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Cervical spine CT and CT angiogram Neck 1/6/2022 11:39 AM Indication: Trauma Comparison: None Technique: Helical contiguous axial CT acquisition was performed during the early arterial phase of a rapid IV infusion of contrast, from the thoracic inlet through the circle of Willis. 3-D CT angiographic images were generated from axial data set. "Sliding slab MIP" images were also generated. Following CTA of the neck, reformatted images were produced to optimize visualization of the osseous structures of the cervical spine. Patient weight: 138 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. IV contrast injection rate: 3.50 ml per sec. Scan delay: bt sec. Scan field of view: 250 mm. DLP: 734 mGy cm. . Findings: CT C-spine: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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Findings: CT C-spine: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: The right MCA territory evolving infarction shows continued severe mass effect effacing the right lateral ventricle and shifting midline 11 mm to the left. Mild right uncal herniation is also noted. The left lateral ventricle shows no obstructive hydrocephalus. There is no interval hemorrhagic transformation of the infarction or evidence of new ischemic event.
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2,601 |
CTA Coronary Artery CLINICAL INFORMATION: 49-year-old male with equivocal stress test and 10 year coronary artery disease risk greater than 20%. TECHNIQUE: Precontrast axial images through the heart were acquired for calcium score evaluation. Postcontrast images were acquired in prospective ECG gating to the heart with dual source 256 detectors Siemens CT scanner (Somatom FORCE). Images reviewed in multiple phases of the cardiac cycle. Source images, multiplanar reformatted images, MIP and volume rendered images were also reviewed. Patient was given 0.4 mg of sublingual nitroglycerin for coronary arterial vasodilatation. Patient weight: 182 lbs. IV contrast: Omnipaque 350, 70 ml, per protocol. Saline flush: 60 ml. IV contrast injection rate: 5 ml per sec. Scan delay: bt sec. Scan field of view: 186 mm. Heart Rate: 54 bpm. DLP: 267 mGy cm. COMPARISON: CT abdomen and pelvis 3/1/2017 FINDINGS: Calcium score: Using a modified Agatston scoring method, the coronary artery calcification score is 0. Coronary arteries: * Dominance: Right dominant with the right coronary artery supplying the posterior descending and posterolateral arteries. * LM: Normal origin from the left coronary cusp. No significant atherosclerotic plaque or stenosis. Conventional bifurcation into the left anterior descending and circumflex arteries. * LAD: Normal course and caliber. Patent diagonal and septal perforator branches. No significant atherosclerotic plaque or stenosis. * LCx: Normal course and caliber. No significant atherosclerotic plaque or significant stenosis. Patent obtuse marginal branches. * RCA: Normal origin from the right coronary cusp. Normal course and caliber. No significant atherosclerotic plaque or significant stenosis. Patent posterior descending and posterolateral arteries. Heart and great vessels: Cardiac chambers: The heart is normal in size. No pericardial effusion. The visualized Thoracic aorta is normal in caliber. The visualized Pulmonary arteries is mildly enlarged measuring 3.3 cm in caliber. Lungs and extracardiac structures: The scanned central tracheobronchial tree is patent and clear. The scanned part of the mediastinum and esophagus are unremarkable. The scanned lungs demonstrate mild bilateral dependent atelectasis. The scanned part of the upper abdomen redemonstrate mild hepatic steatosis. The scanned chest wall soft tissues and skeletal structures demonstrate mild multilevel degenerative changes of the thoracic spine. CONCLUSION: 1. No evidence of atherosclerotic coronary artery disease, CAD-RADS 0. 2. No acute abnormality in the imaged chest. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: Calcium score: Using a modified Agatston scoring method, the coronary artery calcification score is 0. Coronary arteries: * Dominance: Right dominant with the right coronary artery supplying the posterior descending and posterolateral arteries. * LM: Normal origin from the left coronary cusp. No significant atherosclerotic plaque or stenosis. Conventional bifurcation into the left anterior descending and circumflex arteries. * LAD: Normal course and caliber. Patent diagonal and septal perforator branches. No significant atherosclerotic plaque or stenosis. * LCx: Normal course and caliber. No significant atherosclerotic plaque or significant stenosis. Patent obtuse marginal branches. * RCA: Normal origin from the right coronary cusp. Normal course and caliber. No significant atherosclerotic plaque or significant stenosis. Patent posterior descending and posterolateral arteries. Heart and great vessels: Cardiac chambers: The heart is normal in size. No pericardial effusion. The visualized Thoracic aorta is normal in caliber. The visualized Pulmonary arteries is mildly enlarged measuring 3.3 cm in caliber. Lungs and extracardiac structures: The scanned central tracheobronchial tree is patent and clear. The scanned part of the mediastinum and esophagus are unremarkable. The scanned lungs demonstrate mild bilateral dependent atelectasis. The scanned part of the upper abdomen redemonstrate mild hepatic steatosis. The scanned chest wall soft tissues and skeletal structures demonstrate mild multilevel degenerative changes of the thoracic spine.
