 x 3.4 cm (image 15 series 6, image 20 series 2). Mass probably restricts diffusion. There is distal pancreatic atrophy. Pancreatic duct duct proximal to the lesion is nondilated. 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: 1. Distal pancreatic body mass with associated pancreatic atrophy could represent malignancy. Per chart review patient is scheduled for endoscopy. Recommend further evaluation with pancreatic protocol CT or MRI, as clinically indicated. 2. No intra or extrahepatic biliary ductal dilation. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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: No biliary ductal dilation. No biliary filling defects. GALLBLADDER: No abnormality. PANCREAS: Solid, well-circumscribed mass with heterogeneous signal intensity in the distal pancreatic body measures 4.1 x 3.2 x 3.4 cm (image 15 series 6, image 20 series 2). Mass probably restricts diffusion. There is distal pancreatic atrophy. Pancreatic duct duct proximal to the lesion is nondilated. 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.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Pelvis Renal Transplant VASCULATURE: LOWER ABDOMINAL AORTA: Not included on the images. RIGHT COMMON / INTERNAL ILIAC ARTERIES: No calcified atherosclerotic disease. RIGHT EXTERNAL ILIAC ARTERY: No calcified atherosclerotic disease. LEFT COMMON / INTERNAL ILIAC ARTERIES: No calcified atherosclerotic disease. LEFT EXTERNAL ILIAC ARTERY: No calcified atherosclerotic disease. LOWER ABDOMEN: Visualized BOWEL: Scattered noninflamed colonic diverticula. PERITONEUM: No ascites. OTHER: No other abnormality. PELVIS: LYMPH NODES: None pathologically enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Decompressed. REPRODUCTIVE ORGANS: Uterus is present. Adnexa are unremarkable. BODY WALL: Small periumbilical hernia which contains a small amount of small bowel. Small amount of soft tissue stranding in the right lower quadrant which may be from injection MUSCULOSKELETAL: Mild multilevel discogenic degenerative changes within the lumbosacral spine.
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CT of the left knee performed at outside facility. Indication: Left knee pain Comparison: None Technique: Multiplanar images of the left knee was performed Per outside facility protocol. Findings: There is no joint space narrowing, fracture or malalignment involving the left knee. The physis are appropriate for stated age. The tibial tuberosity trochlear groove distance is normal at 10 mm. There is borderline hypoplasia of the medial femoral condyle with normal position patella. Bone mineralization is appropriate for age. Conclusion: 1. Borderline hypoplasia of the medial femoral condyle without CT evidence of patellar instability. 2. No evidence of fracture, malalignment or degenerative disease.
Findings: There is no joint space narrowing, fracture or malalignment involving the left knee. The physis are appropriate for stated age. The tibial tuberosity trochlear groove distance is normal at 10 mm. There is borderline hypoplasia of the medial femoral condyle with normal position patella. Bone mineralization is appropriate for age.
Findings: ACDF hardware spanning C C6-C7 without evidence of loosening or hardware failure. The left inferior C7 vertebral body screw head projects approximately 5 mm anteriorly from the plate into the prevertebral soft tissues . No abnormality of cervical spinal alignment. Vertebral body heights are well-maintained. Partial bony ankylosis is noted between C6-C7. Moderate degenerative changes are present of the atlantoaxial joint. Heights are well-maintained. Mild bilateral uncovertebral joint arthropathy at C5-C6 is seen. Mild right greater than left uncovertebral joint hypertrophy is noted at C6-C7. No area of osseous neuroforaminal or cervical spinal canal narrowing. Left C7 vertebral body screw contacts the overlying esophageal wall as seen on series 5 image 249. Remaining prevertebral and paravertebral soft tissues are otherwise unremarkable.
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EXAM: Outside MR Image Interpretation CLINICAL INFORMATION: Left knee mass. Interpretation of outside exam. COMPARISON: Outside bone scan dated 12/6/2021. TECHNIQUE: Outside MR images of the left knee with and without contrast dated 12/21/2021 were submitted for interpretation on 1/18/2022. 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: Susceptibility artifact from left knee arthroplasty limits evaluation of the adjacent osseous and soft tissue structures. There is a fairly well-circumscribed ovoid lesion in the subcutaneous soft tissues posterior to the knee. The lesion appears partially cystic, with thick enhancing septations, and measures approximately 1.7 x 1.7 x 2.6 cm (image 19 series 9, image 8 series 11). The lesion extends from the skin surface to the superficial fascia of the medial head of the gastrocnemius and abuts the semitendinosus tendon. No evidence of fracture or suspicious bone marrow lesion, within limits above. Small suprapatellar effusion. The distal quadriceps and patellar tendons are intact. Evaluation of the knee ligaments is limited due to artifact. CONCLUSION: 01. Enhancing complex cystic and solid lesion with multiple septations in the medial popliteal fossa apparently arising from subcutaneous tissues measures up to 2.6 cm. Located adjacent to the medial gastrocnemius muscle and some tendinosis tendon without evidence of invasion. Differential includes inflammatory process such as inflamed/infected sebaceous cyst or could also represent neoplastic process. Tissue sampling is recommended. 02. Limited evaluation of the knee joint secondary to total knee arthroplasty. However no osseous abnormality is identified. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: Susceptibility artifact from left knee arthroplasty limits evaluation of the adjacent osseous and soft tissue structures. There is a fairly well-circumscribed ovoid lesion in the subcutaneous soft tissues posterior to the knee. The lesion appears partially cystic, with thick enhancing septations, and measures approximately 1.7 x 1.7 x 2.6 cm (image 19 series 9, image 8 series 11). The lesion extends from the skin surface to the superficial fascia of the medial head of the gastrocnemius and abuts the semitendinosus tendon. No evidence of fracture or suspicious bone marrow lesion, within limits above. Small suprapatellar effusion. The distal quadriceps and patellar tendons are intact. Evaluation of the knee ligaments is limited due to artifact.
FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: There is a stable groundglass nodule in the left lung apex measuring 1.4 x 1.3 cm in diameter on series 201 image 20, previously measuring 1.3 cm in diameter. Redemonstration of right lower lobe pulmonary mass today measuring 3.6 x 2.7 cm on series 201 image 60, previously measuring approximately 4.8 x 3.5 cm. Fiducial markers corresponding to the right lower lobe pulmonary mass are identified. Stable appearance of subpleural pulmonary nodule measuring 1.1-1.1 cm in diameter on series 201 image 85 with internal "popcorn" calcifications, previously measuring 1.1 cm in diameter. Additional scattered calcified pulmonary nodules throughout the bilateral lungs are stable in appearance. No focal consolidation, pleural effusion, or pneumothorax. Central airways patent. HEART / VESSELS: Heart size is normal. Trace pericardial effusion. Severe coronary artery calcifications. The aorta is normal in caliber with scattered atherosclerotic disease. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Fluid density soft tissue lesion in the right perinephric space measuring 3.2 x 2.0 cm on series 201 image 128 is similar in size, appearance compared to prior examination. Partially evaluated right calculus within the renal pelvis is better seen on prior PET/CT. MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality. Moderate degenerative changes of the mid to lower thoracic spine.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: 54-year-old male with history of kidney stones and hydronephrosis. COMPARISON: None. 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: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Mild diffuse hepatic steatosis. Left hepatic lobe cyst. No focal lesions. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: There are scattered calcified granulomas in the spleen. ADRENALS: Left adrenal nodule measures 1.7 x 1.5 cm (series 4, image 45), attenuation of which is less than 10 Hounsfield units on noncontrast CT consistent with adrenal adenoma. The right adrenal is normal. KIDNEYS: There is a 12 mm x 9 mm nonobstructive calculus in the right renal pelvis (series 2, image 67) without calyceal dilation. Additional small punctate calculi are seen in the bilateral calyces. No hydroureteronephrosis. Bilateral subcentimeter simple renal cysts. Postsurgical changes are seen along the lower pole the right kidney. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis without diverticulitis in the sigmoid colon. Otherwise, the colon, including the appendix, is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild aortobiiliac atherosclerotic calcifications. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: There is a small fat-containing umbilical hernia. MUSCULOSKELETAL: Chronic degenerative changes including grade 1 retrolisthesis of L5 on S1 and osteophyte formation in the thoracic spine. No aggressive osseous lesions. CONCLUSION: 1. Nonobstructive 12 x 9 mm calculus in the right renal pelvis, along with scattered punctate calculi in the kidneys bilaterally. No hydronephrosis. 2. Left adrenal adenoma and 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.
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: Mild diffuse hepatic steatosis. Left hepatic lobe cyst. No focal lesions. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: There are scattered calcified granulomas in the spleen. ADRENALS: Left adrenal nodule measures 1.7 x 1.5 cm (series 4, image 45), attenuation of which is less than 10 Hounsfield units on noncontrast CT consistent with adrenal adenoma. The right adrenal is normal. KIDNEYS: There is a 12 mm x 9 mm nonobstructive calculus in the right renal pelvis (series 2, image 67) without calyceal dilation. Additional small punctate calculi are seen in the bilateral calyces. No hydroureteronephrosis. Bilateral subcentimeter simple renal cysts. Postsurgical changes are seen along the lower pole the right kidney. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis without diverticulitis in the sigmoid colon. Otherwise, the colon, including the appendix, is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild aortobiiliac atherosclerotic calcifications. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: There is a small fat-containing umbilical hernia. MUSCULOSKELETAL: Chronic degenerative changes including grade 1 retrolisthesis of L5 on S1 and osteophyte formation in the thoracic spine. No aggressive osseous lesions.
FINDINGS: The quality of study is excellent for evaluation of aortic root and was not tailored for coronary artery evaluation. There is extensive calcification of the tricuspid aortic leaflets with restricted opening during systole. The aortic root measurements done in systolic phase are as follows (all using double oblique method): Annulus: 26 x 21 mm Approximate Annulus area: 426 mm2 Perimeter: 77 mm Distance of LM coronary artery from Annulus: 13 mm Distance of Right coronary artery from Annulus: 13 mm RCC height:21 mm LCC height: 21 mm Aortic sinuses: 30 mm Sinotubular junction: 30 x 28 mm Mid ascending aorta:: 34 x 34 mm Suitable Valve deployment angle: RAO three CRA three Aortic valve calcification score: 1982 LVEF: 74 % LVED volume: 124 ml LVES volume: 33 ml Stroke volume: 91 ml No intracardiac mass or thrombus is present. There is mild calcification of the posterior mitral annulus. No significant left ventricular outflow tract calcification is seen. Severe coronary arterial calcification is noted with an LAD stent present. No significant pericardial effusion is seen. Pulmonary venous drainage is normal. The thoracic aorta and main pulmonary artery normal in caliber. There is no adenopathy or pleural effusion. Mild upper lobe predominant centrilobular emphysema seen with diffuse bronchial wall thickening suggesting bronchitis or asthma. Basilar scarring/subsegmental atelectasis is present. Lungs are otherwise clear. No acute or aggressive osseous lesion. Abdomen findings reported separately. ------------------------------------------------------------------------------ --------------------------------------
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Pancreatic pseudocyst. COMPARISON: Chest CT 9/20/2021. TECHNIQUE: Outside CT images with 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: Satisfactory. STRUCTURED REPORT: CT Abdomen LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Tiny subcentimeter hypoattenuating focus within hepatic segment IV which is too small to characterize, likely cyst. No suspicious lesions. BILIARY TRACT: Normal. GALLBLADDER: Multiple calcified gallstones. No pericholecystic fluid or gallbladder wall thickening. PANCREAS: Well-defined cystic lesion arising from the body of the pancreas measuring 3.4 x 1.7 x 2.9 cm (series 5 image 36). Innumerable pancreatic calcifications and pancreatic atrophy. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Left upper pole simple renal cyst. Otherwise, bilateral kidneys are normal without hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Normal. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: Moderate atherosclerotic disease of the abdominal aorta which is normal in caliber. BODY WALL: Tiny fat-containing periumbilical hernia. Left posterior chest wall cystic lesion is unchanged. MUSCULOSKELETAL: No aggressive osseous lesions. CONCLUSION: 1. Sequela of chronic pancreatitis. Pancreatic cystic lesion along the anterior pancreatic body likely pancreatic pseudocyst, similar compared to 9/2021. 2. Other incidental and chronic findings as detailed 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.
FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Tiny subcentimeter hypoattenuating focus within hepatic segment IV which is too small to characterize, likely cyst. No suspicious lesions. BILIARY TRACT: Normal. GALLBLADDER: Multiple calcified gallstones. No pericholecystic fluid or gallbladder wall thickening. PANCREAS: Well-defined cystic lesion arising from the body of the pancreas measuring 3.4 x 1.7 x 2.9 cm (series 5 image 36). Innumerable pancreatic calcifications and pancreatic atrophy. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Left upper pole simple renal cyst. Otherwise, bilateral kidneys are normal without hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Normal. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: Moderate atherosclerotic disease of the abdominal aorta which is normal in caliber. BODY WALL: Tiny fat-containing periumbilical hernia. Left posterior chest wall cystic lesion is unchanged. MUSCULOSKELETAL: No aggressive osseous lesions.
FINDINGS: STRUCTURED REPORT: CTA TAVR Protocol VASCULATURE: ABDOMINAL AORTA: No significant abnormality. Mild infrarenal abdominal aortic ectasia with scattered calcific plaque without significant stenosis. CELIAC AXIS: No significant abnormality. Replaced left hepatic artery arising from left gastric. SMA: No significant abnormality. RIGHT RENAL: No significant abnormality. LEFT RENAL: No significant abnormality. IMA: No significant abnormality. RIGHT ILIAC ARTERIES: No significant abnormality. Scattered calcific plaque without significant stenosis. RIGHT COMMON FEMORAL ARTERY: Moderate stenosis secondary to fibrofatty plaque (series 18, image 213). LEFT ILIAC ARTERIES: No significant abnormality. Scattered calcific plaque without significant stenosis. LEFT COMMON FEMORAL ARTERY: No significant abnormality. Extensive calcific plaque without significant stenosis. MEASUREMENTS: Right Common iliac dimensions: avg = 11, min = 10, max = 12 mm. Right External iliac dimensions: avg = 8, min = 7, max = 9 mm. Right Common femoral dimensions: avg = 10, min = 9, max = 11 mm. Left Common iliac dimensions: avg = 11, min = 9, max = 12 mm. Left External iliac dimensions: avg = 9, min = 8, max = 10 mm. Left Common femoral dimensions: avg = 9, min = 7, max = 12 mm. ------------------------------------------------------------- LOWER CHEST: A cardiac CTA was performed in conjunction with this examination and will be dictated in a separate report. Please see that report for all findings above the diaphragm. ABDOMEN and PELVIS: LIVER: Postsurgical changes are present in the posterior right hepatic lobe. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. Small splenule is present. ADRENALS: Normal. KIDNEYS: Normal. STOMACH / SMALL BOWEL: Small hiatal hernia. Small bowel loops are nondilated. COLON / APPENDIX: Status post right colon resection. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: No lymph node enlargement. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostatic hypertrophy and calcifications. BODY WALL: Small bilateral fat-containing inguinal hernias. MUSCULOSKELETAL: Degenerative changes of the spine with severe intervertebral disc space loss at L5-S1 and associated endplate sclerosis. Lytic lesion within the L4 vertebral body measuring approximately 2.7 x 2.3 (series 14, image 74), stable since PET CT examination from 2016, likely a hemangioma.
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Interpretation of Outside Films CT Chest Clinical Information: Spec Inst: Pancreatic mass - CT CAP from Dekalb Regional done 12-2-21 rec 1-19-22 Study reviewed: CT of chest performed at Dekalb Regional Medical Center on 12/2/2021. . 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:None Findings: Included images of the lower neck demonstrate a low-attenuation lesion in the right lobe of the thyroid measuring about 1.6 x 1.0 cm. Normal heart size. Left dual lead pacer in place. Dense coronary artery calcifications. Mild circumferential thickening of the lower esophagus may reflect reflux esophagitis. Mediastinal structures are otherwise within normal limits. No pathologically enlarged intrathoracic lymph nodes. Filling defects within the trachea peripherally may represent retained secretions. No pleural effusions. Mild bilateral upper lung predominant centrilobular emphysema. Mild biapical scarring. Small cluster tree-in-bud type of nodularity within the middle lobe and lingula likely atypical infection/bronchiolitis. Groundglass nodule measuring one 0.5 cm in the left upper lobe (series 5; image 32). Please note that the concurrently obtained CT scan of the Abdomen will be dictated separately. Soft tissues of the chest wall are unremarkable. No aggressive osseous lesions. Conclusion: 1. No intrathoracic metastatic disease. 2. Subcentimeter groundglass nodule in the left upper lobe; attention to this on subsequent examinations is recommended given the emphysema. 3. Incidental findings of mild changes of atypical infection (MAC)/bronchiolitis, mild changes of reflux.
Findings: Included images of the lower neck demonstrate a low-attenuation lesion in the right lobe of the thyroid measuring about 1.6 x 1.0 cm. Normal heart size. Left dual lead pacer in place. Dense coronary artery calcifications. Mild circumferential thickening of the lower esophagus may reflect reflux esophagitis. Mediastinal structures are otherwise within normal limits. No pathologically enlarged intrathoracic lymph nodes. Filling defects within the trachea peripherally may represent retained secretions. No pleural effusions. Mild bilateral upper lung predominant centrilobular emphysema. Mild biapical scarring. Small cluster tree-in-bud type of nodularity within the middle lobe and lingula likely atypical infection/bronchiolitis. Groundglass nodule measuring one 0.5 cm in the left upper lobe (series 5; image 32). Please note that the concurrently obtained CT scan of the Abdomen will be dictated separately. Soft tissues of the chest wall are unremarkable. No aggressive osseous lesions.
FINDINGS: BRAIN PARENCHYMA: There is no acute intracranial hemorrhage or acute infarct. No brain edema or mass effect. Chronic infarct-related encephalomalacia within the right cerebellum. 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: Pancreatic lesion COMPARISON: None. TECHNIQUE: Outside CT images with 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: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Innumerable hypoattenuating foci throughout the liver. The largest are fluid attenuation, consistent with simple cysts, however the subcentimeter lesions are technically indeterminate but likely represent additional cysts. BILIARY TRACT: Prominent size of the common bile duct, likely related to postcholecystectomy status. GALLBLADDER: Absent. PANCREAS: A cystic lesion in the uncinate process measuring approximately 1.0 cm (series 6, image 85). Main pancreatic duct is not dilated. Possible additional cystic focus in the pancreatic body (series 6, image 59). SPLEEN: Subcentimeter hypoattenuating foci are too small to accurately characterize. ADRENALS: Normal. KIDNEYS: Nonobstructing right renal stone in the inferior pole measuring approximately 4 mm. Left renal cyst. Additional subcentimeter hypoattenuating foci are too small to accurately characterize, but likely represent additional cysts. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Nonspecific trace fluid in the left upper quadrant. RETROPERITONEUM: Normal. VESSELS: Atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Diffuse osteopenia. CONCLUSION: Cystic lesion in the pancreas, likely reflecting a side branch IPMN. Recommend annual surveillance with MRI/MRCP. 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.
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: Innumerable hypoattenuating foci throughout the liver. The largest are fluid attenuation, consistent with simple cysts, however the subcentimeter lesions are technically indeterminate but likely represent additional cysts. BILIARY TRACT: Prominent size of the common bile duct, likely related to postcholecystectomy status. GALLBLADDER: Absent. PANCREAS: A cystic lesion in the uncinate process measuring approximately 1.0 cm (series 6, image 85). Main pancreatic duct is not dilated. Possible additional cystic focus in the pancreatic body (series 6, image 59). SPLEEN: Subcentimeter hypoattenuating foci are too small to accurately characterize. ADRENALS: Normal. KIDNEYS: Nonobstructing right renal stone in the inferior pole measuring approximately 4 mm. Left renal cyst. Additional subcentimeter hypoattenuating foci are too small to accurately characterize, but likely represent additional cysts. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Nonspecific trace fluid in the left upper quadrant. RETROPERITONEUM: Normal. VESSELS: Atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Diffuse osteopenia.
FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. MAXILLOFACIAL: There are no acute maxillofacial or mandibular fractures. 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 CT Image Interpretation CT abdomen and pelvis with and without contrast dated 11/24/2021 CLINICAL INFORMATION: 58-year-old male with history of pancreatic cancer (per chart review, biopsy-proven pancreatic adenocarcinoma). COMPARISON: 11/22/2021. TECHNIQUE: Outside CT images without and with IV contrast dated 11/24/2021 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 Pancreatic Mass FINDINGS: LOWER CHEST: LUNG BASES / PLEURA: Bibasilar atelectasis. DISTAL ESOPHAGUS: Tiny hiatal hernia. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: No suspicious hepatic lesions. Diffuse hepatic steatosis. PERITONEUM: No ascites. No peritoneal nodules. PANCREAS: There is a 3.0 x 2.5 cm hypoattenuating ill-defined lesion in the tail of the pancreas (series 4, image 34). This is significantly increased compared to recent prior examination where it measured 2.0 x 1.3 cm on 11/22/2021. A subcentimeter peripancreatic soft tissue nodule is seen just anterior to this mass in the retroperitoneal fat, unchanged. Additionally noted mild peripancreatic fat stranding surrounding the tail of pancreas, new compared to prior examination. Pancreatic mass: - Location: Tail - Size: 3.0 x 2.5 cm (series 4, image 34). - 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: Absent. VASCULATURE: - 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): No tumor contact. - IVC and Renal Veins: No tumor contact. - Vessel thrombosis: Nonocclusive thrombus in the splenic vein (series 5, image 37). - Venous collaterals: None. - Other peripancreatic vessel comment: None. LYMPH NODES: None enlarged. RETROPERITONEUM: No direct tumor extension into the retroperitoneal fat. Subcentimeter retroperitoneal nodule is described above. No tumor invasion into the anterior pararenal fat. MESENTERY: No tumor invasion. ADRENALS: Normal. KIDNEYS: Normal. SPLEEN: Normal. STOMACH: Oral contrast agent is seen in the stomach without abnormality. DUODENUM: No abnormality. SMALL BOWEL: Oral contrast is seen in the small bowel without abnormality. COLON / APPENDIX: Scattered diverticulosis without evidence of diverticulitis. The appendix is not included within the study. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Mild rectus diastasis. MUSCULOSKELETAL: No aggressive osseous lesion in the visualized thoracolumbar spine. Mild degenerative changes of the lower thoracic and lower lumbar spine. CONCLUSION: 1. Findings suggestive of acute tail pancreatitis likely obscuring the underlying pancreatic tail mass visualized on recent prior CT, as the hypoattenuation in the pancreatic tail is increased in size compared to two days prior. New nonocclusive thrombus is also seen within the splenic vein. Repeat pancreatic protocol CT may be of benefit, if clinically indicated. 2. Diffuse hepatic steatosis and additional incidental findings as above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Pancreatic Mass FINDINGS: LOWER CHEST: LUNG BASES / PLEURA: Bibasilar atelectasis. DISTAL ESOPHAGUS: Tiny hiatal hernia. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: No suspicious hepatic lesions. Diffuse hepatic steatosis. PERITONEUM: No ascites. No peritoneal nodules. PANCREAS: There is a 3.0 x 2.5 cm hypoattenuating ill-defined lesion in the tail of the pancreas (series 4, image 34). This is significantly increased compared to recent prior examination where it measured 2.0 x 1.3 cm on 11/22/2021. A subcentimeter peripancreatic soft tissue nodule is seen just anterior to this mass in the retroperitoneal fat, unchanged. Additionally noted mild peripancreatic fat stranding surrounding the tail of pancreas, new compared to prior examination. Pancreatic mass: - Location: Tail - Size: 3.0 x 2.5 cm (series 4, image 34). - 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: Absent. VASCULATURE: - 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): No tumor contact. - IVC and Renal Veins: No tumor contact. - Vessel thrombosis: Nonocclusive thrombus in the splenic vein (series 5, image 37). - Venous collaterals: None. - Other peripancreatic vessel comment: None. LYMPH NODES: None enlarged. RETROPERITONEUM: No direct tumor extension into the retroperitoneal fat. Subcentimeter retroperitoneal nodule is described above. No tumor invasion into the anterior pararenal fat. MESENTERY: No tumor invasion. ADRENALS: Normal. KIDNEYS: Normal. SPLEEN: Normal. STOMACH: Oral contrast agent is seen in the stomach without abnormality. DUODENUM: No abnormality. SMALL BOWEL: Oral contrast is seen in the small bowel without abnormality. COLON / APPENDIX: Scattered diverticulosis without evidence of diverticulitis. The appendix is not included within the study. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Mild rectus diastasis. MUSCULOSKELETAL: No aggressive osseous lesion in the visualized thoracolumbar spine. Mild degenerative changes of the lower thoracic and lower lumbar spine.
FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. MAXILLOFACIAL: There are no acute maxillofacial or mandibular fractures. 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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Interpretation of Outside Films CT Chest Clinical Information: Spec Inst: PANCREATIC CA CT CHEST 12121 MOBILE INFIRMARY REC 11922 Study reviewed: CT of chest performed at Mobile Infirmary Health Thomas North Baldwin Atmore on 12/1/2021. . 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:7/26/2021 Findings: Included images of the lower neck are unremarkable. Borderline heart size. Biventricular pacer with intact leads. Mild aortic valve calcifications without significant dilation of the ascending aorta. Mediastinal structures are otherwise within normal limits. No pathologically enlarged intrathoracic lymph nodes. The central airways are patent. No pleural effusions. Calcified granulomas in the right lower lobe. A tiny nonspecific less than 0.5 cm noncalcified nodule in the left upper lobe (series 4; image 24) is unchanged. No new or growing pulmonary nodules. Please note that the concurrently obtained CT scan of the Abdomen will be dictated separately. Soft tissues of the chest wall are unremarkable. 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.
Findings: Included images of the lower neck are unremarkable. Borderline heart size. Biventricular pacer with intact leads. Mild aortic valve calcifications without significant dilation of the ascending aorta. Mediastinal structures are otherwise within normal limits. No pathologically enlarged intrathoracic lymph nodes. The central airways are patent. No pleural effusions. Calcified granulomas in the right lower lobe. A tiny nonspecific less than 0.5 cm noncalcified nodule in the left upper lobe (series 4; image 24) is unchanged. No new or growing pulmonary nodules. Please note that the concurrently obtained CT scan of the Abdomen will be dictated separately. Soft tissues of the chest wall are unremarkable. No aggressive osseous lesions.
FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. MAXILLOFACIAL: There are no acute maxillofacial or mandibular fractures. 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 CT Image Interpretation CLINICAL INFORMATION: 71-year-old male with biopsy-proven pancreatic adenocarcinoma. COMPARISON: CT abdomen dated 8/18/2021. TECHNIQUE: Outside CT images with IV contrast dated 12/1/2021 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 Pancreatic Mass LOWER CHEST: LUNG BASES / PLEURA: Bibasilar atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Pacemaker leads. ABDOMEN and PELVIS: LIVER: No liver metastases within the limits of contrast bolus timing. PERITONEUM: No ascites. No peritoneal nodules. PANCREAS: Pancreatic mass: - Location: Head - Size: 3.0 x 3.7 cm (series 7, image 30) - Composition: Solid - Enhancement relative to pancreas: Hypoenhancing - Margins: Ill-defined with irregular margins. - Pancreatic duct: Moderate upstream pancreatic ductal dilatation. Measuring up to 7 mm. - Pancreatic atrophy: Mild upstream pancreatic atrophy. - Biliary ducts: Not dilated - Gallbladder: Surgically absent. VASCULATURE: - Arterial anatomy: Evaluation is limited by slice thickness and artifact. Suspected replaced right hepatic artery arising directly from the SMA. - Celiac Axis (CA): No tumor contact. Aneurysmal dilatation of the celiac axis origin is noted which measures up to 1.3 cm (series 7, image 21; series 605, image 73). - 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 >=180 degrees or bilateral narrowing NOT exceeding the inferior border of the duodenum. [BORDERLINE RESECTABLE - PORTAL VENOUS] Evaluation of portal vein patency is limited by contrast bolus timing. - IVC and Renal Veins: No tumor contact. - Vessel thrombosis: No apparent definite thrombosis, although detailed evaluation is limited by lack of venous phase images. - Venous collaterals: None. - Other peripancreatic vessel comment: None. LYMPH NODES: None enlarged. RETROPERITONEUM: No tumor invasion. MESENTERY: No tumor invasion. ADRENALS: Normal. KIDNEYS: Postsurgical changes in the right kidney are unchanged compared to prior. No renal calculi or hydronephrosis. SPLEEN: Normal. STOMACH: No abnormality. DUODENUM: No abnormality. SMALL BOWEL: Contrast material seen within the small bowel. COLON / APPENDIX: No abnormality. Surgical clips in the right lower quadrant and the appendix is not definitively visualized. OTHER VESSELS: No significant abnormality within the limits of single phase arterial technique. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Schmorl's node at the inferior endplate of L3. Mild facet arthropathy in the lumbar facets. No aggressive osseous lesion. CONCLUSION: 1. Hypoattenuating pancreatic head mass consistent with known pancreatic adenocarcinoma. There is abutment of the main portal vein approximately 180 degrees. Evaluation of portal venous patency is limited by single phase technique. 2. No definite abdominopelvic metastatic disease. 3. Celiac axis origin aneurysmal dilatation incidentally noted. 4. Chronic and incidental findings as above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: IMAGE QUALITY: Suboptimal. STRUCTURED REPORT: CT Pancreatic Mass LOWER CHEST: LUNG BASES / PLEURA: Bibasilar atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Pacemaker leads. ABDOMEN and PELVIS: LIVER: No liver metastases within the limits of contrast bolus timing. PERITONEUM: No ascites. No peritoneal nodules. PANCREAS: Pancreatic mass: - Location: Head - Size: 3.0 x 3.7 cm (series 7, image 30) - Composition: Solid - Enhancement relative to pancreas: Hypoenhancing - Margins: Ill-defined with irregular margins. - Pancreatic duct: Moderate upstream pancreatic ductal dilatation. Measuring up to 7 mm. - Pancreatic atrophy: Mild upstream pancreatic atrophy. - Biliary ducts: Not dilated - Gallbladder: Surgically absent. VASCULATURE: - Arterial anatomy: Evaluation is limited by slice thickness and artifact. Suspected replaced right hepatic artery arising directly from the SMA. - Celiac Axis (CA): No tumor contact. Aneurysmal dilatation of the celiac axis origin is noted which measures up to 1.3 cm (series 7, image 21; series 605, image 73). - 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 >=180 degrees or bilateral narrowing NOT exceeding the inferior border of the duodenum. [BORDERLINE RESECTABLE - PORTAL VENOUS] Evaluation of portal vein patency is limited by contrast bolus timing. - IVC and Renal Veins: No tumor contact. - Vessel thrombosis: No apparent definite thrombosis, although detailed evaluation is limited by lack of venous phase images. - Venous collaterals: None. - Other peripancreatic vessel comment: None. LYMPH NODES: None enlarged. RETROPERITONEUM: No tumor invasion. MESENTERY: No tumor invasion. ADRENALS: Normal. KIDNEYS: Postsurgical changes in the right kidney are unchanged compared to prior. No renal calculi or hydronephrosis. SPLEEN: Normal. STOMACH: No abnormality. DUODENUM: No abnormality. SMALL BOWEL: Contrast material seen within the small bowel. COLON / APPENDIX: No abnormality. Surgical clips in the right lower quadrant and the appendix is not definitively visualized. OTHER VESSELS: No significant abnormality within the limits of single phase arterial technique. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Schmorl's node at the inferior endplate of L3. Mild facet arthropathy in the lumbar facets. No aggressive osseous lesion.
FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. MAXILLOFACIAL: There are no acute maxillofacial or mandibular fractures. 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: Renal cyst COMPARISON: CT abdomen and pelvis dated 10/29/2021 TECHNIQUE: Outside MR images without and with IV contrast dated 11/23/2021 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: Trace bilateral pleural effusions. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. Mild diffuse hepatic steatosis. No suspicious liver lesions. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. PANCREAS: Normal. SPLEEN: Enlarged. ADRENALS: Normal. KIDNEYS: Right parapelvic cyst measures up to 13.8 x 13.3 x 14.8 cm in AP by transverse by craniocaudal dimensions (image 12 series 401, image 15 series 501). T2 hypointense/mildly T1 hyperintense mural nodularity versus debris within the cyst. There are other nondependent irregular mural nodules along the periphery of the cyst most pronounced in the cranial aspect of the cystic lesion. These areas of nodularity demonstrate some enhancement on more delayed venous phase images, for example on images 30 and 42 of series 805. Lesion is centered in the renal sinus with effacement of the collecting system and renal vasculature without invasion. Partially exophytic cystic lesion in the medial aspect of the left lower pole 2.2 x 2.2 x 3.0 in AP by transverse by craniocaudal dimensions (image 31 series 3, image 101 series 7). There are multiple irregular septations that demonstrate enhancement as well as mural nodularity. No invasion of the renal sinus, renal vasculature, or adjacent organs. Left upper pole simple cyst. LYMPH NODES: Multiple enlarged retroperitoneal lymph nodes, for example para-aortic lymph node measures 1.5 x 1.4 cm on image 36 series 804. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Trace ascites. RETROPERITONEUM: Normal. VESSELS: Hepatic vasculature is patent. Upper abdominal varices/collaterals. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Right parapelvic cyst with internal debris and enhancing mural nodules is concerning for malignancy (Bosniak IV). 2. Left exophytic cyst with enhancing septations and mural nodularity is also concerning for malignancy (Bosniak IV). 3. Retroperitoneal lymphadenopathy, nonspecific but perhaps metastatic disease. 4. Hepatic cirrhosis with sequela of portal hypertension including splenic lesion, trace ascites, and upper abdominal varices/collaterals. 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.
FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: Trace bilateral pleural effusions. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. Mild diffuse hepatic steatosis. No suspicious liver lesions. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. PANCREAS: Normal. SPLEEN: Enlarged. ADRENALS: Normal. KIDNEYS: Right parapelvic cyst measures up to 13.8 x 13.3 x 14.8 cm in AP by transverse by craniocaudal dimensions (image 12 series 401, image 15 series 501). T2 hypointense/mildly T1 hyperintense mural nodularity versus debris within the cyst. There are other nondependent irregular mural nodules along the periphery of the cyst most pronounced in the cranial aspect of the cystic lesion. These areas of nodularity demonstrate some enhancement on more delayed venous phase images, for example on images 30 and 42 of series 805. Lesion is centered in the renal sinus with effacement of the collecting system and renal vasculature without invasion. Partially exophytic cystic lesion in the medial aspect of the left lower pole 2.2 x 2.2 x 3.0 in AP by transverse by craniocaudal dimensions (image 31 series 3, image 101 series 7). There are multiple irregular septations that demonstrate enhancement as well as mural nodularity. No invasion of the renal sinus, renal vasculature, or adjacent organs. Left upper pole simple cyst. LYMPH NODES: Multiple enlarged retroperitoneal lymph nodes, for example para-aortic lymph node measures 1.5 x 1.4 cm on image 36 series 804. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Trace ascites. RETROPERITONEUM: Normal. VESSELS: Hepatic vasculature is patent. Upper abdominal varices/collaterals. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma THORACIC SPINE: VERTEBRA: No fracture. Chronic appearing mild compression deformities of T4 and T7. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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EXAM: Outside MR Image Interpretation CLINICAL INFORMATION: Spec Inst: ELEVATED PSA MRI PEL 121721 NORTH MISS MED REC 11922 PSA density 0.12. COMPARISON: None. TECHNIQUE: Outside MR images without and with IV 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: STRUCTURED REPORT: MRI Prostate PROSTATE: Measurement: 4.1 x 5.7 x 6.2 cm; estimated volume: 76 cc Focal lesion(s): Lesion # 1 (index lesion): - Key image: image 16; series 10 - Size: 11 mm - Location: left; mid; lateral PZ-CG junction - T2WI: 3; DWI: 3; DCE (early and focal enhancement): negative - PI-RADS v2.1 score: 3 - Intermediate (the presence of clinically significant cancer is equivocal) - Likelihood of extraprostatic extension: 1 - Highly unlikely - Likelihood of seminal vesicle invasion: 1 - Highly unlikely Lesion # 2 (index lesion): - Key image: image 19; series 10 - Size: 14 mm - Location: left; base; posterior PZ-CG junction - T2WI: 3; DWI: 3; DCE (early and focal enhancement): negative - PI-RADS v2.1 score: 3 - Intermediate (the presence of clinically significant cancer is equivocal) - Likelihood of extraprostatic extension: 1 - Highly unlikely - Likelihood of seminal vesicle invasion: 1 - Highly unlikely Diffuse prostate abnormalities: Diffusely striated appearance of the peripheral zone on T2WI may reflect prostatitis Other prostate findings: Diffuse heterogeneity within the gland largely replaced by cystic degeneration. VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. BLADDER: Within normal limits. OTHER PELVIC FINDINGS: None. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. Note: For more details about the Prostate Imaging-Reporting and Data System (PI-RADS) version 2.1, please visit: http://www.acr.org/Quality-Safety/Resources/PIRADS CONCLUSION: 1. Two possible lesions within the left transitional zone as detailed above, which demonstrate similar imaging characteristics including heterogeneous T2 hypointensity, mild ADC hypointensity, and no early dynamic contrast enhancement or definite hyperintensity on DWI (PIRADS 3). Suboptimal B 2000 series slightly limits evaluation, though no suspicious region seen on the B 1200 series. 2. Moderate to severe benign prostatic hypertrophy. 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.
FINDINGS: STRUCTURED REPORT: MRI Prostate PROSTATE: Measurement: 4.1 x 5.7 x 6.2 cm; estimated volume: 76 cc Focal lesion(s): Lesion # 1 (index lesion): - Key image: image 16; series 10 - Size: 11 mm - Location: left; mid; lateral PZ-CG junction - T2WI: 3; DWI: 3; DCE (early and focal enhancement): negative - PI-RADS v2.1 score: 3 - Intermediate (the presence of clinically significant cancer is equivocal) - Likelihood of extraprostatic extension: 1 - Highly unlikely - Likelihood of seminal vesicle invasion: 1 - Highly unlikely Lesion # 2 (index lesion): - Key image: image 19; series 10 - Size: 14 mm - Location: left; base; posterior PZ-CG junction - T2WI: 3; DWI: 3; DCE (early and focal enhancement): negative - PI-RADS v2.1 score: 3 - Intermediate (the presence of clinically significant cancer is equivocal) - Likelihood of extraprostatic extension: 1 - Highly unlikely - Likelihood of seminal vesicle invasion: 1 - Highly unlikely Diffuse prostate abnormalities: Diffusely striated appearance of the peripheral zone on T2WI may reflect prostatitis Other prostate findings: Diffuse heterogeneity within the gland largely replaced by cystic degeneration. VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. BLADDER: Within normal limits. OTHER PELVIC FINDINGS: None. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. Note: For more details about the Prostate Imaging-Reporting and Data System (PI-RADS) version 2.1, please visit: http://www.acr.org/Quality-Safety/Resources/PIRADS
FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. MAXILLOFACIAL: There are no acute maxillofacial or mandibular fractures. 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: Spec Inst: HCC - MRI Liver from Clearview Cancer Institute done 11-3-21 rec 1-20-22 COMPARISON: None. TECHNIQUE: Outside MR images without and with IV contrast dated 11/3/2021 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. Left lobe cyst. LIVER LESIONS: Innumerable arterially hyperenhancing lesions which demonstrate washout of contrast on delayed compatible with multifocal HCC. Index lesions are detailed below. - Lesion Number: 1 - Location: Segment(s) IVA - Size: 4.4 x 4.3 (Image 83, Series 700) - Enhancement: Nonrim arterial phase hyperenhancement - Vascular invasion: No - Additional major features present: 2 - Enhancing "capsule": Present. - Nonperipheral "washout": Present. - Threshold growth (>= 50% in = 50% in <= 6 months): Not present. - Other features: None. - LI-RADS: LR-TIV LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Nonocclusive bland thrombus within the right portal vein. Enhancement within the anterior branch of the right portal vein which follows tumor signal characteristics compatible with tumor thrombus. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: Small (
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. Left lobe cyst. LIVER LESIONS: Innumerable arterially hyperenhancing lesions which demonstrate washout of contrast on delayed compatible with multifocal HCC. Index lesions are detailed below. - Lesion Number: 1 - Location: Segment(s) IVA - Size: 4.4 x 4.3 (Image 83, Series 700) - Enhancement: Nonrim arterial phase hyperenhancement - Vascular invasion: No - Additional major features present: 2 - Enhancing "capsule": Present. - Nonperipheral "washout": Present. - Threshold growth (>= 50% in = 50% in <= 6 months): Not present. - Other features: None. - LI-RADS: LR-TIV LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Nonocclusive bland thrombus within the right portal vein. Enhancement within the anterior branch of the right portal vein which follows tumor signal characteristics compatible with tumor thrombus. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: Small (
FINDINGS: Extensive peripheral and peribronchovascular fibrosis is again seen with associated traction bronchiectasis. There does appear to be a slight basilar predominance. The overall extent of disease has not significantly changed from the prior examination. However, there does appear to be increased diffuse groundglass opacity bilaterally. Peripheral cystic changes in the left upper lobe may be due to traction bronchiolectasis or honeycombing. This is unchanged from the prior examination. No new or enlarging lung nodules. No pleural effusion or pleural thickening. The supraclavicular region is unremarkable. Central airways are patent. The thoracic aorta is nonaneurysmal. Unchanged dilated. Mild cardiomegaly is unchanged. No pericardial effusion. Mediastinal hilar lymph nodes are not significantly changed from the prior examination. The esophagus is mildly patulous. No acute or aggressive osseous abnormality.