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FINDINGS: On the venous phase images, there is a mildly dilated tubular structure anterior to the mid manubrium in the midline on image 37 of series 13. This measures up to 7 mm in diameter on the axial images and extends for approximately 20 mm in craniocaudal extent. This does increase in size between the arterial and venous phases. No other dilated vascular lesions are seen within the anterior chest wall. The supraclavicular region is unremarkable. Central airways are patent. The thoracic aorta is nonaneurysmal. The pulmonary arteries are not dilated. The heart is not enlarged. No pericardial effusion. No enlarged thoracic lymph nodes. Residual thymic tissue seen within the anterior mediastinum. The esophagus is not dilated. There is no acute lung abnormality. No suspicious lung nodules. No pleural effusion or pleural thickening. No acute or aggressive osseous abnormality.
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2,602 |
CT Neck Soft Tissue w contrast Clinical Information: 76-year-old patient with history of stage III esophageal cancer treated with chemoradiation 16 years ago. Left soft palate carcinoma status post palate resection and left tonsillectomy with close margins on 8/12/2021. Status post reexcision of left tonsil and pelvic margins with pathology consistent with left tonsil cancer. Oropharyngeal cancer, recurrence suspected or known, R22.1 Localized swelling, mass and lump, neck Spec Inst: Believes last CT had contrast, thinks may have had allergy in the past. Comparison: 8/4/2021 Technique: Axial images of the neck were obtained following the administration of intravenous contrast. Reformatted coronal and sagittal images were also obtained. Patient weight: 118 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 2 ml per sec. Scan delay: 45 sec. Scan field of view: 240 mm. DLP: 675.84 mGy cm. Findings: Included portions of the brain and skull base appear normal. Dental amalgam with significant streak artifacts limiting evaluation of the oral cavity and oropharynx. There is soft tissue fullness within the left soft palate/anterior tonsillar pillar measuring approximately 0.9 x 0.8 cm (series 4 image 8 ). Heterogeneously enhancing masses within the left jugular chain level IIa underneath the sternomastoid muscle with difficult size evaluation given the infiltrative nature (series 3 image 215). This mass appears to involve the overlying sternomastoid muscle and underlying paravertebral muscles (series 3 image 224). There is large conglomerated necrotic lymphadenopathy with poorly demarcated margin in the left jugulodigastric chain measuring 3.4 x 1.8 cm. Multiple subcentimeter partially necrotic lymph nodes are present along the left level IIA/IIB, III and IV. No enlarged right-sided lymph nodes. The parotid glands, submandibular, and thyroid glands are unremarkable aside from suspected unchanged left thyroid nodule. Retropharyngeal course of the internal carotid arteries. Mild arterial atherosclerotic disease. Mild aneurysmal dilatation at the distal left MCA artery. The caliber of the artery at this location measures 5 x 5 mm (sagittal series 602 image 57). The cervical and major intracranial vasculature are prominent size in general. Review of bone window demonstrate no aggressive osseous lesion. Multilevel cervical degenerative changes with stepladder mild anterior listhesis from C3-C5. Conclusion: 1. Suspected recurrent left soft palate/anterior tonsillar pillar malignancy. 2. Large conglomerated necrotic left jugulodigastric lymphadenopathy with extracapsular invasion, and multiple subcentimeter metastatic lymphadenopathy along the left level IIA/IIB, III and IV. 3. Prominent luminal size of the cervical and major intracranial vasculature with small aneurysmal dilatation of the distal left middle cerebral artery. Retropharyngeal course of the internal carotid arteries. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: Included portions of the brain and skull base appear normal. Dental amalgam with significant streak artifacts limiting evaluation of the oral cavity and oropharynx. There is soft tissue fullness within the left soft palate/anterior tonsillar pillar measuring approximately 0.9 x 0.8 cm (series 4 image 8 ). Heterogeneously enhancing masses within the left jugular chain level IIa underneath the sternomastoid muscle with difficult size evaluation given the infiltrative nature (series 3 image 215). This mass appears to involve the overlying sternomastoid muscle and underlying paravertebral muscles (series 3 image 224). There is large conglomerated necrotic lymphadenopathy with poorly demarcated margin in the left jugulodigastric chain measuring 3.4 x 1.8 cm. Multiple subcentimeter partially necrotic lymph nodes are present along the left level IIA/IIB, III and IV. No enlarged right-sided lymph nodes. The parotid glands, submandibular, and thyroid glands are unremarkable aside from suspected unchanged left thyroid nodule. Retropharyngeal course of the internal carotid arteries. Mild arterial atherosclerotic disease. Mild aneurysmal dilatation at the distal left MCA artery. The caliber of the artery at this location measures 5 x 5 mm (sagittal series 602 image 57). The cervical and major intracranial vasculature are prominent size in general. Review of bone window demonstrate no aggressive osseous lesion. Multilevel cervical degenerative changes with stepladder mild anterior listhesis from C3-C5.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Couple of hypoattenuating structures, technically indeterminate but most suggestive of cysts. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Well-circumscribed hypodensity within the medial aspect of the spleen, indeterminate but benign-appearing. ADRENALS: Normal. KIDNEYS: Left renal cyst. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Trace pelvic free fluid, likely physiologic. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Enlarged, fibroid uterus. Dominant fibroid in the anterior uterine body measures approximately 5.8 cm on axial series 2, image 254. BODY WALL: Small supraumbilical fat-containing ventral abdominal wall hernia measures 3.1 x 1.4 cm on axial series 2, image 139. The hernia measures up to 3.5 cm in craniocaudal dimension on sagittal series 602, image 132. Tiny fat-containing umbilical hernia is also present. MUSCULOSKELETAL: No significant abnormality.