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CT head without contrast Indication: Spec Inst: sp Chiari decompression, concern for pseudomeningocele - CT Head from AHI done 12-29-21 rec 1-20-22. Comparison: Multiple priors, most recent CT head without contrast 12/17/2021.. Technique: CT head from outside facility was available for review. Findings: Patient status post suboccipital craniectomy, C1 laminectomy and duraplasty for Chiari decompression. Evolving postsurgical changes as noted at the operative site. The subgaleal collection has substantially improved. Fluid density soft tissue overlying the dura plasty appears slightly more prominent. Expansion of the posterior subarachnoid space. CT technique and thick slice limit the evaluation for detecting dural rent with certainty however there appears to be a focal defect posteriorly as annotated on series 12 image 31 of series 2 image six. Additionally small amount of fluid/edema in the subcutaneous tissue and occipital region. There is no evidence of acute intra- or extra-axial hemorrhage. There is no midline shift, mass effect, Gray-white differentiation appears maintained. The ventricular system are normal in configuration. The basal cisterns are clear. The visualized paranasal sinuses and mastoid air cells are clear of acute process. The visualized bones of the calvarium demonstrate no acute osseous abnormality. Impression: 1. No acute intracranial process. 2. Evolving postsurgical changes from Chiari decompression, possibility of small pseudomeningocele cannot be excluded. Further evaluation with MRI is suggested if clinically indicated .
Findings: Patient status post suboccipital craniectomy, C1 laminectomy and duraplasty for Chiari decompression. Evolving postsurgical changes as noted at the operative site. The subgaleal collection has substantially improved. Fluid density soft tissue overlying the dura plasty appears slightly more prominent. Expansion of the posterior subarachnoid space. CT technique and thick slice limit the evaluation for detecting dural rent with certainty however there appears to be a focal defect posteriorly as annotated on series 12 image 31 of series 2 image six. Additionally small amount of fluid/edema in the subcutaneous tissue and occipital region. There is no evidence of acute intra- or extra-axial hemorrhage. There is no midline shift, mass effect, Gray-white differentiation appears maintained. The ventricular system are normal in configuration. The basal cisterns are clear. The visualized paranasal sinuses and mastoid air cells are clear of acute process. The visualized bones of the calvarium demonstrate no acute osseous abnormality.
FINDINGS: BONES/JOINTS: No acute fracture or malalignment. There is periosteal reaction along the medial tibia extending from the inferior level of the soft tissue mass caudally to the distal tibial diaphysis (for example, this is best demonstrated on series 2 image 492).. There is also osteolysis of the mid tibial shaft anterior cortex. In addition there are also several areas of new periosteal reaction involving the fibular shaft on axial image 54. This is present approximately 3.5 cm inferior to the anterior compartment lesion. SOFT TISSUES: There is a large peripherally enhancing mass within the anterior right mid calf measuring approximately 7.3 x 7.1 x 11.4 cm (series 301 image 211 and series 601 image 73), previously measuring 4.1 x 2.9 x 5.5 cm on MRI from 12/2/2021. The mass extends into the subcutaneous adipose tissues with overlying dermal thickening and surrounding edema.
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CT head without contrast Indication: Spec Inst: Parafalcine SDH - CT Head from St Francis done 12-10-21 rec 1-20-22. Comparison: CT head without contrast 11/2/2021. Technique: Multiple contiguous axial images of the brain were obtained from base to the vertex without the use of intravenous contrast. Sagittal and coronal reconstruction images were formatted in postprocessing. . Findings: Interval resolution of the subdural hemorrhage along the interhemispheric fissure. There is no evidence of acute intra- or extra-axial hemorrhage. There is no midline shift, mass effect, or other space-occupying lesion. Gray-white differentiation appears maintained. The ventricular system are normal in configuration. The basal cisterns are clear. The visualized paranasal sinuses and mastoid air cells are clear of acute process. The visualized bones of the calvarium demonstrate no acute osseous abnormality. Impression: No acute intracranial process. Interval resolution of the parafalcine SDH.
Findings: Interval resolution of the subdural hemorrhage along the interhemispheric fissure. There is no evidence of acute intra- or extra-axial hemorrhage. There is no midline shift, mass effect, or other space-occupying lesion. Gray-white differentiation appears maintained. The ventricular system are normal in configuration. The basal cisterns are clear. The visualized paranasal sinuses and mastoid air cells are clear of acute process. The visualized bones of the calvarium demonstrate no acute osseous abnormality.
Findings: Previously noted left neck soft tissue abscess is no longer visualized. Minimal underlying fat plane hyperattenuation and stranding is noted at the location of previous abscess and in the left supraclavicular region. There is interval size decrease of the left SCM muscle in favor of resolution of the myositis. Oropharyngeal lymphoid tissue is prominent in size likely reactive changes. The visualized aerodigestive tract is unremarkable. No pathologically enlarged cervical lymph nodes, several mildly prominent cervical nodes are unchanged. Parotid, submandibular salivary glands appear normal. The left thyroid lobe is diminutive. The visualized cervical vasculature is unremarkable. The limited images of the chest are unremarkable. No acute osseous abnormality.
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EXAM: Outside MR Image Interpretation CLINICAL INFORMATION: Left buttock UPS COMPARISON: Outside CT abdomen/pelvis and MR pelvis same day. No preoperative imaging available for comparison. TECHNIQUE: Outside MR images of the left femur without and with contrast dated 12/6/2021 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: A skin marker over the left buttock along the gluteal cleft presumably indicates the area of surgical resection. Deep to this marker, there is asymmetric soft tissue thickening which extends deep to likely involve the left levator ani muscle. On postcontrast images, this area demonstrates mild heterogeneous enhancement, findings could represent postsurgical scarring. No abnormal nodular enhancement is evident. Preoperative MRI is unavailable for comparison. No left inguinal femoral adenopathy identified. Muscles and tendons of the proximal left thigh are unremarkable. The left hip joint is also unremarkable. Distal left femur is not included in field-of-view on this exam. Visual portions of the lower pelvis and left proximal and mid femur without evidence of fracture, marrow replacement, or aggressive osseous lesion. No abnormal enhancement in the left proximal to mid femur on the postcontrast images. CONCLUSION: Mild Asymmetric thickening and mild enhancement of the soft tissues of the left perineum extending to the left levator ani. This could be related to postsurgical scarring. No preoperative imaging is available for comparison. Recommend attention on follow-up and correlation with findings of same day pelvic MR, dictated separately. 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.
FINDINGS: A skin marker over the left buttock along the gluteal cleft presumably indicates the area of surgical resection. Deep to this marker, there is asymmetric soft tissue thickening which extends deep to likely involve the left levator ani muscle. On postcontrast images, this area demonstrates mild heterogeneous enhancement, findings could represent postsurgical scarring. No abnormal nodular enhancement is evident. Preoperative MRI is unavailable for comparison. No left inguinal femoral adenopathy identified. Muscles and tendons of the proximal left thigh are unremarkable. The left hip joint is also unremarkable. Distal left femur is not included in field-of-view on this exam. Visual portions of the lower pelvis and left proximal and mid femur without evidence of fracture, marrow replacement, or aggressive osseous lesion. No abnormal enhancement in the left proximal to mid femur on the postcontrast images.
FINDINGS: Scouts: No additional findings. Lower neck and Mediastinum: Evaluation of the mediastinum is a slightly limited in the noncontrast study. Thyroid gland is unremarkable. No evidence of focal esophageal wall abnormalities. Ill-defined anterior mediastinal soft tissue, slightly increased from prior, likely represents thymic rebound. Lymph nodes: Within the limits of the noncontrast study, no evidence of new pathologically enlarged supraclavicular, axillary, mediastinal or hilar lymph nodes. Heart and great arteries: Cardiac chambers are normal in size. No pericardial effusion. The main pulmonary artery is mildly prominent and measures up to 3.2 cm. The thoracic aorta is normal in caliber. Mild atherosclerotic calcification of the coronary arteries is again noted. Interval removal of the left subclavian PICC.. Airways: The trachea and central bronchi are patent and clear. There is mild diffuse bronchial wall thickening, which could be seen with bronchitis, similar to prior. Lungs : Interval mild increase in size of the previously noted right apical cavitary pulmonary nodule, abutting the mediastinal pleura, which is now a solid nodule, measuring up to 22 x 29 mm (series 2, image 27), previously measured by myself at the same level up to 21 x 20 mm (series 201, image 26 of the prior exam), with interval resolution of the previously noted central cavitation. Interval decrease in the previously noted bilateral diffuse, upper lobe predominant, tree-in-bud nodular groundglass opacities and clustered pulmonary nodules. No new pulmonary parenchymal abnormalities. Pleura: No pleural effusion or pneumothorax. Upper abdomen: Limited noncontrast visualization of the upper abdomen is without acute or significant abnormalities. Bones and soft tissues: The visualized chest wall soft tissues are unremarkable. No aggressive or destructive intrathoracic osseous lesions.
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EXAM: Outside MR Image Interpretation CLINICAL INFORMATION: Left buttock undifferentiated pleomorphic sarcoma, status post resection COMPARISON: CT 12/6/2021. TECHNIQUE: Outside MR images with and without contrast dated 12/6/2021 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 Pelvis LOWER ABDOMEN: BOWEL: No abnormality. PERITONEUM: Normal. OTHER: No other abnormality. PELVIS: VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Focal area of soft tissue thickening and enhancement is observed within the puborectalis musculature/ischioanal fossa on the left aspect of the anal canal measuring about 2.7 x 1.7 cm (series 4 image 11). No significant T2 signal abnormality seen within this region to suggest acute/ongoing inflammation. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Focal enhancing region within the puborectalis musculature/ischioanal fossa, indeterminate but most likely postsurgical in nature. Local recurrence is felt less likely but not excluded. Comparison with prior imaging would be of benefit. 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.
FINDINGS: STRUCTURED REPORT: MRI Pelvis LOWER ABDOMEN: BOWEL: No abnormality. PERITONEUM: Normal. OTHER: No other abnormality. PELVIS: VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Focal area of soft tissue thickening and enhancement is observed within the puborectalis musculature/ischioanal fossa on the left aspect of the anal canal measuring about 2.7 x 1.7 cm (series 4 image 11). No significant T2 signal abnormality seen within this region to suggest acute/ongoing inflammation. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. Mild atherosclerotic calcifications of bilateral external iliac arteries. Moderate calcifications of bilateral internal iliac arteries, superficial and deep femoral arteries. Urinary bladder is partially distended. Prostate gland is not enlarged. No abnormal dilatation of visualized bowel loops in the lower abdomen/pelvis. Multilevel degenerative changes in the lower lumbar spine and pelvic bones. Superficial soft tissues of pelvic wall are unremarkable.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Left gluteal undifferentiated pleomorphic sarcoma status post resection COMPARISON: None. TECHNIQUE: Outside CT images with IV contrast 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. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately dictated CT chest. ABDOMEN and PELVIS: LIVER: Subcentimeter focus of hypoattenuation in the right hepatic dome on image 49 series 8. Additional subcentimeter focus hypoattenuation inferior right hepatic lobe on image 205 series 8. 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: Well-circumscribed rectal wall lipoma. Normal appendix. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered atherosclerotic calcifications of the abdominal aorta and branch vessels URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Asymmetric thickening of the soft tissues in the left perineum (3.4 x 2.1 cm on image 784 series 8) extending to the left levator ani. Small fat-containing umbilical hernia and small fat-containing left inguinal hernia. MUSCULOSKELETAL: No destructive osseous lesion. Chronic bilateral L5 pars defects. CONCLUSION: 1. Asymmetric thickening of the soft tissues in the left perineum extending to involve the left levator ani, which may be related to postsurgical scarring. Local recurrence is also a possibility. Recommend attention on follow-up and correlation with findings of same day pelvic MR. No other convincing evidence of recurrent or metastatic disease in the pelvis. 2. Subcentimeter foci of hypoattenuation in the liver are too small for accurate characterization, possible cysts. If clinically indicated, this could be confirmed with liver protocol MR with Eovist. 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.
FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately dictated CT chest. ABDOMEN and PELVIS: LIVER: Subcentimeter focus of hypoattenuation in the right hepatic dome on image 49 series 8. Additional subcentimeter focus hypoattenuation inferior right hepatic lobe on image 205 series 8. 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: Well-circumscribed rectal wall lipoma. Normal appendix. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered atherosclerotic calcifications of the abdominal aorta and branch vessels URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Asymmetric thickening of the soft tissues in the left perineum (3.4 x 2.1 cm on image 784 series 8) extending to the left levator ani. Small fat-containing umbilical hernia and small fat-containing left inguinal hernia. MUSCULOSKELETAL: No destructive osseous lesion. Chronic bilateral L5 pars defects.
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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Interpretation of Outside Films CT Chest Clinical Information: 51-year-old male Spec Inst: LT Buttock UPS - CT AbdPel from Mobile Infirmary Health done 12-6-21 rec 1-20-22 Study reviewed: CT of chest with contrast performed at mobile infirmary health Thomas North Baldwin ultimately on 12/6/2021, The images are available in PACS. Findings: Limitations: None. Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: Scattered calcified granulomas. No suspicious pulmonary nodule. No focal consolidation. Bilateral dependent atelectasis. Mild bronchiectatic changes mainly involving both lower lobes. The trachea and main bronchi are patent. No pleural effusion. Thoracic inlet, heart, and mediastinum: Partially calcified left thyroid nodule. No thoracic lymphadenopathy. 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: Reported separately. Conclusion: 1. No evidence of acute or metastatic disease in the chest. 2. Mild bronchiectatic changes mainly involving both lower lobes.
Findings: Limitations: None. Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: Scattered calcified granulomas. No suspicious pulmonary nodule. No focal consolidation. Bilateral dependent atelectasis. Mild bronchiectatic changes mainly involving both lower lobes. The trachea and main bronchi are patent. No pleural effusion. Thoracic inlet, heart, and mediastinum: Partially calcified left thyroid nodule. No thoracic lymphadenopathy. 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: Reported separately.
FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Small filling defect dependently in the distal trachea may represent retained secretions/aspiration. Small left pleural effusion. Bilateral dependent airspace opacities may represent a combination of atelectasis and aspiration. Scattered areas of septal thickening in the lung apices and diffuse groundglass opacities may represent pulmonary edema. HEART / OTHER VESSELS: Mild cardiomegaly. Small pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: A right chest port terminates in the right ventricle, unchanged. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: Innumerable low-attenuation lesions within the thoracic spine. Marked compression deformities of the thoracic vertebral bodies at multiple levels are again seen.
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Interpretation of Outside Films CT Chest Clinical Information: 47-year-old female with provided history of metastatic colon cancer. Spec Inst: Metastatic colon cancer - CT CAP from St Vincents done 12-2-21 rec 1-20-22 Study reviewed: CT of chest with contrast performed at St Vincents on 12/2/2021, The images are available in PACS. Findings: Limitations: None. Chest: Lines, tubes, and devices: None. 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 intrathoracic metastases.
Findings: Limitations: None. Chest: Lines, tubes, and devices: None. 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.
FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus.. Borderline enlargement pulmonary artery. LUNGS / AIRWAYS / PLEURA: Small, right greater than left, pleural effusions with overlying atelectasis and subtle ground glass opacities throughout both lungs. Lungs are otherwise aside from scattered atelectasis and/or scarring. HEART / OTHER VESSELS: Dilated right atrium MEDIASTINUM / ESOPHAGUS: Normal LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. Limited images through the upper abdomen show no acute abnormality. MUSCULOSKELETAL: There is a new T10 inferior endplate fracture
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Metastatic colon cancer COMPARISON: None. TECHNIQUE: Outside CT images with 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: Please see separately dictated CT chest. ABDOMEN and PELVIS: LIVER: Multiple ill-defined hypoattenuating lesions in the hepatic dome with the largest lesion measuring 2.6 x 1.9 cm on image 118 series 11. Smaller more posterior right hepatic dome lesion measures 1.2 x 1.0 cm on image 109 series 11. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Subcentimeter foci of hypoattenuation are too small for accurate characterization. LYMPH NODES: Enlarged left upper quadrant lymph nodes adjacent to the area of irregular colonic wall thickening with the largest measuring 3.0 x 2.7 cm on image 141 series 11. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Focal area of irregular wall thickening with adjacent stranding in the proximal descending colon (image 137 series 11, image 73 series 6). Normal appendix. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Physiologic ovarian cysts. BODY WALL: Small fat-containing umbilical hernia. Small fat-containing ventral hernia to the right of midline with the abdominal wall defect measuring 1.6 cm on image 196 series 11. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Focal irregular wall thickening in the proximal descending colon is likely primary site of patient's colon cancer. Adjacent left upper quadrant nodal metastases. 2. Ill-defined hypoattenuating hepatic dome lesions are indeterminate on the current CT examination, but suspicious for hepatic metastases. Correlation with subsequently performed liver MR with Eovist 1/20/2022 is recommended. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately dictated CT chest. ABDOMEN and PELVIS: LIVER: Multiple ill-defined hypoattenuating lesions in the hepatic dome with the largest lesion measuring 2.6 x 1.9 cm on image 118 series 11. Smaller more posterior right hepatic dome lesion measures 1.2 x 1.0 cm on image 109 series 11. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Subcentimeter foci of hypoattenuation are too small for accurate characterization. LYMPH NODES: Enlarged left upper quadrant lymph nodes adjacent to the area of irregular colonic wall thickening with the largest measuring 3.0 x 2.7 cm on image 141 series 11. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Focal area of irregular wall thickening with adjacent stranding in the proximal descending colon (image 137 series 11, image 73 series 6). Normal appendix. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Physiologic ovarian cysts. BODY WALL: Small fat-containing umbilical hernia. Small fat-containing ventral hernia to the right of midline with the abdominal wall defect measuring 1.6 cm on image 196 series 11. MUSCULOSKELETAL: No significant abnormality.
FINDINGS: SOFT TISSUES: Postsurgical changes with multifocal dermal thickening and subcutaneous fat stranding related to prior Mohs surgery of the left frontal scalp, left supraorbital ridge, and infratemporal fossa (for example: series 3; images 11, 29, 85). Two subcentimeter left facial cutaneous nodules without subcutaneous invasion (series 3, images 127 and 136. LYMPH NODES: There are mildly enlarged bilateral cervical lymph nodes mainly in the bilateral level two. AERODIGESTIVE STRUCTURES: There is a 22 x 30 mm enhancing mucosal mass lesion centered in the right aspect of epiglottis and right piriform sinus highly suggestive for neoplasm such as SCC. PAROTID GLANDS: Normal. SUBMANDIBULAR GLANDS: Normal. THYROID GLAND: Normal. VASCULAR STRUCTURES: Mild thoracic aorta and proximal great vessel atherosclerotic calcifications. Mixed-type noncalcified calcified atherosclerotic plaque at the bilateral carotid siphons with moderate to severe stenosis of the right proximal ICA. Minimal bilateral carotid siphon atherosclerotic calcifications. Carotid artery calcification is seen. OSSEOUS STRUCTURES: No fracture, dislocation, or destructive lesion. ORBITS: Normal. PARANASAL SINUSES AND MASTOID AIR CELLS: Left maxillary sinus mucous retention cyst. The remaining paranasal sinuses are well-aerated. Partial right mastoid effusion. The left mastoid air cells are clear. PARTIALLY VISUALIZED INTRACRANIAL STRUCTURES: Confluent deep white matter hypoattenuation, likely moderate chronic microangiopathic changes. LUNG APICES: Thin-walled subpleural posterior right upper lobe intraparenchymal cyst. Bilateral dependent atelectasis.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Duplication cyst versus esophageal mass. COMPARISON: None. TECHNIQUE: Outside CT images with IV contrast 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: Normal. DISTAL ESOPHAGUS: Diffuse, masslike concentric wall thickening of the distal esophagus, just above the gastroesophageal junction measuring approximately 4.7 x 4.2 cm. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Diffuse hepatic steatosis with small areas of geographic sparing near the gallbladder fossa. No focal hepatic lesion. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Scattered subcentimeter hypoattenuating foci involving the left kidney are too small to characterize, but statistically likely to represent cysts. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Appendix is surgically absent. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostate is grossly unremarkable. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Masslike thickening expands the distal esophagus, concerning for malignancy. The patient is scheduled to undergo endoscopy with biopsy today. 2. Hepatic steatosis. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Diffuse, masslike concentric wall thickening of the distal esophagus, just above the gastroesophageal junction measuring approximately 4.7 x 4.2 cm. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Diffuse hepatic steatosis with small areas of geographic sparing near the gallbladder fossa. No focal hepatic lesion. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Scattered subcentimeter hypoattenuating foci involving the left kidney are too small to characterize, but statistically likely to represent cysts. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Appendix is surgically absent. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostate is grossly unremarkable. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
FINDINGS: Examination limited due to lack of intravenous contrast and photons duration artifact. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Minimal bibasilar subpleural bandlike atelectasis versus scarring. Mosaic attenuation with mild air trapping is seen on expiration. No focal consolidation or suspicious nodules. No pneumothorax. No effusions. Minimal lower lobe predominant bronchiectasis. HEART / VESSELS: Enlargement pulmonary artery. Cardiomegaly. Minimal coronary artery calcifications. Increased caliber peripheral pulmonary arteries. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Postcholecystectomy changes. Splenic autoinfarction. MUSCULOSKELETAL: No significant abnormality. Heterogeneous osseous structures.
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EXAM: Outside CT Image Interpretation CT abdomen and pelvis with and without contrast CLINICAL INFORMATION: 77-year-old female reportedly with pancreatic mass. COMPARISON: None available at UAB TECHNIQUE: Outside CT images without and with IV contrast dated 12/21/2021 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 Pancreatic Mass FINDINGS: LOWER CHEST: LUNG BASES / PLEURA: Trace dependent bibasilar atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Small subcentimeter low-density lesion in hepatic segment VI is most likely a small hepatic cyst. No other lesions are suspicious for metastasis. PERITONEUM: No ascites. No suspicious peritoneal nodules. PANCREAS: Locally invasive hypoattenuating pancreatic mass is described below. Pancreatic mass: - Location: Body and tail. The measurement is likely foreshortened given the shape of the pancreas in extensive infiltrative appearance. - Size: 5.3 cm x 3.6 cm (series 3, image 27). - 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): Tumor contact with vessel deformity and/or involvement >=180 degrees [UNRESECTABLE - LOCALLY ADVANCED]. - Common Hepatic Artery (CHA): Tumor contact with extension to proper hepatic artery or celiac axis and/or involvement >=180 degrees. [UNRESECTABLE - LOCALLY ADVANCED] . Slight narrowing of the common hepatic artery (series 3, image 22). - Superior Mesenteric Artery (SMA): Tumor contact >180 degrees without contour abnormality. - Aorta: No definite tumor contact. - Main Portal Vein (PV) and Superior Mesenteric Vein (SMV): Tumor contact
FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Pancreatic Mass FINDINGS: LOWER CHEST: LUNG BASES / PLEURA: Trace dependent bibasilar atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Small subcentimeter low-density lesion in hepatic segment VI is most likely a small hepatic cyst. No other lesions are suspicious for metastasis. PERITONEUM: No ascites. No suspicious peritoneal nodules. PANCREAS: Locally invasive hypoattenuating pancreatic mass is described below. Pancreatic mass: - Location: Body and tail. The measurement is likely foreshortened given the shape of the pancreas in extensive infiltrative appearance. - Size: 5.3 cm x 3.6 cm (series 3, image 27). - 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): Tumor contact with vessel deformity and/or involvement >=180 degrees [UNRESECTABLE - LOCALLY ADVANCED]. - Common Hepatic Artery (CHA): Tumor contact with extension to proper hepatic artery or celiac axis and/or involvement >=180 degrees. [UNRESECTABLE - LOCALLY ADVANCED] . Slight narrowing of the common hepatic artery (series 3, image 22). - Superior Mesenteric Artery (SMA): Tumor contact >180 degrees without contour abnormality. - Aorta: No definite tumor contact. - Main Portal Vein (PV) and Superior Mesenteric Vein (SMV): Tumor contact
FINDINGS: Examination limited due to patient motion. BONES/JOINTS: No acute fracture or aggressive osseous lesion of the tibia or fibula, within limits of patient motion. Incidentally noted well-circumscribed stippled sclerotic lesion of the proximal tibial metaphysis measuring 1.5 x 0.9 cm (image 38 series 80360), consistent with a benign cartilaginous lesion such as an enchondroma. Subtle serpiginous sclerotic changes within the proximal tibial diaphysis could represent a developing bone infarct (series 80412 image 48). Degenerative changes of the knee, most pronounced in the patellofemoral femoral compartment. There is no osseous erosion, cortical indistinctness, or abnormal periosteal reaction seen. SOFT TISSUES: Diffuse skin thickening of the foreleg with marked thickening and septation of the subcutaneous fat. No large fluid collection, within limits of noncontrast technique. Diffuse atherosclerotic calcifications.
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EXAM: Outside MR Image Interpretation CLINICAL INFORMATION: Prostate cancer, eval for extracapsular extension. for Dr Snider Rad Onc Spec Inst: MRI Pelvis from Hsv Hospital done 10-8-21 rec 1-20-22 COMPARISON: None. TECHNIQUE: Outside MR images without and with IV contrast dated 10/8/2021 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: 3.0 x 4.6 x 5.0 cm; estimated volume: 36 cc Focal lesion(s): Lesion # 1 (index lesion): - Key image: image 12; series 11 - Size: 23 x 17 mm - Location: left; base; anterior central gland - T2WI: 5; DWI: 5; DCE (early and focal enhancement): positive - PI-RADS v2.1 score: 5 - Very high (clinically significant cancer is highly likely to be present) - Likelihood of extraprostatic extension: 1 - Highly unlikely - Likelihood of seminal vesicle invasion: 1 - Highly unlikely Diffuse prostate abnormalities: Diffusely striated appearance of the peripheral zone on T2WI may reflect prostatitis Other prostate findings: None. VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. BLADDER: Within normal limits. OTHER PELVIC FINDINGS: Scattered colonic diverticuli. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. Note: For more details about the Prostate Imaging-Reporting and Data System (PI-RADS) version 2.1, please visit: http://www.acr.org/Quality-Safety/Resources/PIRADS CONCLUSION: T2 hypointense lesion within the base of the left mid gland which demonstrates restricted diffusion and early focal postcontrast enhancement, highly suspicious for clinically significant prostate cancer (PIRADS 5). No convincing evidence of extracapsular extension or extraprostatic 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.
FINDINGS: STRUCTURED REPORT: MRI Prostate PROSTATE: Measurement: 3.0 x 4.6 x 5.0 cm; estimated volume: 36 cc Focal lesion(s): Lesion # 1 (index lesion): - Key image: image 12; series 11 - Size: 23 x 17 mm - Location: left; base; anterior central gland - T2WI: 5; DWI: 5; DCE (early and focal enhancement): positive - PI-RADS v2.1 score: 5 - Very high (clinically significant cancer is highly likely to be present) - Likelihood of extraprostatic extension: 1 - Highly unlikely - Likelihood of seminal vesicle invasion: 1 - Highly unlikely Diffuse prostate abnormalities: Diffusely striated appearance of the peripheral zone on T2WI may reflect prostatitis Other prostate findings: None. VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. BLADDER: Within normal limits. OTHER PELVIC FINDINGS: Scattered colonic diverticuli. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. Note: For more details about the Prostate Imaging-Reporting and Data System (PI-RADS) version 2.1, please visit: http://www.acr.org/Quality-Safety/Resources/PIRADS
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Multiple subcentimeter arterial phase foci of hyperenhancement are seen, predominantly peripheral, grossly unchanged from prior, without a definite correlate on portal venous phase. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: 1.4 cm left nonobstructing hilar stone. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Moderate hiatal hernia COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No ascites. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Fibroid uterus. Ovaries are unremarkable. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Diffuse sclerotic metastasis are again seen, similar to prior
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CT scan of the soft tissues of the neck with contrast. Outside scan dated 12/13/2021 for interpretation only. Findings: There are postsurgical changes following partial glossectomy and there is a sizable graft containing fat in the floor the mouth on the right. There is a 1.8 x 2.4 cm mass along the upper posterior aspect of the left tongue, apparent tumor. There is slight fullness in the inferior aspect of the left 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 a nodule in the left lung abutting the pleura (axial series 6 #91). CT scan of the chest is suggested. -------------- Conclusion: Small mass along the posterior aspect of the left tongue. Comparison with prior scans and follow-up CT scan of soft tissues of the neck is suggested. Nodular mass in the left lung; follow-up CT chest is suggested.
Findings: There are postsurgical changes following partial glossectomy and there is a sizable graft containing fat in the floor the mouth on the right. There is a 1.8 x 2.4 cm mass along the upper posterior aspect of the left tongue, apparent tumor. There is slight fullness in the inferior aspect of the left 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 a nodule in the left lung abutting the pleura (axial series 6 #91). CT scan of the chest is suggested. --------------
FINDINGS: Limitations: Evaluation of chest findings is significantly limited by severe respiratory motion artifacts, especially evaluation of the pulmonary parenchyma. Scouts: No additional findings. Lower neck and Mediastinum: Moderate hiatal hernia is again noted with associated mild diffuse patulous esophagus. No new focal esophageal wall abnormalities. Lymph nodes: No new pathologically enlarged supraclavicular, axillary, mediastinal or hilar lymph nodes. Few calcified right hilar lymph nodes are again noted. Heart and great arteries: Cardiac chambers are normal in size. No pericardial effusion. Mediastinal great arteries are normal in caliber. No evidence of large central pulmonary thromboembolic disease. Airways: Trachea and central bronchi are patent and clear. Lungs : Evaluation of the pulmonary parenchyma is significantly limited by multiple respiratory motion artifacts. Within these limits, there appears to be an interval relatively stable bilateral diffuse tiny pulmonary nodules. Linear opacities of scarring/atelectasis within the left lung are again noted. Pleura: Residual trace possible loculated left pleural effusion. No pneumothorax. Upper abdomen: The CT of the abdomen and pelvis will be reported separately. Bones and soft tissues: The previously noted left breast soft tissue nodule is unchanged when compared to prior, now measures up to 21 x 25 mm (series 13, image 80), previously measured the same. No new chest wall soft tissue abnormalities. Diffuse chest skeletal osteolytic and osteo-sclerotic osseous metastatic deposits are largely unchanged when compared to prior, with redemonstrated severe compression fracture of T2 vertebral body with more than 50% height loss.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Uterine mass COMPARISON: None. TECHNIQUE: CT study of abdomen and pelvis 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: 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: Normal. GALLBLADDER: Surgically absent PANCREAS: Atrophic SPLEEN: Normal ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Uncomplicated colonic diverticulosis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Partially distended REPRODUCTIVE ORGANS: Enlarged uterus containing heterogeneous mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Multilevel degenerative changes in lumbar spine predominantly L4-L5 and L5-S1. No destructive osseous lesions. CONCLUSION: 1. Enlarged uterus with large heterogenous mass which may represent large uterine fibroid or uterine cancer. 2. No metastatic disease in the abdomen and pelvis.
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: Normal. GALLBLADDER: Surgically absent PANCREAS: Atrophic SPLEEN: Normal ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Uncomplicated colonic diverticulosis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Partially distended REPRODUCTIVE ORGANS: Enlarged uterus containing heterogeneous mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Multilevel degenerative changes in lumbar spine predominantly L4-L5 and L5-S1. No destructive osseous lesions.
Findings: Extensive streak artifact from dental hardware limits evaluation of the oral cavity. The proximal right Stensen's duct appears prominent in size and measures 5 mm adjacent to the right parotid gland but without obvious filling defect or density suggestive for stone. The nasopharynx and oropharynx are normal. The base of the tongue and lymphoid tissue within Waldeyer's ring are unremarkable. The hypopharynx and larynx are normal. The submandibular and thyroid glands are normal. No discrete mass or necrotic lymphadenopathy. Imaged portions of the brain and skull base are normal.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: 48 years old female with lymphadenopathy COMPARISON: None. TECHNIQUE: Outside hospital CT study of abdomen and pelvis dated 11/25/2021. 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: No significant abnormality. 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: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Mild central mesenteric haziness. No ascites or pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Bilateral femoral hardware. No destructive osseous lesions. CONCLUSION: 1. A few subcentimeter mesenteric lymph nodes with associated mesenteric haziness, is nonspecific, may be related to sclerosing mesenteritis. No suspicious enlarged abdominal or pelvic lymph nodes. 2. Otherwise unremarkable unenhanced CT of the abdominal pelvis.
FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. 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: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Mild central mesenteric haziness. No ascites or pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Bilateral femoral hardware. No destructive osseous lesions.
Findings: Evolving infarcts in the left frontal lobe and insular region as well as parietal lobe are again noted without superimposed hemorrhagic transformation. There is localized mass effect without midline shift. There is no evidence of new infarction, hemorrhage or hydrocephalus. There is no new edema or mass effect. Chronic bilateral small cerebellar infarcts are also noted. Chronic left maxillary sinus hyperostosis with mucosal thickening is again noted. There is partial left frontal sinus opacification. The remaining 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: 78-year-old male with history of bladder cancer status post cystectomy with ileal conduit. COMPARISON: None available at UAB TECHNIQUE: Outside CT images from Main 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: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. No suspicious pulmonary nodules. DISTAL ESOPHAGUS: Normal. ABDOMEN and PELVIS: LIVER: Subcentimeter hypoattenuating lesions in the hepatic lobe without prior imaging for comparison are statistically simple hepatic cysts. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: 4.0 cm indeterminate right renal hypodensity on image 80 series 2. Simple lower pole renal cyst. Subcentimeter hypodensity left kidney is statistically a cyst but formally indeterminate. Ureters a diverted and now drain into a right lower quadrant neobladder. No hydroureteroneprehrosis. LYMPH NODES: Normal STOMACH / SMALL BOWEL: Postsurgical changes of urinary conversion with ileal conduit are seen in the right lower quadrant. Nonspecific fat stranding adjacent to the subcutaneous portion of conduit. COLON: anastomotic staple line is seen at the hepatic flexure. PERITONEUM / MESENTERY: No ascites. RETROPERITONEUM: Normal. VESSELS: Moderate calcific atherosclerosis of the abdominal aorta. URINARY BLADDER: Surgically absent. REPRODUCTIVE ORGANS: Surgically absent BODY WALL: Right lower quadrant ileal conduit. Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: Postsurgical changes of posterior spinal fusion of L4 and L5 with severe degenerative change at the L3-L4 level. There is significant narrowing of the bilateral L3-L4 neural foramen. No destructive osseous lesions seen. CONCLUSION: 1. Postsurgical changes of cystectomy and urinary diversion with ileal conduit. 2. No definite evidence of metastatic disease in abdomen pelvis. 3. Postsurgical changes and chronic findings 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. Addendum: An item was added to the impression: EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: 78-year-old male with history of bladder cancer status post cystectomy with ileal conduit. COMPARISON: None available at UAB TECHNIQUE: Outside CT images from Main 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: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. No suspicious pulmonary nodules. DISTAL ESOPHAGUS: Normal. ABDOMEN and PELVIS: LIVER: Subcentimeter hypoattenuating lesions in the hepatic lobe without prior imaging for comparison are statistically simple hepatic cysts. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: 4.0 cm indeterminate right renal hypodensity on image 80 series 2. Simple lower pole renal cyst. Subcentimeter hypodensity left kidney is statistically a cyst but formally indeterminate. Ureters a diverted and now drain into a right lower quadrant neobladder. No hydroureteronephrosis. LYMPH NODES: Normal STOMACH / SMALL BOWEL: Postsurgical changes of urinary conversion with ileal conduit are seen in the right lower quadrant. Nonspecific fat stranding adjacent to the subcutaneous portion of conduit. COLON: anastomotic staple line is seen at the hepatic flexure. PERITONEUM / MESENTERY: No ascites. RETROPERITONEUM: Normal. VESSELS: Moderate calcific atherosclerosis of the abdominal aorta. URINARY BLADDER: Surgically absent. REPRODUCTIVE ORGANS: Surgically absent BODY WALL: Right lower quadrant ileal conduit. Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: Postsurgical changes of posterior spinal fusion of L4 and L5 with severe degenerative change at the L3-L4 level. There is significant narrowing of the bilateral L3-L4 neural foramen. No destructive osseous lesions seen. CONCLUSION: 1. 4.0 cm indeterminate hypodensity off the right kidney. Recommend ultrasound for further evaluation. 2. Postsurgical changes of cystectomy and urinary diversion with ileal conduit. 3. No definite evidence of metastatic disease in abdomen pelvis. 4. Postsurgical changes and chronic findings 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.
FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. No suspicious pulmonary nodules. DISTAL ESOPHAGUS: Normal. ABDOMEN and PELVIS: LIVER: Subcentimeter hypoattenuating lesions in the hepatic lobe without prior imaging for comparison are statistically simple hepatic cysts. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: 4.0 cm indeterminate right renal hypodensity on image 80 series 2. Simple lower pole renal cyst. Subcentimeter hypodensity left kidney is statistically a cyst but formally indeterminate. Ureters a diverted and now drain into a right lower quadrant neobladder. No hydroureteroneprehrosis. LYMPH NODES: Normal STOMACH / SMALL BOWEL: Postsurgical changes of urinary conversion with ileal conduit are seen in the right lower quadrant. Nonspecific fat stranding adjacent to the subcutaneous portion of conduit. COLON: anastomotic staple line is seen at the hepatic flexure. PERITONEUM / MESENTERY: No ascites. RETROPERITONEUM: Normal. VESSELS: Moderate calcific atherosclerosis of the abdominal aorta. URINARY BLADDER: Surgically absent. REPRODUCTIVE ORGANS: Surgically absent BODY WALL: Right lower quadrant ileal conduit. Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: Postsurgical changes of posterior spinal fusion of L4 and L5 with severe degenerative change at the L3-L4 level. There is significant narrowing of the bilateral L3-L4 neural foramen. No destructive osseous lesions seen.
FINDINGS: Heterogeneous, basilar predominant subpleural reticulation with associated honeycombing in the bilateral lower lobes, left greater than right is again noted. The overall severity and extent of disease has not significantly changed from the prior examination. Mild traction bronchiectasis in association with the fibrosis is not significantly changed. Within these areas of fibrosis, there are multiple punctate calcific nodules suggestive of pulmonary ossification. A 15 x 9 mm nodular opacity within the right upper lobe on image 99 of series 3 is unchanged from the prior examination. There is an 11 x 7 mm subpleural nodule within the left upper lobe on image 72 which is increased in size from the prior examination where there was a small cluster of nodular opacities. No acute lung abnormality. The thyroid gland is unremarkable. Central airways are patent. The thoracic aorta is nonaneurysmal. The main pulmonary artery is dilated measuring up to 3.4 cm, similar to prior. The heart is not enlarged. No pericardial effusion. Prominent mediastinal and right hilar lymph nodes are again noted. A 14 mm short axis AP window lymph node on image 71 of series 3 is not significantly changed in size. A subcarinal lymph node measuring up to 10 mm in short axis. A 20 x 16 mm right hilar lymph node on image 93 is also unchanged. No new or enlarging thoracic lymph nodes are identified. The esophagus is not dilated. There is no acute or aggressive osseous abnormality.