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2,603 |
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Colon cancer surveillance COMPARISON: 7/1/2021 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 157 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. IV contrast injection rate: 3 ml per sec. Scan delay: 78 sec. Scan field of view: 427 mm. DLP: 793 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately reported chest CT. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral simple renal cysts. Mild right extrarenal pelvis. No obstructing mass or calculus visualized. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. Small bowel anastomosis within the right upper quadrant is noted and unremarkable. COLON / APPENDIX: Stable postsurgical changes of ascending colectomy with right upper quadrant ileal-proximal transverse anastomosis. No nodularity obstruction to suggest recurrence at the anastomosis. There is improved perianastomotic stranding, postsurgical in nature. PERITONEUM / MESENTERY: Postsurgical changes as above. Otherwise, normal. RETROPERITONEUM: Normal. VESSELS: Mild to moderate atherosclerosis involving the descending aorta and branching vessels. URINARY BLADDER: No abnormality. Collapsed. REPRODUCTIVE ORGANS: Uterus is surgically absent. No adnexal masses. There is a well-circumscribed lesion in the low right perineum, likely Bartholin's cyst. Additionally, there is bulky soft tissue more superiorly and along the midline of the perineum that may be related to pelvic floor muscle relaxation. BODY WALL: Tiny fat-containing umbilical hernia. Lower abdominal midline scar noted. MUSCULOSKELETAL: No acute or aggressive osseous abnormality. Moderate to severe degenerative changes involving the lumbar spine, most severe at the L1-L2 level where there is advanced joint space narrowing and small Schmorl's node at the L1 inferior endplate. Mild retrolisthesis of L1 on L2 and L2 on L3. CONCLUSION: 1. No disease recurrence or metastatic disease within the abdomen/pelvis. 2. Postsurgical changes related to right hemicolectomy with improved surrounding postsurgical inflammation. 3. Bulky soft tissue along the midline of the perineum. This may be indicative of vaginal prolapse. Recommend correlation with physical exam. 4. Moderate to severe lumbar spine degenerative changes. Other stable/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.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately reported chest CT. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral simple renal cysts. Mild right extrarenal pelvis. No obstructing mass or calculus visualized. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. Small bowel anastomosis within the right upper quadrant is noted and unremarkable. COLON / APPENDIX: Stable postsurgical changes of ascending colectomy with right upper quadrant ileal-proximal transverse anastomosis. No nodularity obstruction to suggest recurrence at the anastomosis. There is improved perianastomotic stranding, postsurgical in nature. PERITONEUM / MESENTERY: Postsurgical changes as above. Otherwise, normal. RETROPERITONEUM: Normal. VESSELS: Mild to moderate atherosclerosis involving the descending aorta and branching vessels. URINARY