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EXAM: Outside MR Image Interpretation CLINICAL INFORMATION: History of neuroendocrine tumor status post bland ablation of liver metastases COMPARISON: MRI dated 7/27/2021 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. Interpretation is limited secondary to the absence of ADC and DWI images and the absence of nonsubtracted postcontrast images. FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: Elevation of the right hemidiaphragm with adjacent atelectasis. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: The liver is normal in morphology. Decrease in size of the treated T2 hyperintense lesion in hepatic segment and VI, which measures 3.1 x 3.1 cm on image 23 series 4, previously measuring 3.5 x 3.1 cm. Similar peripheral enhancement is likely related to posttreatment change. Lesion continues to restrict diffusion. Decrease in size of the treated T2 hyperintense lesion in hepatic segment VII, which measures 1.7 x 1.3 cm on image 17 series 4, previously measuring 2.1 x 1.8 cm. Similar peripheral enhancement, which is likely related to post treatment change. Lesion continues to be restrict diffusion. Previously described foci of diffusion restriction scattered throughout the liver are less distinct on today's and secondary to combination of technique and patient motion. An example is a persistent restricted diffusion in the hepatic dome seen on image 62 series 9. There is no corresponding enhancement associated with this lesion. No new enhancing lesions. There is T2 hyperintense signal medial to the superior lesion on series 5 image 16 of unclear significance. There is some enhancement in this area however there is ill-defined and does not definitively correlate. BILIARY TRACT: Stable dilation of the common bile duct, which measures up to 1 cm on image 25 series 4. GALLBLADDER: Absent. PANCREAS: Enhancing lesion in the proximal pancreatic body measures 4 x 1.4 cm on image 86 series 11402, previously measuring similarly. Unchanged cystic lesion in the uncinate process. SPLEEN: Borderline size with small splenule. ADRENALS: Normal. KIDNEYS: Right renal cyst. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: Bilateral breast implants. MUSCULOSKELETAL: No significant abnormality. Nonenhanced, nonfat sat T1 images of the pelvis demonstrate colonic diverticula. Uterus is surgically absent. CONCLUSION: 1. Decreased size of the treated right hepatic lobe metastases. No evidence of new arterial enhancing lesion. 2. Previously described foci of diffusion restriction scattered throughout the liver are not well seen on this exam; however, some do persist. These do not demonstrate associated enhancement. Recommend continued attention on follow-up as small metastases are not excluded. In addition a T2 hyperintense area medial to the superior treated lesion demonstrates ill-defined enhancement but no restricted diffusion or definite correlate on other sequences. Attention on follow-up also suggested. 3. Enhancing lesion in the pancreatic body may represent site of primary neuroendocrine tumor. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: Elevation of the right hemidiaphragm with adjacent atelectasis. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: The liver is normal in morphology. Decrease in size of the treated T2 hyperintense lesion in hepatic segment and VI, which measures 3.1 x 3.1 cm on image 23 series 4, previously measuring 3.5 x 3.1 cm. Similar peripheral enhancement is likely related to posttreatment change. Lesion continues to restrict diffusion. Decrease in size of the treated T2 hyperintense lesion in hepatic segment VII, which measures 1.7 x 1.3 cm on image 17 series 4, previously measuring 2.1 x 1.8 cm. Similar peripheral enhancement, which is likely related to post treatment change. Lesion continues to be restrict diffusion. Previously described foci of diffusion restriction scattered throughout the liver are less distinct on today's and secondary to combination of technique and patient motion. An example is a persistent restricted diffusion in the hepatic dome seen on image 62 series 9. There is no corresponding enhancement associated with this lesion. No new enhancing lesions. There is T2 hyperintense signal medial to the superior lesion on series 5 image 16 of unclear significance. There is some enhancement in this area however there is ill-defined and does not definitively correlate. BILIARY TRACT: Stable dilation of the common bile duct, which measures up to 1 cm on image 25 series 4. GALLBLADDER: Absent. PANCREAS: Enhancing lesion in the proximal pancreatic body measures 4 x 1.4 cm on image 86 series 11402, previously measuring similarly. Unchanged cystic lesion in the uncinate process. SPLEEN: Borderline size with small splenule. ADRENALS: Normal. KIDNEYS: Right renal cyst. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: Bilateral breast implants. MUSCULOSKELETAL: No significant abnormality. Nonenhanced, nonfat sat T1 images of the pelvis demonstrate colonic diverticula. Uterus is surgically absent.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. Mild diffuse ectasia of bilateral common iliac, internal and external iliac arteries without focal aneurysm or significant wall calcifications. Partially visualized small/large bowel loops in the lower abdomen/pelvis are nondilated. Urinary bladder is partially distended. No enlarged pelvic lymph nodes. No intra-abdominal/pelvic free fluid. Superficial soft tissues of pelvic wall are unremarkable. Patchy sclerotic changes in the femoral bones likely degenerative without any definite findings of osteonecrosis. There are multiple degenerative periarticular geodes seen. No osseous destructive changes.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Vaginal squamous cell carcinoma COMPARISON: CT abdomen pelvis dated 3/2/2014 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: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Unchanged tiny subcentimeter hypodensity in the left hepatic lobe. No suspicious or new hepatic lesion is identified. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Sigmoid diverticulosis. Next is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: There is a rounded low-density structure in the right adnexa measuring approximately 2.0 cm (series 2, image 129), difficult to discretely separate from adjacent fluid-filled loops of bowel. Uterus is absent. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Bilateral sacral stimulator with generator in the right lower back soft tissues. CONCLUSION: Possible right adnexal cyst versus fluid-filled loop of bowel. Recommend correlation with more recent prior outside imaging versus evaluation with pelvic ultrasound if indicated. Otherwise no evidence of abdominopelvic metastatic 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.
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: Unchanged tiny subcentimeter hypodensity in the left hepatic lobe. No suspicious or new hepatic lesion is identified. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Sigmoid diverticulosis. Next is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: There is a rounded low-density structure in the right adnexa measuring approximately 2.0 cm (series 2, image 129), difficult to discretely separate from adjacent fluid-filled loops of bowel. Uterus is absent. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Bilateral sacral stimulator with generator in the right lower back soft tissues.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Small left pleural effusion with adjacent atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Redemonstration of numerous hypoattenuating lesions throughout the liver. A lesion within the right hepatic dome measures 4.5 x 3.9 cm (series 2 image 30), previously measured 4.4 x 3.9 cm (series 9 image 185). BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Stable multiple areas of hypoattenuation within the inferior spleen consistent with metastatic disease. ADRENALS: Enhancing left adrenal lesion measures 2.8 x 1.7 cm (series 2 image 93), previously 2.6 x 1.7 cm (series 9 image 259). KIDNEYS: Stable right anterior heterogenously enhancing lesion measures 4.1 x 2.3 cm (series 2 image 135), previously measured 4.5 x 2.5 cm (series 4 image 147). Unchanged bilateral subcentimeter hypodensities which are likely cysts. LYMPH NODES: Retroperitoneal and periportal lymphadenopathy is unchanged with the reference periportal lymph node measuring 1.3 cm in short axis (series 2 image 113). STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered noninflamed colonic diverticula. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate calcific and noncalcific atherosclerosis of the abdominal aorta and its branch vessels. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostatomegaly. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Discogenic degenerative changes most prominent at L5-S1.
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Interpretation of outside CT the chest without contrast from East Alabama Medical Center dated 12/22/2021. Indication: Evaluate for Haller index Technique: Noncontrast axial 1 mm and 3 mm reconstructions are presented. Additional 3 mm coronal and sagittal MPR reconstructions are available. Comparison: None Findings: Remnant thymic tissue is seen. No enlarged intrathoracic lymph nodes are identified. Within the limits of a noncontrast exam, the heart size and the mediastinum are otherwise normal. No pleural effusion. Slight biapical pleural parenchymal scarring is seen. Tiny nodule is seen along the right minor fissure on series 4 image 403 consistent with benign intrapulmonary lymph node. Mild bilateral bronchial wall thickening is seen. The lungs are otherwise normal. Limited noncontrast images of the upper abdomen are unremarkable. The sternum is tilted slightly to the right but without pectus excavatum. The Haller index is 266/117 or 2.27 on series 4 image 505. This is measured from the right anterior rib cartilage just below the level of the xiphoid to the spine. The bones are otherwise normal. Two ventricular peritoneal shunts are seen in the anterior right chest wall. Conclusion: 1. The Haller index and little just below the xiphoid at the level the diaphragm is 2.27. Visually no significant pectus excavatum deformity is seen. 2. Mild bilateral bronchial wall thickening which may represent airway disease.
Findings: Remnant thymic tissue is seen. No enlarged intrathoracic lymph nodes are identified. Within the limits of a noncontrast exam, the heart size and the mediastinum are otherwise normal. No pleural effusion. Slight biapical pleural parenchymal scarring is seen. Tiny nodule is seen along the right minor fissure on series 4 image 403 consistent with benign intrapulmonary lymph node. Mild bilateral bronchial wall thickening is seen. The lungs are otherwise normal. Limited noncontrast images of the upper abdomen are unremarkable. The sternum is tilted slightly to the right but without pectus excavatum. The Haller index is 266/117 or 2.27 on series 4 image 505. This is measured from the right anterior rib cartilage just below the level of the xiphoid to the spine. The bones are otherwise normal. Two ventricular peritoneal shunts are seen in the anterior right chest wall.
Findings: There is no CT evidence of intracranial hemorrhage, acute infarct, hydrocephalus, or mass effect. The interface between the gray and white matter is preserved. Minimal mucosal thickening of the right frontal and anterior ethmoidal air cells. The rest of the paranasal sinuses and mastoid air cells are clear.
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Interpretation of Outside Films MR CSPN CLINICAL INFORMATION: 46 years Female Spec Inst: MRI C-SPINE 122821 REC 012122 MONTGOMERY OPEN COMPARISON: TECHNIQUE: Multiplanar, multisequence MRI of the cervical spine was performed before and after the intravenous administration of contrast. FINDINGS: CRANIOCERVICAL JUNCTION: Craniocervical articulations and alignment are preserved. VERTEBRA: Cervical vertebral body height and anterior alignment are preserved. Vertebra demonstrate normal marrow signal. DISC SPACES AND FACET JOINTS: At C5-C6 there is a broad disc bulge with superimposed central disc protrusion resulting in moderate to severe narrowing of the spinal canal with flattening of the cervical spinal cord. There is only minimal CSF at this level. There is also mild bilateral neural foraminal narrowing at this level No other significant degenerative disc disease. POSTERIOR FOSSA \T\ CORD: Visualized posterior fossa structures have a normal appearance. The spinal cord demonstrates normal intrinsic signal. No abnormal cord enhancement. PARAVERTEBRAL SOFT TISSUES: No significant abnormality. IMPRESSION: C5-C6 posterior disc protrusion and ligamentum flavum thickening combining to result in moderate-severe spinal canal narrowing with flattening of the cervical spinal cord. There is however no definite abnormal cord signal. There is impending cord compression at this level. Mild bilateral neural foraminal narrowing at this level. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: CRANIOCERVICAL JUNCTION: Craniocervical articulations and alignment are preserved. VERTEBRA: Cervical vertebral body height and anterior alignment are preserved. Vertebra demonstrate normal marrow signal. DISC SPACES AND FACET JOINTS: At C5-C6 there is a broad disc bulge with superimposed central disc protrusion resulting in moderate to severe narrowing of the spinal canal with flattening of the cervical spinal cord. There is only minimal CSF at this level. There is also mild bilateral neural foraminal narrowing at this level No other significant degenerative disc disease. POSTERIOR FOSSA \T\ CORD: Visualized posterior fossa structures have a normal appearance. The spinal cord demonstrates normal intrinsic signal. No abnormal cord enhancement. PARAVERTEBRAL SOFT TISSUES: No significant abnormality.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Right lower lobe atelectatic collapse with multifocal mucus plugging. Focal tree-in-bud nodularity in the right upper lobe Trace right pleural effusion. There is a small amount of atelectasis at the left base. DISTAL ESOPHAGUS: Small hiatal hernia with distal esophageal wall thickening which can be seen with reflux esophagitis. HEART / VESSELS: The heart is enlarged. Small pericardial effusion. Coronary calcifications are noted. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Obstructing proximal left ureteral stone measuring up to 1 cm on axial series 201 image 155. There is associated moderate upstream hydroureteronephrosis and delayed nephrogram suggesting obstructive physiology. There is urothelial thickening and enhancement. The ureter distal to this point is decompressed. Multiple bilateral small nonobstructing renal calculi are noted the largest of which is within the right hilum and measures 1 cm. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Appropriately positioned gastrostomy tube. COLON / APPENDIX: The appendix and colon are unremarkable. There is mild rectal thickening with associated inflammatory stranding. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Mild fluid is noted in the inferior left retroperitoneum. There is mild to left perinephric retroperitoneal stranding. VESSELS: Scattered vascular calcifications. URINARY BLADDER: Collapsed around a Suprapubic catheter. Curvilinear eggshell calcification in the urinary bladder, unchanged from prior exam. REPRODUCTIVE ORGANS: Similar curvilinear hyperdense within the base of the penis, unchanged. BODY WALL: Full-thickness ulcer overlying the left aspect of the sacrum, improved when compared to prior. Small fat-containing umbilical hernia. MUSCULOSKELETAL: Multiple left lateral chronic rib deformities. Redemonstrated left predominant decubitus ulcer with extension to the posterior aspect of the sacrum. Unchanged mild cortical irregularity in this region suggesting chronic osteomyelitis. Diffusely decreased bone mineralization. Advanced discogenic degenerative change of the lower lumbar spine.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: 69-year-old male with pancreatic cystic lesion. COMPARISON: No prior study. TECHNIQUE: Outside CT images of the abdomen and pelvis with intravenous contrast from Carmichael Imaging Center dated 12/6/2021 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: See separate chest CT report. ABDOMEN and PELVIS: LIVER: Normal size and configuration. There are three subcentimeter hypodensities which are too small to characterize. No cirrhotic morphology. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: A mildly complex cystic lesion is present in the pancreatic head measuring 2.2 x 1.3 cm (image 131 series 2). A separate hypodense lesion in the pancreatic body measures 1.1 x 0.8 cm (image 128 series 2). There is mild pancreatic ductal dilatation leading to the pancreatic head lesion. No peripancreatic stranding or calcifications are identified4. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Kidneys are normal in size and configuration. A mildly hyperdense central left renal lesion measures 2.1 x 1.6 cm and 14 Hounsfield units (image 125 series 2). A subcentimeter exophytic mildly hyperdense left renal lesion measures 26 Hounsfield units (image 124 series 2). LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: A rectosigmoid anastomosis has normal appearance. The rest of the colon is unremarkable. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small right inguinal hernia contains a short segment of nonobstructed small bowel. No significant abnormality. MUSCULOSKELETAL: Multiple poorly marginated small lytic lesions are present within the lumbar spine and iliac bones. A lytic lesion with cortical destruction is present in the L4 spinous process. There is also a left iliac lesion with narrow zone of transition on image 178 series 2. CONCLUSION: 1. Multiple lytic osseous lesions are concerning for metastatic disease. Further evaluation with PET study is recommended. 2. Mildly hyperdense left renal lesions are indeterminant. 3. There are two separate pancreatic cystic lesions with internal complexity, not consistent with simple pancreatic cysts. Considering these lesions, PET MRI may be favorable to PET/CT for further characterization. 4. Numerous subcentimeter hypodense hepatic lesions. 5. No focal mass in the region of previous rectosigmoid anastomosis. Is there history of colon cancer? 6. Right inguinal hernia contains nonobstructed loop of small bowel. Findings were notified to Dr. Dudeja by Dr. Lockhart at 8:10 a.m. on 1/24/2022.
FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: See separate chest CT report. ABDOMEN and PELVIS: LIVER: Normal size and configuration. There are three subcentimeter hypodensities which are too small to characterize. No cirrhotic morphology. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: A mildly complex cystic lesion is present in the pancreatic head measuring 2.2 x 1.3 cm (image 131 series 2). A separate hypodense lesion in the pancreatic body measures 1.1 x 0.8 cm (image 128 series 2). There is mild pancreatic ductal dilatation leading to the pancreatic head lesion. No peripancreatic stranding or calcifications are identified4. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Kidneys are normal in size and configuration. A mildly hyperdense central left renal lesion measures 2.1 x 1.6 cm and 14 Hounsfield units (image 125 series 2). A subcentimeter exophytic mildly hyperdense left renal lesion measures 26 Hounsfield units (image 124 series 2). LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: A rectosigmoid anastomosis has normal appearance. The rest of the colon is unremarkable. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small right inguinal hernia contains a short segment of nonobstructed small bowel. No significant abnormality. MUSCULOSKELETAL: Multiple poorly marginated small lytic lesions are present within the lumbar spine and iliac bones. A lytic lesion with cortical destruction is present in the L4 spinous process. There is also a left iliac lesion with narrow zone of transition on image 178 series 2.
FINDINGS: STRUCTURED REPORT: CTA Abdomen Pelvis VASCULATURE: DISTAL DESCENDING THORACIC AORTA: No significant abnormality. ABDOMINAL AORTA: Interval endoscopic stenting of aorta and iliac arteries. Stent extends from the infrarenal aorta into the common iliac arteries bilaterally. Endoscopic stent is patent. No evidence of endoleak on arterial or venous phase images. The maximum transverse dimensions of the infrarenal aortic aneurysm measures about 5.9 x 4.8 cm (series 3/image 94), previous CT 5.9 x 4.9 cm. CELIAC AXIS: No significant abnormality. SMA: No significant abnormality. RIGHT RENAL: No significant abnormality. LEFT RENAL: No significant abnormality. IMA: No significant abnormality. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. ------------------------------------------------------------- LOWER CHEST: LUNG BASES / PLEURA: 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: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Ventral midline large ventral abdominal wall hernia containing several small bowel loops and abdominal fat without obstruction or strangulation. Focal subcutaneous thickening/stranding in the anterior abdominal wall subcutaneous gas pattern with associated calcifications. MUSCULOSKELETAL: No acute osseous findings. Posterior lumbosacral spinal fusion hardware extends from L2 to S1 vertebrae. There is L4-L5 and L5-S1 osseous fusion. Remainder of the lumbar vertebrae demonstrate normal height.
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Interpretation of Outside Films CT Chest Clinical Information: 69-year-old male with provided history of pancreatic cystic lesion. Spec Inst: PANCREATIC CYSTIC LESIONCT CHEST 12621 CARMICHAEL IMAGING CTR. REC 12222 Study reviewed: CT of chest with contrast performed at Carmichael imaging Center on 12/6/2021, The images are available in PACS. Findings: Chest: Lines, tubes, and devices: Right subclavian port catheter with tip at the mid SVC. Lung parenchyma and pleura: A 9 mm right upper lobe groundglass density (image 24, series 2) is seen. Bilateral dependent atelectasis. No focal consolidation. 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. 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: 1. Right upper lobe 9 mm groundglass density, comparison with the prior CT if available. Attention on follow-up within three months is recommended giving history of suspicious malignancy. 2. No thoracic lymphadenopathy.
Findings: Chest: Lines, tubes, and devices: Right subclavian port catheter with tip at the mid SVC. Lung parenchyma and pleura: A 9 mm right upper lobe groundglass density (image 24, series 2) is seen. Bilateral dependent atelectasis. No focal consolidation. 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. 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.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Unchanged scattered nonenhancing hypoattenuating foci within the liver. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Enhancing lesion previously described as a tiny hemangioma within the spleen is stable measuring 6 mm (series 301, image 72), previously measured 6 mm (series 5 image 53). ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No ascites. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Absent uterus. Adnexa are unremarkable. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Mild multilevel discogenic degenerative changes most prominent at L5-S1 with associated loss of lumbar lordosis.
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EXAM: Interpretation of Outside Films CT Neck CLINICAL INFORMATION: Male patient 76 years with Spec Inst: LARYNGEAL CANCERCT SOFT TISSUE NECK 122021 CULLMAN PRIMARY CARE DIAG. REC 12322 TECHNIQUE: 3 mm thick serial axial images of the neck were obtained without intravenous contrast. Sagittal and coronal reformatted views were also obtained COMPARISON: None FINDINGS: Outside examination dated 12/20/2021 is submitted for interpretation on 1/23/2022. Examination is limited without intravenous contrast. The nasopharynx and oropharynx appear unremarkable. There is large mass in the supraglottic region and also involving the left piriform sinus resulting in significant mass effect upon the glottis. Superiorly the lesion involves the left preepiglottic fat. Inferiorly The lesion extends to the level of the lower left laryngeal vestibule. Lesion measures approximately 4 x 3 x 4 cm. Lesion abuts both the hyoid bone and the thyroid cartilage without frank invasion.. Thyroid gland is small in size without discrete lesion. The parotid glands and submandibular glands appear grossly normal on this noncontrast examination. There is no definite lymphadenopathy using CT size criteria but there is asymmetric effacement of fat within the upper left neck on image 32 which may be secondary to lymph node. Evaluation is limited secondary to both slice thickness and lack of intravenous contrast. There are advanced atherosclerotic calcifications involving both carotid bifurcations. There are also significant atherosclerotic calcifications involving both carotid siphons There is no destructive osseous lesion. There is multilevel degenerative disc disease. Emphysematous changes are noted within the visualized lungs. There is mucosal thickening within both maxillary sinuses. CONCLUSION: 01. Large left supraglottic mass resulting in airway narrowing. 02. No definite lymphadenopathy is identified. There is suggestion of possible lymph node within the upper left neck. However evaluation for small lymph nodes is limited due to slice thickness and lack of intravenous contrast 03. Advanced atherosclerotic calcifications. 04. Emphysema.