BLADDER: No abnormality. Collapsed. REPRODUCTIVE ORGANS: Uterus is surgically absent. No adnexal masses. There is a well-circumscribed lesion in the low right perineum, likely Bartholin's cyst. Additionally, there is bulky soft tissue more superiorly and along the midline of the perineum that may be related to pelvic floor muscle relaxation. BODY WALL: Tiny fat-containing umbilical hernia. Lower abdominal midline scar noted. MUSCULOSKELETAL: No acute or aggressive osseous abnormality. Moderate to severe degenerative changes involving the lumbar spine, most severe at the L1-L2 level where there is advanced joint space narrowing and small Schmorl's node at the L1 inferior endplate. Mild retrolisthesis of L1 on L2 and L2 on L3.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Innumerable heterogenous liver masses of varying size resulting in marked hepatomegaly, such as a centrally necrotic appearing lesion measuring 7.0 x 9.0 cm on image 135, series 601. Liver lesions exert mass effect and narrowing of the portal and hepatic veins. BILIARY TRACT: Multifocal areas of intrahepatic biliary ductal dilation. No extrahepatic duct dilation. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Left adrenal nodule measuring 1.2 cm. Right adrenal gland is normal. KIDNEYS: Small right renal cyst. Mass effect on the right kidney from an enlarged right hepatic lobe. Kidneys are otherwise normal. LYMPH NODES: Enlarged retroperitoneal and periportal lymph nodes. There is also prominent rounded perigastric node. STOMACH / SMALL BOWEL: Masslike wall thickening along the anterior aspect of the gastric antrum with mild overlying infiltrative fat stranding. COLON / APPENDIX: Noninflamed colonic diverticula. PERITONEUM / MESENTERY: No ascites or free air RETROPERITONEUM: Normal. VESSELS: Moderate aortoiliac atherosclerotic disease without aneurysm. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No acute abnormality. Calcified fibroid along the posterior uterine body.. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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2,604 |
EXAM: CT Chest with contrast CLINICAL INFORMATION: 74-year-old female with provided history of colon cancer. COMPARISON: Outside chest CT dated 6/14/2021 TECHNIQUE: CT Chest with contrast. Patient weight: 157 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. IV contrast injection rate: 3 ml per sec. Scan delay: 35 sec. Scan field of view: 345 mm. DLP: 264 mGy cm. FINDINGS: Limitations: None. Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: Few small subcentimeter pulmonary nodules are unchanged, for example in the right middle lobe at image 64, series 2. No new or enlarging suspicious pulmonary nodule. No focal consolidation. Redemonstrated bibasilar mild subpleural reticulation with minimal traction bronchiolectasis. No honeycombing. The trachea and main bronchi are patent. No pleural effusion. Thoracic inlet, heart, and mediastinum: No new or enlarging thoracic lymphadenopathy. The esophagus is nondilated. Stable mild ectasia of the ascending aorta, measures up to 4.4 cm. Main pulmonary artery is 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: Stable CT exam with no new intrathoracic metastases.
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FINDINGS: Limitations: None. Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: Few small subcentimeter pulmonary nodules are unchanged, for example in the right middle lobe at image 64, series 2. No new or enlarging suspicious pulmonary nodule. No focal consolidation. Redemonstrated bibasilar mild subpleural reticulation with minimal traction bronchiolectasis. No honeycombing. The trachea and main bronchi are patent. No pleural effusion. Thoracic inlet, heart, and mediastinum: No new or enlarging thoracic lymphadenopathy. The esophagus is nondilated. Stable mild ectasia of the ascending aorta, measures up to 4.4 cm. Main pulmonary artery is 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.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Pelvis LOWER ABDOMEN: BOWEL: No abnormality. PERITONEUM: Normal. OTHER: No other abnormality. PELVIS: VESSELS: No significant atherosclerotic wall calcifications of bilateral external iliac arteries.. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Moderate subcutaneous soft tissue edema in the anterior pelvic wall.. MUSCULOSKELETAL: No significant abnormality.
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2,605 |
RADIOLOGIC EXAM: CT Head wo contrast, CT Maxillofacial wo contrast CLINICAL INFORMATION: Trauma., Fall. COMPARISON: None. TECHNIQUE: CT Head wo contrast, CT Maxillofacial wo contrastScan field of view: 245 mm. DLP: 1178 mGy cm. (accession CT220003111), Scan field of view: 200 mm. DLP: 344 mGy cm. (accession CT220003112) STRUCTURED REPORT: CT Head and CT maxillofacial Trauma FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Generalized brain involution, mildly advanced for age. Extensive periventricular white matter hypoattenuation in a pattern compatible with moderate small vessel ischemic disease. Nonspecific torcular prominence. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Laceration in the left anterior frontal scalp extending to the left supraorbital soft tissues.. VENTRICULAR SYSTEM: Normal. ORBITS: Mild preseptal left supraorbital soft tissue swelling. Otherwise no acute abnormality. SINUSES: Mucous retention cyst in the left maxillary sinus. No acute fractures. Bilateral mastoid air cells and middle ear cavities are unremarkable. MAXILLOFACIAL: No acute maxillofacial or mandibular fracture. Bilateral temporomandibular joints are intact. Edentulous. See above. Otherwise, soft tissues of the face are otherwise unremarkable. CONCLUSION: 1. No acute intracranial process. 2. No acute maxillofacial or mandibular fractures. 3. Left frontal scalp soft tissue laceration and mild left preseptal supraorbital soft tissue swelling.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Generalized brain involution, mildly advanced for age. Extensive periventricular white matter hypoattenuation in a pattern compatible with moderate small vessel ischemic disease. Nonspecific torcular prominence. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Laceration in the left anterior frontal scalp extending to the left supraorbital soft tissues.. VENTRICULAR SYSTEM: Normal. ORBITS: Mild preseptal left supraorbital soft tissue swelling. Otherwise no acute abnormality. SINUSES: Mucous retention cyst in the left maxillary sinus. No acute fractures. Bilateral mastoid air cells and middle ear cavities are unremarkable. MAXILLOFACIAL: No acute maxillofacial or mandibular fracture. Bilateral temporomandibular joints are intact. Edentulous. See above. Otherwise, soft tissues of the face are otherwise unremarkable.