FINDINGS: Outside examination dated 12/20/2021 is submitted for interpretation on 1/23/2022. Examination is limited without intravenous contrast. The nasopharynx and oropharynx appear unremarkable. There is large mass in the supraglottic region and also involving the left piriform sinus resulting in significant mass effect upon the glottis. Superiorly the lesion involves the left preepiglottic fat. Inferiorly The lesion extends to the level of the lower left laryngeal vestibule. Lesion measures approximately 4 x 3 x 4 cm. Lesion abuts both the hyoid bone and the thyroid cartilage without frank invasion.. Thyroid gland is small in size without discrete lesion. The parotid glands and submandibular glands appear grossly normal on this noncontrast examination. There is no definite lymphadenopathy using CT size criteria but there is asymmetric effacement of fat within the upper left neck on image 32 which may be secondary to lymph node. Evaluation is limited secondary to both slice thickness and lack of intravenous contrast. There are advanced atherosclerotic calcifications involving both carotid bifurcations. There are also significant atherosclerotic calcifications involving both carotid siphons There is no destructive osseous lesion. There is multilevel degenerative disc disease. Emphysematous changes are noted within the visualized lungs. There is mucosal thickening within both maxillary sinuses.
FINDINGS: LINES AND TUBES: None. LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Stable postradiation changes to the left upper lobe aerated scattered dependent subpleural bandlike groundglass opacity. No suspicious nodules or masses. No consolidation, effusion, or pneumothorax. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Post surgical changes of left mastectomy with left breast augmentation. Stable thickening of the left axillary soft tissues overlying the left anterior thoracic wall. This soft tissue thickening/density is similar compared to 5/3/2019 but new when compared to 5/8/2016. UPPER ABDOMEN: See separate abdominal dictation. MUSCULOSKELETAL: Similar appearing left anterior rib deformities. No new sclerotic or blastic lesions.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Painful right knee COMPARISON: 6/30/2021 TECHNIQUE: Outside CT images of the right knee without 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: Status post total knee arthroplasty. There is persistent lucency and cortical breakthrough of the anterolateral proximal tibia which approximates the tibial stem and articular plate. There was a similar-appearing lucency on the prior exam with scattered foci of gas. The distal femur is unremarkable without acute osseous abnormality. Unchanged chronic fragmentation of the patella. Small joint effusion. In the subcutaneous soft tissues of the proximal foreleg overlying the tibial lucency and cortical breakthrough, there is a well-circumscribed fluid collection measuring approximately 1.7 x 4.8 x 4.8 cm (image 92, series 2; image 29, series 401). There is surrounding soft tissue edema and overlying cutaneous thickening. CONCLUSION: 1. Lucency and cortical breakthrough of the anterolateral proximal tibia adjacent to the tibial arthroplasty hardware with overlying well-circumscribed fluid collection and inflammatory changes. These findings are concerning for osteomyelitis with overlying soft tissue abscess and cellulitis.
FINDINGS: Status post total knee arthroplasty. There is persistent lucency and cortical breakthrough of the anterolateral proximal tibia which approximates the tibial stem and articular plate. There was a similar-appearing lucency on the prior exam with scattered foci of gas. The distal femur is unremarkable without acute osseous abnormality. Unchanged chronic fragmentation of the patella. Small joint effusion. In the subcutaneous soft tissues of the proximal foreleg overlying the tibial lucency and cortical breakthrough, there is a well-circumscribed fluid collection measuring approximately 1.7 x 4.8 x 4.8 cm (image 92, series 2; image 29, series 401). There is surrounding soft tissue edema and overlying cutaneous thickening.
Findings: There is a sizable (1.4 cm) ulcerated lesion in the skin of the right orbit with possible ulceration. There is a small lesion in the facial soft tissues lateral to the posterior body of the right mandible measuring 6 x 16mm. No bone erosion or invasion is seen. The petrous bones are essentially negative. There is cerumen in the left EAC. The paranasal sinuses are essentially clear except for a sizable retention cyst in the right maxillary sinus. The upper cervical spine is minor degenerative changes but otherwise normal appearance. --------------
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Kidney stones COMPARISON: None. TECHNIQUE: Outside CT images without IV contrast dated 12/10/2021 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: Emphysematous changes. Right basilar atelectasis or scarring. 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: There are multiple nonobstructing right intrarenal calculi, largest measuring 1.7 cm within the renal pelvis. No left intrarenal calculi. There is an exophytic fluid density cyst arising from the left kidney measuring about 1.5 cm. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Colonic diverticulosis. The appendix is within normal limits. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerosis of the abdominal aorta without aneurysm URINARY BLADDER: Decompressed but otherwise unremarkable REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing umbilical hernia MUSCULOSKELETAL: Multilevel degenerative changes in the lumbar spine. CONCLUSION: 1. Multiple nonobstructing right renal calculi as described above. No urinary calculi identified on the left. No hydronephrosis. 2. Additional, nonacute findings as detailed in the report.. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Emphysematous changes. Right basilar atelectasis or scarring. 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: There are multiple nonobstructing right intrarenal calculi, largest measuring 1.7 cm within the renal pelvis. No left intrarenal calculi. There is an exophytic fluid density cyst arising from the left kidney measuring about 1.5 cm. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Colonic diverticulosis. The appendix is within normal limits. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerosis of the abdominal aorta without aneurysm URINARY BLADDER: Decompressed but otherwise unremarkable REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing umbilical hernia MUSCULOSKELETAL: Multilevel degenerative changes in the lumbar spine.
Findings: CT head: BRAIN PARENCHYMA: No hemorrhage, intracranial mass, large territory infarct, or edema. Gray-white matter differentiation maintained. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No acute fracture. No aggressive osseous lesion. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal.
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EXAM: Interpretation of Outside Films MR Body CLINICAL INFORMATION: Hepatic lesion COMPARISON: None. TECHNIQUE: Interpretation of Outside Films MR Body outside examination performed 12/9/2021 FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: Small hiatal hernia. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Questionable areas of steatosis versus artifact. T2 hyperintense lesion in the caudate lobe series 701 image 24 measures 2.1 x 1.6 cm. This appears to demonstrate peripheral nodular interrupted enhancement which is progressive consistent with hemangioma. Multiple punctate cysts are noted series 701 image 23 and image 31. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Lobular right kidney with areas of scarring. There is a renal cyst on series 401 image 12 which measures 4.0 x 3.1 cm. LYMPH NODES: Few mildly and borderline enlarged periportal lymph nodes. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Small hepatic hemangioma and punctate cysts. 2. Few mildly enlarged periportal lymph nodes, nonspecific.
FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: Small hiatal hernia. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Questionable areas of steatosis versus artifact. T2 hyperintense lesion in the caudate lobe series 701 image 24 measures 2.1 x 1.6 cm. This appears to demonstrate peripheral nodular interrupted enhancement which is progressive consistent with hemangioma. Multiple punctate cysts are noted series 701 image 23 and image 31. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Lobular right kidney with areas of scarring. There is a renal cyst on series 401 image 12 which measures 4.0 x 3.1 cm. LYMPH NODES: Few mildly and borderline enlarged periportal lymph nodes. 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.
FINDINGS: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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EXAM: Interpretation of Outside Films CT Chest CLINICAL INFORMATION: Interpretation of outside CT chest COMPARISON: Outside CT chest 7/13/2021, 5/4/2021 TECHNIQUE: Interpretation of Outside Films CT Chest. CTA chest performed at Helen Keller Medical Center on 12/29/2021 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. FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Moderately suboptimal quality with incomplete evaluation of segmental and subsegmental pulmonary arteries. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for central pulmonary embolus. Evaluation of segmental and subsegmental pulmonary arteries is limited due to contrast bolus timing. Pulmonary artery trunk is borderline enlarged, measuring 3.1 cm in diameter. LUNGS / AIRWAYS / PLEURA: No focal consolidation, pleural effusion, or pneumothorax. Central airways are patent. Scattered less than 6 mm pulmonary nodules are present, none meeting criteria to require follow-up. HEART / OTHER VESSELS: Heart size is normal. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal arterial phase appearance of the imaged upper abdomen. MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality. CONCLUSION: 1. No evidence of central pulmonary embolus. No acute cardiopulmonary abnormality. 2. Borderline enlargement of the pulmonary artery trunk can be seen in pulmonary artery hypertension. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Moderately suboptimal quality with incomplete evaluation of segmental and subsegmental pulmonary arteries. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for central pulmonary embolus. Evaluation of segmental and subsegmental pulmonary arteries is limited due to contrast bolus timing. Pulmonary artery trunk is borderline enlarged, measuring 3.1 cm in diameter. LUNGS / AIRWAYS / PLEURA: No focal consolidation, pleural effusion, or pneumothorax. Central airways are patent. Scattered less than 6 mm pulmonary nodules are present, none meeting criteria to require follow-up. HEART / OTHER VESSELS: Heart size is normal. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal arterial phase appearance of the imaged upper abdomen. MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality.
FINDINGS: BRAIN PARENCHYMA and EXTRA-AXIAL SPACES: Enhancing mass in the left frontal lobe involving the dura shows interval progressive increase in size and measures 2.4 x 1.9 cm (image 25, series 303). Mass measures 1.7 x 1.5 cm on the MRI dated 12/16/2021. There is small focus of enhancement underlying the craniotomy flap anteriorly on image #42, series 303 similar to prior MRI from 10/21/2021 and may represent post surgical/reactive dural thickening versus residual tumor. Hypodensities in the left frontal, parietal, temporal lobes with extension into the left midbrain and pons which represent incidental malacia and vasogenic edema from prior surgery. No acute intracranial hemorrhage or midline shift. No abnormal enhancement is seen in this region. There are no extra-axial fluid collections identified. VENTRICULAR SYSTEM: Asymmetrically enlarged lateral ventricles, left greater than right. SKULL AND SKULL BASE: Postsurgical craniotomy changes in the left frontal and parietal bones. No acute displaced fracture. SINUSES: Mild mucosal thickening of the right posterior ethmoid air cells and sphenoid sinus. The remaining visualized paranasal sinuses and mastoid air cells are clear. ORBITS: Globes are intact. Orbits unremarkable. SOFT TISSUE: Remaining visualized soft tissues are within normal limits.
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Interpretation of Outside Films MR CSPN 1/25/2022 8:29 AM Clinical Information: Spec Inst: Cervical spinal stenosis - MRI C-Spine from UAB West done 12-3-21 rec 1-25-22 Comparison: Subsequent performed CT cervical spine from 1/20/2022. Technique: T2 sagittal and axial fast spin spin echo, T1 sagittal spin echo, sagittal STIR, axial T2* gradient echo. Findings: There is straightening of the cervical spine. No marrow edema. Pre and paravertebral soft tissues appear unremarkable. Posterior paravertebral musculature is unremarkable. Cervical cord and cervicomedullary junction appear unremarkable. C2-C3: Unremarkable. C3-C4 disc osteophyte complex results in mild bilateral neural foramina narrowing. C4-C5: Disc osteophyte complex results in mild to moderate canal narrowing with slight indentation on the anterior surface of spinal cord. There is severe bilateral neural foramina narrowing C5-C6: Asymmetric right paracentral disc herniation results in mild canal narrowing with indentation on the spinal cord. No significant neural from narrowing. C6-C7: Disc osteophyte complex results in minimal canal but moderate to severe bilateral neural foramina narrowing. C7-T1: Unremarkable. Impression: Multilevel degenerative changes, most severe at C4-C5 and C6-C7 where there is advanced bilateral neural foramina narrowing and likely exiting nerve compression. Mild to moderate canal narrowing at C4-C5. .
Findings: There is straightening of the cervical spine. No marrow edema. Pre and paravertebral soft tissues appear unremarkable. Posterior paravertebral musculature is unremarkable. Cervical cord and cervicomedullary junction appear unremarkable. C2-C3: Unremarkable. C3-C4 disc osteophyte complex results in mild bilateral neural foramina narrowing. C4-C5: Disc osteophyte complex results in mild to moderate canal narrowing with slight indentation on the anterior surface of spinal cord. There is severe bilateral neural foramina narrowing C5-C6: Asymmetric right paracentral disc herniation results in mild canal narrowing with indentation on the spinal cord. No significant neural from narrowing. C6-C7: Disc osteophyte complex results in minimal canal but moderate to severe bilateral neural foramina narrowing. C7-T1: Unremarkable.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: No abnormalities for unenhanced technique. BILIARY TRACT: Normal. GALLBLADDER: Unchanged peripherally calcified gallstone within otherwise normal-appearing gallbladder. The PANCREAS: No abnormalities for unenhanced technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Large calculus in the left renal pelvis today measures 2.1 x 2.0 cm (image 26 series 601); was 2.3 x 2.1 cm (image 201 series 601 previously. No additional stones are seen within the left collecting system. No right renal calculi are evident. There is no hydronephrosis. Minimal bilateral perinephric stranding is nonspecific and unchanged. LYMPH NODES: None enlarged.1 STOMACH / SMALL BOWEL: No abnormality for unenhanced technique. COLON / APPENDIX: Scattered diverticula are present without evidence of inflammation.. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: The abdominal aorta is normal in caliber. Focal peripheral calcification adjacent to the distal splenic artery is unchanged and consistent with aneurysm, stable. A smaller peripheral consultation adjacent to the right renal artery is also unchanged and consistent with focal aneurysm. URINARY BLADDER: Normal. No bladder calculi are evident. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Unchanged fat-containing left inguinal hernia. Degenerative changes seen in the lumbar spine. MUSCULOSKELETAL: Degenerative changes present at the lumbosacral junction. No aggressive osseous lesions.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Pre-Y90 Imaging COMPARISON: CT 11/30/2021. TECHNIQUE: Outside CT abdomen and pelvis dated 11/30/2021 and 12/22/2021 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. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: There is a hypoenhancing lesion in the segment 3 of the left lobe, measuring 4.3 x 3.7 cm there is no corresponding arterial hyperenhancement. This lesion was subsequently embolized and on CT from 12/22/2021, there is hyperdense embolization material occupying is lesion and adjacent segment 2/3 hepatic parenchyma. Also seen are patchy areas of hyperattenuating embolization material within segment 4A. Small simple cyst is in the lateral right hepatic dome. Conventional hepatic artery anatomy. Main portal, splenic and super mesenteric veins and hepatic veins are patent. Numerous dilated paraumbilical venous collaterals are seen. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Kidneys demonstrate symmetric enhancement. There is small simple right renal cyst. Nonobstructing left renal calculi. No hydronephrosis or hydroureter. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach is partially distended. Is no abnormal dilatation small bowel loops. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Anterior abdominal wall venous collaterals. MUSCULOSKELETAL: No acute osseous findings. Generalized bone demineralization. CONCLUSION: 1. Preembolization CT dated 11/30/2021 demonstrates segment 3, LR4 lesions which was embolized. On post embolization CT from 12/22/2021, hyperattenuating embolization material is seen within the treated lesion and adjacent hepatic parenchyma. Evaluation of the residual disease is limited and further evaluation with MRI is recommended. 2. No new hepatic lesions. Liver cirrhosis and sequelae of portal venous hypertension. Other incidental/chronic findings as described above.
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 is a hypoenhancing lesion in the segment 3 of the left lobe, measuring 4.3 x 3.7 cm there is no corresponding arterial hyperenhancement. This lesion was subsequently embolized and on CT from 12/22/2021, there is hyperdense embolization material occupying is lesion and adjacent segment 2/3 hepatic parenchyma. Also seen are patchy areas of hyperattenuating embolization material within segment 4A. Small simple cyst is in the lateral right hepatic dome. Conventional hepatic artery anatomy. Main portal, splenic and super mesenteric veins and hepatic veins are patent. Numerous dilated paraumbilical venous collaterals are seen. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Kidneys demonstrate symmetric enhancement. There is small simple right renal cyst. Nonobstructing left renal calculi. No hydronephrosis or hydroureter. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach is partially distended. Is no abnormal dilatation small bowel loops. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Anterior abdominal wall venous collaterals. MUSCULOSKELETAL: No acute osseous findings. Generalized bone demineralization.
Findings: There is no evidence of acute intracranial hemorrhage, infarction, brain edema, mass effect or hydrocephalus. There is diffuse brain volume loss with ex vacuo ventricular dilatation and moderate white matter microangiopathic changes. There is a partially empty sella. The visualized paranasal sinuses, mastoid air cells and middle ear cavities are clear. Both orbits appear normal.
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EXAM: Outside MR Image Interpretation CLINICAL INFORMATION: Liver transplant evaluation COMPARISON: Outside MRI of abdomen dated 5/26/2021 TECHNIQUE: Outside MR images without and with IV contrast dated 12/29/2021 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: MR HCC Screening IMAGE QUALITY: Satisfactory, though the arterial phase is too early. LOWER CHEST: LUNG BASES / PLEURA: Moderate right pleural effusion. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. No steatosis. LIVER LESIONS: No arterially enhancing lesion with washout is identified to suggest hepatocellular carcinoma, though the arterial phase is limited, being obtained in early hepatic arterial rather than late hepatic arterial timing. LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Nonocclusive thrombus is seen in the main portal vein extending into the portal splenic confluence and the central portion of the splenic vein. The main portal vein and left portal vein are prominent in caliber. The intrahepatic portal venous system is patent. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: Small (
FINDINGS: STRUCTURED REPORT: MR HCC Screening IMAGE QUALITY: Satisfactory, though the arterial phase is too early. LOWER CHEST: LUNG BASES / PLEURA: Moderate right pleural effusion. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. No steatosis. LIVER LESIONS: No arterially enhancing lesion with washout is identified to suggest hepatocellular carcinoma, though the arterial phase is limited, being obtained in early hepatic arterial rather than late hepatic arterial timing. LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Nonocclusive thrombus is seen in the main portal vein extending into the portal splenic confluence and the central portion of the splenic vein. The main portal vein and left portal vein are prominent in caliber. The intrahepatic portal venous system is patent. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: Small (
FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: There is no focal consolidation, pleural effusion, or pneumothorax. No subpleural reticulations or cystic changes. Scattered tiny calcified and noncalcified pulmonary nodules all measuring less than 6 mm, largest measuring 4 mm in the right lower lobe. No significant air trapping on expiratory views. HEART / VESSELS: Heart size is normal. No pericardial effusion. Moderate atherosclerotic calcifications of the left main left anterior descending coronary arteries. Moderate atherosclerotic calcifications of the aortic arch and thoracic aorta. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Scattered calcified lymph nodes in the mediastinum and right hilum. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Incidental hepatic cyst. MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality.
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Interpretation of Outside Films MR Face 1/25/2022 8:24 AM Clinical Information: Spec Inst: RT bell s palsy, please eval for brainstem pathology - MRI Orbit Face Neck from Cullman done 12-6-21 rec 1-25-22 Comparison: CT temporal bone from 1/12/2022. Technique: Diffusion weighted series, T1 sagittal and axial spin echo, T2 axial fast spin echo, axial FLAIR, coronal T2* gradient echo, post contrast axial and coronal T1. Findings: Soft tissues of the neck appear unremarkable. There is fluid in the right mastoid air cells. No abnormal enhancement in the neck. There is suspicious increased enhancement of the right facial nerve in its distal mastoid segment, best seen on series 7 image nine but the rest of the facial nerve appears normal in enhancement. Impression: 1.Study is not optimized to evaluate for brainstem pathology as MRI neck was performed. Within these limitations there appears to be some some asymmetrical enhancement of the right facial nerve in the mastoid segment which could suggest underlying Bell's palsy. There is no brainstem or cerebellar abnormality. 2. Incidental right mastoid effusion.
Findings: Soft tissues of the neck appear unremarkable. There is fluid in the right mastoid air cells. No abnormal enhancement in the neck. There is suspicious increased enhancement of the right facial nerve in its distal mastoid segment, best seen on series 7 image nine but the rest of the facial nerve appears normal in enhancement.
FINDINGS: STRUCTURED REPORT: CTA Abdomen Pelvis Renal Donor RIGHT KIDNEY: - RENAL ARTERY: Single. - RENAL VEIN: Single. - COLLECTING SYSTEM: Single. - RENAL CALCULI: Absent. - CYSTS/MASSES: Absent. - VOLUME: 146 cm\S\3 LEFT KIDNEY: - RENAL ARTERY: Duplicated. Early bifurcation of the left renal artery. Accessory left upper pole renal artery arises from aorta. - RENAL VEIN: Single with conventional pre-aortic anatomy. A prominent paravertebral draining collateral measuring 8.5 mm is present (on series 7/image 44). - COLLECTING SYSTEM: Single. - RENAL CALCULI: Absent. - CYSTS/MASSES: Absent. - VOLUME: 168 cm\S\3 ------------------------------------------------------------- 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. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. 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: Spec Inst: SOB; hx breast cancer - CT Chest from Walker Medical Diagnostics done 1-12-22 rec 1-25-22 Study reviewed: CT of chest performed at Walker Medical Diagnostic on 1/12/2022. . 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:None Findings: A couple of axial slices appear to be corrupted. Included images of the lower neck are unremarkable. Normal heart size. Small hiatal hernia. Small atypical paraesophageal lymph nodes are seen measuring under 0.5 cm in short axis. Mediastinal structures are otherwise within normal limits. The central airways are patent. No pleural effusions. Right lower lobe nodule measures about 1.4 x 1.1 cm (series 2; image 33). Scarring anteriorly in the middle lobe. Included images of the upper abdomen demonstrate cholecystectomy clips and cirrhotic morphology of the liver. Right breast collection measuring about 2.6 x 4.2 cm and about 21 Hounsfield units in attenuation (series 2; image 29). No aggressive osseous lesions. Conclusion: 1. Right breast low-attenuation collection may represent a postprocedural collection/seroma. Correlation with clinical history and dedicated breast imaging is recommended. 2. Right lower lobe nodule measuring 1.1 x 1.4 cm may represent infectious/inflammatory changes versus a solitary metastasis. Short-term follow-up is recommended. 3. Linear scarring anteriorly in the middle lobe is presumably secondary to radiation treatment changes. 4. Incidental note of cirrhotic liver.
Findings: A couple of axial slices appear to be corrupted. Included images of the lower neck are unremarkable. Normal heart size. Small hiatal hernia. Small atypical paraesophageal lymph nodes are seen measuring under 0.5 cm in short axis. Mediastinal structures are otherwise within normal limits. The central airways are patent. No pleural effusions. Right lower lobe nodule measures about 1.4 x 1.1 cm (series 2; image 33). Scarring anteriorly in the middle lobe. Included images of the upper abdomen demonstrate cholecystectomy clips and cirrhotic morphology of the liver. Right breast collection measuring about 2.6 x 4.2 cm and about 21 Hounsfield units in attenuation (series 2; image 29). No aggressive osseous lesions.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Mild mosaic attenuation at the lung bases, likely air trapping secondary to small airways disease. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Stable postsurgical changes from prior liver transplant. Similar appearance of hypodensities along the inferior hepatic margin. BILIARY TRACT: Interval placement of two biliary stents with improved appearance of the intra and extrahepatic biliary ductal dilation. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Absent. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None pathologically enlarged. STOMACH / SMALL BOWEL: Similar appearance of surgical clips along the greater curvature of the stomach and adjacent to the pylorus. COLON / APPENDIX: Scattered noninflamed colonic diverticula. Transverse colon is seen within the ventral hernia/diastases. Normal appendix. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Excreted contrast layering within the bladder. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Richter hernia within the upper abdomen containing the anterior wall the transverse colon. Small fat-containing umbilical hernia with underlying hernia repair anchors within the abdominal wall. MUSCULOSKELETAL: Mild discogenic degenerative changes which are most prominent at L5-S1.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: 30-year-old female with history of endometriosis. Status post TLH/BS. Exam ordered for pelvic pain. COMPARISON: None available at UAB at the time of dictation. 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 LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. OTHER: Postsurgical changes of bilateral breast implants. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. No renal calculi or hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Normal appearing appendix. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is surgically absent. There is a 2.1 x 1.8 cm cyst within the left ovary (series 2, image 77). BODY WALL: Fat stranding in the bilateral lower abdominal wall likely correlates to recent laparoscopic trocar sites. Additional, there is a soft tissue nodule in the left inguinal region which measures 1.9 x 1.3 cm (series 2, image 83). MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Postsurgical changes of hysterectomy. No acute abnormality visualized to explain patient's pelvic pain. 2. Left groin soft tissue nodule, potentially enlarged reactive inguinal lymph node. Follow up with targeted ultrasound is recommended for further characterization and to ensure resolution. 3. Additional incidental findings as above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. OTHER: Postsurgical changes of bilateral breast implants. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. No renal calculi or hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Normal appearing appendix. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is surgically absent. There is a 2.1 x 1.8 cm cyst within the left ovary (series 2, image 77). BODY WALL: Fat stranding in the bilateral lower abdominal wall likely correlates to recent laparoscopic trocar sites. Additional, there is a soft tissue nodule in the left inguinal region which measures 1.9 x 1.3 cm (series 2, image 83). MUSCULOSKELETAL: No significant abnormality.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Pelvis Renal Transplant Exam limited by streak artifact from bilateral hip arthroplasty hardware. VASCULATURE: LOWER ABDOMINAL AORTA: Mild to moderate calcified atherosclerotic disease. RIGHT COMMON / INTERNAL ILIAC ARTERIES: Mild to moderate calcified atherosclerotic disease. RIGHT EXTERNAL ILIAC ARTERY: No calcified atherosclerotic disease. LEFT COMMON / INTERNAL ILIAC ARTERIES: Mild calcified atherosclerotic disease. LEFT EXTERNAL ILIAC ARTERY: No calcified atherosclerotic disease. LOWER ABDOMEN: BOWEL: No significant abnormality. PERITONEUM: Normal. OTHER: No other abnormality. PELVIS: LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is absent. Adnexa are grossly unremarkable but not well visualized because of bilateral total hip arthroplasty. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: Bilateral total hip arthroplasty hardware. Advanced degenerative changes of within the visualized lumbosacral spine with L4-L5 and L5-S1 laminectomy postsurgical changes
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Interpretation of Outside Films CT Chest Clinical Information: Spec Inst: Metastatic breast cancer - CT CAP from Russell Medical Center done 12-2-21 rec 1-25-22 Study reviewed: CT of the chest with contrast 12/2/2021 performed at Russell Medical Center. The images are available in PACS. Please note the examination was performed outside of UAB protocol, monitoring and oversight. Findings: Comparison, 8/5/2021 from the same institution. No destructive osseous lesions. CT of abdomen and pelvis will be reported separately. No axillary or mediastinal adenopathy. No central PTE, pleural, or pericardial effusion. Probable scarring at the right lung apex. No suspicious appearing pulmonary nodules. Conclusion: No evidence of intrathoracic metastatic disease.
Findings: Comparison, 8/5/2021 from the same institution. No destructive osseous lesions. CT of abdomen and pelvis will be reported separately. No axillary or mediastinal adenopathy. No central PTE, pleural, or pericardial effusion. Probable scarring at the right lung apex. No suspicious appearing pulmonary nodules.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: No significant abnormality. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered noninflamed colonic diverticula. Normal appendix. PERITONEUM / MESENTERY: No ascites. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is present. Uterine fibroid measures approximately 5.6 x 4.0 x 5.2 cm (series 602 image 403, series 603 image 147). Adnexa are unremarkable. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Mild multilevel discogenic degenerative changes most prominent at L1-L2 and L2-L3.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: 41-year-old female with history of metastatic breast cancer. COMPARISON: None. TECHNIQUE: Outside CT images with 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 CT chest findings are reported separately. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Focal wedge-shaped hypodensities seen within the upper pole of the left kidney, suggestive of scarring. 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 appears surgically absent. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: No evidence of metastatic disease within the abdomen or pelvis. Hypodensities in the upper pole of left kidney are suggestive of scarring.
FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Abdomen Pelvis CT chest findings are reported separately. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Focal wedge-shaped hypodensities seen within the upper pole of the left kidney, suggestive of scarring. 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 appears surgically absent. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
FINDINGS: LINES AND TUBES: Subcentimeter hypodense thyroid nodule. No follow-up is necessary. LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Normal. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Right axillary soft tissue densities. No internal mammary lymphadenopathy. Small pericardial lymph node best seen on series 602 image #162. CHEST WALL: Two soft tissue densities within the right axilla measure 1.2 x 1.2 x 2.0 cm and 2.2 x 2.1 x 1.6 cm. Additional soft tissue density within the lateral aspect of the right breast is visualized with adjacent biopsy clip. UPPER ABDOMEN: See separate abdominal dictation. MUSCULOSKELETAL: No significant abnormality. Left humeral head bone island. No suspicious lytic or blastic lesions.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: Cirrhosis. COMPARISON: 11/22/2021. TECHNIQUE: Outside CT images without and with IV contrast dated 12/10/2021 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. Arterial phase timing is early for proper evaluation of suspicious hepatic lesions. LOWER CHEST: LUNG BASES / PLEURA: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. No steatosis. Hypoattenuating lesions within the hepatic dome do not demonstrate postcontrast enhancement, likely cysts. No suspicious hepatic lesions are seen; however, evaluation is limited due to early arterial phase timing. No regions of washout are visualized. Ablation site is again noted along the inferior right hepatic lobe which again contains internal gas (series 4, image 66) and abuts the duodenum (series 8, image 44). LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Chronically occluded right, left, and main portal vein which are small in caliber and contain internal calcifications. Cavernous transformation is noted. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: Large (>5 mm diameter). - Other varices or collaterals: Recanalized paraumbilical vein. Mesenteric venous collaterals. Few perigastric collaterals. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: Absent. LYMPH NODES: None enlarged. SPLEEN: Splenomegaly. PERITONEUM / ASCITES: Trace ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Redemonstrated early medullary nephrocalcinosis. No hydronephrosis bilaterally. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Mild mucosal thickening of the ascending colon likely secondary to portal colopathy. The appendix is normal. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: Trace atherosclerotic calcification of the abdominal aorta which is normal in caliber. BODY WALL: Small umbilical hernia which contains a nondilated loop of small bowel. MUSCULOSKELETAL: No aggressive osseous lesions. CONCLUSION: 1. Hepatic cirrhosis with sequelae of portal hypertension. No suspicious hepatic lesions; however, evaluation is limited due to early arterial phase timing. 2. Chronic occlusion of the main portal vein with cavernous transformation. 3. Persistent gas within the ablation site along the inferior right hepatic lobe which again abuts the duodenum concerning for fistulization. 4. Chronic and incidental findings as above.
FINDINGS: IMAGE QUALITY: Suboptimal. Arterial phase timing is early for proper evaluation of suspicious hepatic lesions. LOWER CHEST: LUNG BASES / PLEURA: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. No steatosis. Hypoattenuating lesions within the hepatic dome do not demonstrate postcontrast enhancement, likely cysts. No suspicious hepatic lesions are seen; however, evaluation is limited due to early arterial phase timing. No regions of washout are visualized. Ablation site is again noted along the inferior right hepatic lobe which again contains internal gas (series 4, image 66) and abuts the duodenum (series 8, image 44). LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Chronically occluded right, left, and main portal vein which are small in caliber and contain internal calcifications. Cavernous transformation is noted. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: Large (>5 mm diameter). - Other varices or collaterals: Recanalized paraumbilical vein. Mesenteric venous collaterals. Few perigastric collaterals. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: Absent. LYMPH NODES: None enlarged. SPLEEN: Splenomegaly. PERITONEUM / ASCITES: Trace ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Redemonstrated early medullary nephrocalcinosis. No hydronephrosis bilaterally. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Mild mucosal thickening of the ascending colon likely secondary to portal colopathy. The appendix is normal. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: Trace atherosclerotic calcification of the abdominal aorta which is normal in caliber. BODY WALL: Small umbilical hernia which contains a nondilated loop of small bowel. MUSCULOSKELETAL: No aggressive osseous lesions.
FINDINGS: CT of the head with and without contrast: There is no acute infarction, hemorrhage, mass, or cerebral edema. Subcortical and periventricular hypodensities, likely advanced chronic microangiopathic changes. Mild parenchymal volume loss with associated ex vacuo dilatation of the ventricles. Cavum septum pellucidum et vergae is incidentally noted. No enhancing intracranial abnormality. There is no acute osseous or orbital abnormality. The paranasal sinuses and mastoid air cells are clear. CT angiogram of the brain: RIGHT CAROTID: Moderate atherosclerotic calcifications of the carotid siphon. There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: Moderate atherosclerotic calcifications of the carotid siphon. There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Unremarkable. VERTEBROBASILAR ARTERIES: The basilar artery is supplied by the right vertebral artery, normal variant. Mild irregularity to the distal basilar artery without flow limitation. There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. RIGHT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT VERTEBRAL ARTERY: The left vertebral artery is hypoplastic, normal variant, and does not contribute to the basilar artery. There is no evidence of stenosis, occlusion, or aneurysmal dilation. SOFT TISSUES: No soft tissue abnormality within the neck. CERVICAL SPINE: Mild degenerative changes.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: 52-year-old male with gastric mass COMPARISON: None. TECHNIQUE: Outside CT images with IV contrast dated 12/9/2021 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. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Subcentimeter foci of hypoattenuation scattered throughout the liver are too small for accurate characterization. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Subcentimeter focus of hypoattenuation in the right kidney is too small for accurate characterization. No urothelial filling defects on delayed images. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Irregular nodular soft tissue mass in the proximal stomach involving the gastric cardia and and possibly gastroesophageal junction measures 3.1 x 2.0 cm on image 112 series 2. This mass is partially exophytic extending towards the gastrohepatic region. Small bowel is normal in caliber. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Dilation of the infrarenal abdominal aorta measuring 3.1 x 2.0 cm in greatest axial dimensions on image 159 series 2. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Fat-containing left inguinal hernia. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Proximal gastric mass involving the cardia and possibly gastroesophageal junction, concerning for GIST versus leiomyomas. No evidence of distant metastatic disease. 2. Infrarenal abdominal aortic aneurysm and other chronic/incidental findings detailed 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.
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: Subcentimeter foci of hypoattenuation scattered throughout the liver are too small for accurate characterization. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Subcentimeter focus of hypoattenuation in the right kidney is too small for accurate characterization. No urothelial filling defects on delayed images. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Irregular nodular soft tissue mass in the proximal stomach involving the gastric cardia and and possibly gastroesophageal junction measures 3.1 x 2.0 cm on image 112 series 2. This mass is partially exophytic extending towards the gastrohepatic region. Small bowel is normal in caliber. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Dilation of the infrarenal abdominal aorta measuring 3.1 x 2.0 cm in greatest axial dimensions on image 159 series 2. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Fat-containing left inguinal hernia. MUSCULOSKELETAL: No significant abnormality.
Findings: There is a focus of decreased CBF in the white matter of the right centrum semiovale white in favor of infarction measuring 5 ml using the threshold of CBF less than 30%. There is a small area of elongated transient time in the right cerebellum in favor of a small ischemia measuring 4 cc using threshold of T max more than six second.
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Left elbow MRI: Indication: Interpretation outside study-elbow mass evaluation Images: Images are submitted from Neuroscience Imaging Center. Images are dated 12/8/2021. Multiplanar multisequence images are provided both pre and post intravenous contrast administration. Findings: There is a large subcutaneous mass in the antecubital fossa. The mass is medial to the biceps tendon, and it displaces the brachial artery posteriorly. The lesion is predominantly intermediate T1/high T2 signal, and it shows intense thick peripheral nodular enhancement in addition to enhancement of some thin internal septations. Measurement is 1.8 x 3.2 x 2.3 cm (AP by transverse by CC). The mass has broad contact with the underlying superficial muscular fascia, but no muscle invasion is seen. Impression: Complex enhancing mass in the subcutaneous antecubital fossa concerning for malignancy such as sarcoma. The lesion contacts the superficial muscular fascia and the anterior surface of the brachial artery. There are thin but preserved fascial planes with the biceps tendon and median nerve.
Findings: There is a large subcutaneous mass in the antecubital fossa. The mass is medial to the biceps tendon, and it displaces the brachial artery posteriorly. The lesion is predominantly intermediate T1/high T2 signal, and it shows intense thick peripheral nodular enhancement in addition to enhancement of some thin internal septations. Measurement is 1.8 x 3.2 x 2.3 cm (AP by transverse by CC). The mass has broad contact with the underlying superficial muscular fascia, but no muscle invasion is seen.
FINDINGS: BONES/JOINTS: No fracture or subluxation. Advanced degenerative arthrosis of the triscaphe joint. Mild to moderate degenerative arthrosis of the thumb and index finger carpometacarpal joints. Subchondral cyst like changes of the distal radius. SOFT TISSUES: No large hematoma or fluid collection.
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EXAM: Interpretation of Outside Films CT Neck CLINICAL INFORMATION: History of right squamous cell carcinoma treated with chemoradiation in 2012 recurrence in 2015 treated with open pharyngectomy with reconstruction with a myocutaneous pectoralis flap isn't presented in 2021 with left jaw pain secondary to radiation-induced osteonecrosis of the left mandible. The patient is now status post left segmental mandibulectomy, LAD, tracheostomy, and reconstruction with left fibula free flap in July 2021. Current presentation of persistent right jaw pain. COMPARISON: CT neck soft tissue dated 5/12/2021. TECHNIQUE: Interpretation of Outside Films CT Neck. FINDINGS: Outside examination from Archibald Ambulatory Care dated 11/24/2021 is submitted for interpretation on 1/26/2022 SOFT TISSUES: Postsurgical changes within the right masticator space and right partial hemiglossectomy appears stable. Interval Postsurgical changes of squamous cell carcinoma resection and myocutaneous pectoralis flap involving the right neck. No evidence of disease recurrence in the resection bed. Fibular free flap graft repair of the left mandible. Otherwise, the masticator spaces are unremarkable. The parapharyngeal spaces are symmetric. No abnormal soft tissue or fluid is noted within the retropharyngeal space. Aside from adjacent postsurgical change the carotid spaces are unremarkable without enhancing mass. LYMPH NODES: No pathologic adenopathy by imaging size criteria. AERODIGESTIVE STRUCTURES: No asymmetric contrast enhancement or asymmetric soft tissue nodularity aside from the expected changes of right free pectoralis flap. PAROTID GLANDS/SUBMANDIBULAR GLANDS: The parotid glands are unremarkable. The submandibular glands are absent. THYROID GLAND: Unremarkable. VASCULAR STRUCTURES: No evidence of dissection, occlusion, or aneurysm. Scattered atherosclerosis of the thoracic aorta. Mild scattered atherosclerosis of the common carotid and internal carotid arteries. OSSEOUS STRUCTURES: Postsurgical change of left mandibular resection and fibular free flap. No acute osseous abnormality or aggressive osseous lesion. Multilevel discogenic degenerative change of the cervical spine with associated multilevel osseous neural foraminal narrowing most pronounced at C3-C4 on the right, C4-C5 on the left, C5-C6 on the left, and C6-C7 bilaterally. PARTIALLY VISUALIZED INTRACRANIAL STRUCTURES: Unremarkable. LUNG APICES: Apical pleural parenchymal scarring. Mild scattered centrilobular emphysema. CONCLUSION: 1. Remote Extensive postsurgical change of the right neck and oral cavity appear unchanged. Interval resection of left mandible body and placement of fibular free flap. No evidence of disease recurrence or distant metastasis. 2. Multilevel discogenic degenerative change with multilevel neuroforaminal narrowing as above. Emphysematous changes within the visualized lungs 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.
FINDINGS: Outside examination from Archibald Ambulatory Care dated 11/24/2021 is submitted for interpretation on 1/26/2022 SOFT TISSUES: Postsurgical changes within the right masticator space and right partial hemiglossectomy appears stable. Interval Postsurgical changes of squamous cell carcinoma resection and myocutaneous pectoralis flap involving the right neck. No evidence of disease recurrence in the resection bed. Fibular free flap graft repair of the left mandible. Otherwise, the masticator spaces are unremarkable. The parapharyngeal spaces are symmetric. No abnormal soft tissue or fluid is noted within the retropharyngeal space. Aside from adjacent postsurgical change the carotid spaces are unremarkable without enhancing mass. LYMPH NODES: No pathologic adenopathy by imaging size criteria. AERODIGESTIVE STRUCTURES: No asymmetric contrast enhancement or asymmetric soft tissue nodularity aside from the expected changes of right free pectoralis flap. PAROTID GLANDS/SUBMANDIBULAR GLANDS: The parotid glands are unremarkable. The submandibular glands are absent. THYROID GLAND: Unremarkable. VASCULAR STRUCTURES: No evidence of dissection, occlusion, or aneurysm. Scattered atherosclerosis of the thoracic aorta. Mild scattered atherosclerosis of the common carotid and internal carotid arteries. OSSEOUS STRUCTURES: Postsurgical change of left mandibular resection and fibular free flap. No acute osseous abnormality or aggressive osseous lesion. Multilevel discogenic degenerative change of the cervical spine with associated multilevel osseous neural foraminal narrowing most pronounced at C3-C4 on the right, C4-C5 on the left, C5-C6 on the left, and C6-C7 bilaterally. PARTIALLY VISUALIZED INTRACRANIAL STRUCTURES: Unremarkable. LUNG APICES: Apical pleural parenchymal scarring. Mild scattered centrilobular emphysema.
FINDINGS: CT of the head with and without contrast: There is no acute infarction, hemorrhage, mass, or cerebral edema. Subcortical and periventricular hypodensities, likely advanced chronic microangiopathic changes. Mild parenchymal volume loss with associated ex vacuo dilatation of the ventricles. Cavum septum pellucidum et vergae is incidentally noted. No enhancing intracranial abnormality. There is no acute osseous or orbital abnormality. The paranasal sinuses and mastoid air cells are clear. CT angiogram of the brain: RIGHT CAROTID: Moderate atherosclerotic calcifications of the carotid siphon. There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: Moderate atherosclerotic calcifications of the carotid siphon. There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Unremarkable. VERTEBROBASILAR ARTERIES: The basilar artery is supplied by the right vertebral artery, normal variant. Mild irregularity to the distal basilar artery without flow limitation. There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. RIGHT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT VERTEBRAL ARTERY: The left vertebral artery is hypoplastic, normal variant, and does not contribute to the basilar artery. There is no evidence of stenosis, occlusion, or aneurysmal dilation. SOFT TISSUES: No soft tissue abnormality within the neck. CERVICAL SPINE: Mild degenerative changes.
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Interpretation of Outside Films CT Chest Clinical Information: 71-year-old female with provided history of? Lung or breast mass Spec Inst: Lung vs breast -CT Chest from St Vincents done 12-30-21 rec 1-26-22 Study reviewed: CT of chest without contrast performed at St. Vincent's East on December 30, 2021, The images are available in PACS. Findings: Compared with an another contrast-enhanced chest CT dated December 28, 2021. A residual moderate right pleural effusion is present which is causing partial atelectasis of the right lower lobe, improved since prior study. Ill-defined groundglass parenchymal opacities are noted in the right upper lobe and to a lesser degree right middle and aerated right lower lobe which could be due to reexpansion edema. The left lung is clear. Few small size nodes are present in the precarinal region measuring approximately 17 x 10 mm in axial image 20, series 3. There is no focal lytic or sclerotic bone lesion. Conclusion: Residual moderate right pleural effusion without pneumothorax. Reexpansion of the underlying lung which demonstrate patchy groundglass parenchymal opacities? Reexpansion edema versus inflammation. Small indeterminate precarinal node
Findings: Compared with an another contrast-enhanced chest CT dated December 28, 2021. A residual moderate right pleural effusion is present which is causing partial atelectasis of the right lower lobe, improved since prior study. Ill-defined groundglass parenchymal opacities are noted in the right upper lobe and to a lesser degree right middle and aerated right lower lobe which could be due to reexpansion edema. The left lung is clear. Few small size nodes are present in the precarinal region measuring approximately 17 x 10 mm in axial image 20, series 3. There is no focal lytic or sclerotic bone lesion.
FINDINGS: There is mild dependent atelectasis bilaterally. A tiny focus of groundglass opacity seen within the posterior basal left lower lobe on image 128 of series 3. Otherwise, no significant groundglass opacities are identified. No fibrotic, cystic or nodular lung disease. The expiratory images are suboptimal. No pleural effusion or pleural thickening. The thyroid gland is unremarkable. Central airways are patent. The thoracic aorta is nonaneurysmal. The pulmonary arteries are not dilated. There is a small to moderate-sized pericardial effusion. The heart is not enlarged. 5Calcified right paratracheal lymph nodes are present. No enlarged noncalcified thoracic lymph nodes. The esophagus is mildly patulous. A gastric lap band is present. No acute or aggressive osseous abnormality.
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EXAM: Outside CT Image Interpretation CLINICAL INFORMATION: 72-year-old male with history of bladder mass. COMPARISON: None available at UAB. TECHNIQUE: Outside CT images of the abdomen and pelvis without and with IV contrast from Urology Associates of Mobile dated 12/1/2021 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 Urogram LOWER CHEST: LUNG BASES / PLEURA: Multiple calcified pleural plaques. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Coronary artery calcifications. No acute abnormality. ABDOMEN AND PELVIS: KIDNEYS: No enhancing renal mass. No hydronephrosis or perinephric stranding. UPPER URINARY TRACTS: - Calculi: No urothelial calculi. - Urothelium: No abnormal urothelial enhancement, thickening or filling defects. URINARY BLADDER: Left posterior urinary bladder diverticulum measuring 6.7 cm x 3.0 cm. Within this diverticulum, there is a 2.5 x 1.1 cm arterially enhancing intraluminal mass with wall thickening and extension into the fat adjacent to the diverticulum (image 67 series 501). No dilation of the ureters. No other areas of bladder wall thickening. No invasion beyond the bladder wall. TURP defect at the bladder neck is present. LIVER: Normal. No suspicious hepatic lesion. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Subcentimeter hypoattenuating focus is indeterminate. ADRENALS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Normal appendix. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Calcified and noncalcified atherosclerosis of the abdominal aorta and iliac vessels. REPRODUCTIVE ORGANS: Calcifications within the prostate gland. TURP defect. BODY WALL: Normal. MUSCULOSKELETAL: No aggressive osseous lesion. CONCLUSION: 1. Large left posterior urinary diverticulum which contains an arterially enhancing hypoattenuating mass most consistent with urothelial tumor with extension into the adjacent fat. 2. No evidence of metastatic disease in the abdomen or pelvis. 3. Multiple calcified pleural plaques. 4. Other chronic findings 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.
FINDINGS: IMAGE QUALITY: Satisfactory. STRUCTURED REPORT: CT Urogram LOWER CHEST: LUNG BASES / PLEURA: Multiple calcified pleural plaques. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Coronary artery calcifications. No acute abnormality. ABDOMEN AND PELVIS: KIDNEYS: No enhancing renal mass. No hydronephrosis or perinephric stranding. UPPER URINARY TRACTS: - Calculi: No urothelial calculi. - Urothelium: No abnormal urothelial enhancement, thickening or filling defects. URINARY BLADDER: Left posterior urinary bladder diverticulum measuring 6.7 cm x 3.0 cm. Within this diverticulum, there is a 2.5 x 1.1 cm arterially enhancing intraluminal mass with wall thickening and extension into the fat adjacent to the diverticulum (image 67 series 501). No dilation of the ureters. No other areas of bladder wall thickening. No invasion beyond the bladder wall. TURP defect at the bladder neck is present. LIVER: Normal. No suspicious hepatic lesion. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Subcentimeter hypoattenuating focus is indeterminate. ADRENALS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Normal appendix. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Calcified and noncalcified atherosclerosis of the abdominal aorta and iliac vessels. REPRODUCTIVE ORGANS: Calcifications within the prostate gland. TURP defect. BODY WALL: Normal. MUSCULOSKELETAL: No aggressive osseous lesion.
FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Resolved nodular opacities in the left upper lobe. Stable biapical pleural-parenchymal scarring. Tiny scattered bilateral pulmonary nodules measuring less than 6 mm, for example in the left lower lobe on series 201 image 129 measuring 3 mm. These are unchanged allowing for differences in technique. Multifocal bronchial filling defects involving the segmental and subsegmental bronchi of the left upper lobe, left lower lobe and right middle lobe. Minimal atelectasis versus scaring with traction bronchiectasis is noted in the right middle lobe. Interval resolution of medial segment of the left lower lobe atelectasis. No new consolidation, pleural effusion, or pneumothorax. Minimal rounded atelectasis is visualized within the right upper lobe adjacent to the fissure. Mosaic attenuation. HEART / VESSELS: Heart size is normal. Moderate coronary artery calcifications.. MEDIASTINUM / ESOPHAGUS: Diffuse esophageal mucosal thickening. LYMPH NODES: Top normal (11 mm short axis on image #89) pretracheal lymph node is stable. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Scattered hypodensities within liver parenchyma which are too small to characterize, although likely benign. High density material is noted within the stomach.. MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality.
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COMPARISON: MR from the outside hospital, dated 10/13/2021 TECHNICAL FACTORS: Brachial plexus MR without and with contrast performed at the outside hospital. UAB radiology had no control over the protocol or the quality of the study. The quality of the study is adequate, with the limitation of nonhomogeneous fat suppression of the soft tissues of the neck. This somewhat limits the assessment. FINDINGS: The study is interpreted combination with shoulder MR, dated 10/13/2021, which was not submitted for interpretation. The brachial plexus is normal in signal intensity. There is no mass effect. Discogenic degenerative changes are seen in the cervical spine, better seen on cervical spine MR. Posterior osteophytes are producing mass effect on the spinal cord at C4-C5 and, to a lesser degree, C5-C6 level. For details, MR of the cervical spine should be submitted. There is marked edema, but no atrophy in the supraspinatus and infraspinatus muscles. Mild enhancement is noted in these muscles. There is no glenohumeral joint effusion. There is no significant rotator cuff tear. The long head of the biceps tendon is intact. The subscapularis and teres muscles and major tendons are normal. Mild degenerative changes are present in the acromioclavicular joint. IMPRESSION: Edema in the supraspinatus and infraspinatus muscles indicates lesion of the suprascapular nerve. However, no mass effect, edema or enhancement are seen along the visualized course or in the brachial plexus. No lesion in the suprascapular notch.
FINDINGS: The study is interpreted combination with shoulder MR, dated 10/13/2021, which was not submitted for interpretation. The brachial plexus is normal in signal intensity. There is no mass effect. Discogenic degenerative changes are seen in the cervical spine, better seen on cervical spine MR. Posterior osteophytes are producing mass effect on the spinal cord at C4-C5 and, to a lesser degree, C5-C6 level. For details, MR of the cervical spine should be submitted. There is marked edema, but no atrophy in the supraspinatus and infraspinatus muscles. Mild enhancement is noted in these muscles. There is no glenohumeral joint effusion. There is no significant rotator cuff tear. The long head of the biceps tendon is intact. The subscapularis and teres muscles and major tendons are normal. Mild degenerative changes are present in the acromioclavicular joint.
FINDINGS: Scouts: Intact median sternotomy wires. Lower neck and Mediastinum: Small thyroid gland is unremarkable. Mildly patulous mid and lower esophagus are again noted. No new focal esophageal wall abnormalities, within the limits of noncontrast scan. Lymph nodes: Within the limits of the noncontrast scan, no evidence of new pathologically enlarged supraclavicular, and within the study, mediastinal or hilar lymph nodes. Heart and great arteries: Cardiac chambers are normal in size. No pericardial effusion. Mediastinal great arteries are normal in caliber. Post median sternotomy and cardiac surgery related changes are again noted. Airways: Small amount of retained secretions is noted lower thoracic trachea and left mainstem bronchus. Redemonstrated mild to moderate diffuse bronchial thickening, which could be seen with bronchitis. Lungs : Mild upper lobe predominant centrilobular and paraseptal emphysema is again noted. A tiny 4 mm noncalcified pulmonary nodule within the right middle lobe is unchanged. No new focal pulmonary opacities or new suspicious pulmonary nodules or masses. Pleura: No pleural effusion or pneumothorax. Upper abdomen: Limited noncontrast visualization of the upper abdomen is without acute or significant abnormalities. Bones and soft tissues: The visualized chest wall soft tissues are unremarkable. Degenerative bony changes are noted, without evidence of aggressive or destructive intrathoracic osseous lesions. Well healed median sternotomy with intact sternotomy wires. Partially visualized cervical anterior fusion hardware is again noted.
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EXAM: Interpretation of Outside Films CT Chest CLINICAL INFORMATION: Interpretation of outside CT chest without contrast performed at Carmichael imaging center. Chronic respiratory failure. History of COVID in August 2021. COMPARISON: None available at this time. TECHNIQUE: Interpretation of Outside Films CT Chest. CT chest without contrast was obtained on 12/30/2021 at Carmichael imaging Center. 2.5 mm axial reformats in inspiration and expiration with additional 1.25 mm reformats are available at the time of interpretation. 3 mm coronal and sagittal reformats are also available. 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. FINDINGS: CONTRAST DISCLAIMER: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: There are focal groundglass opacities throughout the bilateral lungs with slight apical predominance. There is a calcified granuloma in the right upper lobe, additional scattered less than 5 mm pulmonary nodules are present. No suspicious pulmonary nodule. There is no pleural effusion or pneumothorax. No significant centrilobular nodularity. Expiratory mages demonstrate patchy air trapping. No tracheobronchomalacia. HEART / VESSELS: Heart size is normal. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Numerous calcified mediastinal and right hilar lymph nodes. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal noncontrast appearance of the imaged upper abdomen. MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality. CONCLUSION: Focal groundglass opacity throughout the bilateral lungs with slight apical predominance and numerous calcified mediastinal lymph nodes. Expiratory mages demonstrate mild air trapping. Differential includes sequela of prior Covid infection with residual reactive airway disease, given the history. Sarcoidosis, hypersensitivity pneumonitis, are also included in the differential. 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.
FINDINGS: CONTRAST DISCLAIMER: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: There are focal groundglass opacities throughout the bilateral lungs with slight apical predominance. There is a calcified granuloma in the right upper lobe, additional scattered less than 5 mm pulmonary nodules are present. No suspicious pulmonary nodule. There is no pleural effusion or pneumothorax. No significant centrilobular nodularity. Expiratory mages demonstrate patchy air trapping. No tracheobronchomalacia. HEART / VESSELS: Heart size is normal. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Numerous calcified mediastinal and right hilar lymph nodes. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal noncontrast appearance of the imaged upper abdomen. MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality.
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. Small right frontal scalp hematoma.
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EXAM: Interpretation of Outside Films CT Chest CLINICAL INFORMATION: Interpretation of outside CT. Lymphadenopathy. CT chest and neck with contrast performed at GE medical system on 12/17/2021. COMPARISON: None. TECHNIQUE: Interpretation of Outside Films CT Chest. 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. Please note that neck CT and abdomen pelvis CT images images are included on the same image set; only CT chest findings included in this report, please see same-day CT neck report for neck findings. FINDINGS: CONTRAST DISCLAIMER: Not applicable. STRUCTURED REPORT: CT Chest LOWER NECK: Please see same-day CT neck for neck findings. CHEST: LUNGS / AIRWAYS / PLEURA: There is no focal consolidation, pleural effusion, or pneumothorax. Scattered, less than 6 mm pulmonary nodules are present, largest measuring 4 mm on series 2 image 147 in the left lower lobe. Central airways are patent. HEART / VESSELS: Heart size is normal. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Residual thymic tissue is present. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Gallbladder is surgically absent. Otherwise normal appearance of the upper abdomen MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality. CONCLUSION: 1. No acute cardiopulmonary abnormality. No significant intrathoracic lymphadenopathy. 2. A few tiny pulmonary nodules, likely post infectious/inflammatory. 3. Same-day CT neck and abdomen will be reported separately 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.
FINDINGS: CONTRAST DISCLAIMER: Not applicable. STRUCTURED REPORT: CT Chest LOWER NECK: Please see same-day CT neck for neck findings. CHEST: LUNGS / AIRWAYS / PLEURA: There is no focal consolidation, pleural effusion, or pneumothorax. Scattered, less than 6 mm pulmonary nodules are present, largest measuring 4 mm on series 2 image 147 in the left lower lobe. Central airways are patent. HEART / VESSELS: Heart size is normal. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Residual thymic tissue is present. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Gallbladder is surgically absent. Otherwise normal appearance of the upper abdomen MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality.
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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CT scan of the soft tissues of the neck with contrast. Outside scan dated 12/17/2021 for interpretation only. Clinical: Lymphadenopathy. Findings: Only axial scans soft tissues of the neck are provided. A homogeneous right submandibular node measures 7 x 15 mm. Bilateral level IIb nodes measure 9 x 6 mm on the right. 2 x 13 mm on the left. There are numerous slightly enlarged and shotty jugular chain nodes bilaterally. Soft tissues are otherwise unremarkable. No defect is seen in the cervical spine. ---------------- Conclusion: Bilateral cervical lymphadenopathy.
Findings: Only axial scans soft tissues of the neck are provided. A homogeneous right submandibular node measures 7 x 15 mm. Bilateral level IIb nodes measure 9 x 6 mm on the right. 2 x 13 mm on the left. There are numerous slightly enlarged and shotty jugular chain nodes bilaterally. Soft tissues are otherwise unremarkable. No defect is seen in the cervical spine. ----------------
FINDINGS: Scouts: No additional findings. Lower neck and Mediastinum: Thyroid gland is unremarkable. Mildly patulous upper and lower esophagus with a small amount of retained fluid within the upper esophagus are again noted, which could be seen with esophageal dysmotility disorders. No new focal esophageal wall abnormalities. Lymph nodes: Few prominent and mildly enlarged right cardiophrenic lymph nodes are unchanged when compared to prior. Other small mediastinal and hilar lymph nodes are also overall unchanged by eyeballing technique. No new pathologically enlarged supraclavicular, mediastinal, hilar or axillary lymph nodes. Heart and great arteries: Cardiac chambers are normal in size. No pericardial effusion. Mediastinal great arteries are normal in caliber. No evidence of large central pulmonary thromboembolic disease. Airways: The trachea and central bronchi are patent and clear. Lungs : Multiple bibasilar linear opacities of scarring/atelectasis are again noted, similar to prior. Stable left upper lobe tiny, 3 mm, possibly centrally calcified left upper lobe pulmonary nodule (series 17, image 48). No new focal pulmonary opacities or suspicious pulmonary nodules or masses. Pleural: No pleural effusion or pneumothorax. Upper abdomen: The CT of the abdomen and pelvis will be reported separately. Bones and soft tissues: The chest wall soft tissues are unremarkable. No new aggressive or destructive intrathoracic osseous lesions. Mild degenerative bony changes are again noted.
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Clinical History: Assess for bone lesion Comparison: MRI abdomen 1/11/2022, CT 1/11/2022, bone scan 1/17/2022 Technique: Noncontrast MRI images of the lumbar spine performed at DIC imaging on 12/30/2021 were submitted for interpretation. Findings: There are small T1 and T2 hyperintense lesions involving S1, L5, T12 vertebral bodies. These are favored to represent small hemangiomas. Small STIR hyperintense lesion in the right L5 vertebral body without appreciable T1 signal (series 6 image 10). Right iliac lesion (series 5 image four) is better assessed on the dedicated MRI pelvis and CT abdomen pelvis. There is grade 1 anterolisthesis of L4 over L5 with slight unroofing of the underlying disc vertebral body heights are maintained. The cord terminates near L1-L2, and has normal morphology and signal intensity. At L4-L5, combination of anterolisthesis, unroofing of underlying disc, moderate to severe facet hypertrophy with joint fluid results in mild-to-moderate right and mild left neuroforaminal narrowing. There is mild bilateral subarticular recess narrowing. At L5-S1, there is mild to moderate bilateral neuroforaminal narrowing due to facet and disc degenerative changes. There are prior presumed Tarlov cyst at S2 and S3. Impression: 1. Small STIR hyperintense lesion in the right L5 vertebral body without appreciable T1 signal. There is favored to represent a small atypical hemangioma. --Right iliac lesion is better assessed on the dedicated MRI pelvis and CT abdomen pelvis. 2. L4-L5 predominant chronic degenerative changes with grade 1 anterolisthesis, mild-to-moderate right neuroforaminal and bilateral mild subarticular recess narrowing.
Findings: There are small T1 and T2 hyperintense lesions involving S1, L5, T12 vertebral bodies. These are favored to represent small hemangiomas. Small STIR hyperintense lesion in the right L5 vertebral body without appreciable T1 signal (series 6 image 10). Right iliac lesion (series 5 image four) is better assessed on the dedicated MRI pelvis and CT abdomen pelvis. There is grade 1 anterolisthesis of L4 over L5 with slight unroofing of the underlying disc vertebral body heights are maintained. The cord terminates near L1-L2, and has normal morphology and signal intensity. At L4-L5, combination of anterolisthesis, unroofing of underlying disc, moderate to severe facet hypertrophy with joint fluid results in mild-to-moderate right and mild left neuroforaminal narrowing. There is mild bilateral subarticular recess narrowing. At L5-S1, there is mild to moderate bilateral neuroforaminal narrowing due to facet and disc degenerative changes. There are prior presumed Tarlov cyst at S2 and S3.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Postsurgical changes of partial right hepatectomy with minimal residual fluid collection along the surgical bed. Stable small simple hepatic cysts. No new suspicious lesion. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Stable bilateral simple renal cysts. Symmetric enhancement. No hydronephrosis or hydroureter. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Moderate colonic stool present. Appendix appears normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Aorta is nonaneurysmal. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Persistent right anterior abdominal wall edema without any discrete collection. MUSCULOSKELETAL: No significant abnormality.