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FINDINGS: Asymmetric peribronchovascular and peripheral reticulation with associated groundglass opacities are again noted bilaterally. There is associated traction bronchiectasis. Again, these findings are most significant within the bilateral lung bases, left greater than right. Overall, the severity and extent of disease has not significantly changed from the prior examination. No superimposed areas of new groundglass opacity or consolidation are identified. No honeycombing. Calcifications are seen within the bilateral lower lobes. No new or enlarging lung nodules. No pleural effusion or pleural thickening. Surgical changes involving the lower neck are again noted. The central airways are patent. The thoracic aorta is nonaneurysmal. The pulmonary arteries are not dilated. Unchanged mild cardiomegaly. Severe coronary artery calcifications with coronary stents present. No pericardial effusion. No enlarged thoracic lymph nodes. The esophagus is not dilated. No acute or aggressive osseous abnormality.
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2,606 |
RADIOLOGIC EXAM: CT Head wo contrast, CT Maxillofacial wo contrast CLINICAL INFORMATION: Trauma., Fall. COMPARISON: None. TECHNIQUE: CT Head wo contrast, CT Maxillofacial wo contrastScan field of view: 245 mm. DLP: 1178 mGy cm. (accession CT220003111), Scan field of view: 200 mm. DLP: 344 mGy cm. (accession CT220003112) STRUCTURED REPORT: CT Head and CT maxillofacial Trauma FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Generalized brain involution, mildly advanced for age. Extensive periventricular white matter hypoattenuation in a pattern compatible with moderate small vessel ischemic disease. Nonspecific torcular prominence. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Laceration in the left anterior frontal scalp extending to the left supraorbital soft tissues.. VENTRICULAR SYSTEM: Normal. ORBITS: Mild preseptal left supraorbital soft tissue swelling. Otherwise no acute abnormality. SINUSES: Mucous retention cyst in the left maxillary sinus. No acute fractures. Bilateral mastoid air cells and middle ear cavities are unremarkable. MAXILLOFACIAL: No acute maxillofacial or mandibular fracture. Bilateral temporomandibular joints are intact. Edentulous. See above. Otherwise, soft tissues of the face are otherwise unremarkable. CONCLUSION: 1. No acute intracranial process. 2. No acute maxillofacial or mandibular fractures. 3. Left frontal scalp soft tissue laceration and mild left preseptal supraorbital soft tissue swelling.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Generalized brain involution, mildly advanced for age. Extensive periventricular white matter hypoattenuation in a pattern compatible with moderate small vessel ischemic disease. Nonspecific torcular prominence. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Laceration in the left anterior frontal scalp extending to the left supraorbital soft tissues.. VENTRICULAR SYSTEM: Normal. ORBITS: Mild preseptal left supraorbital soft tissue swelling. Otherwise no acute abnormality. SINUSES: Mucous retention cyst in the left maxillary sinus. No acute fractures. Bilateral mastoid air cells and middle ear cavities are unremarkable. MAXILLOFACIAL: No acute maxillofacial or mandibular fracture. Bilateral temporomandibular joints are intact. Edentulous. See above. Otherwise, soft tissues of the face are otherwise unremarkable.
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FINDINGS: STRUCTURED REPORT: CT Pelvis LOWER ABDOMEN: BOWEL: No abnormality. PERITONEUM: Normal. OTHER: No other abnormality. PELVIS: VESSELS: Moderate aortobiiliac atherosclerotic disease LYMPH NODES: Borderline enlarged external iliac lymph nodes. PERIRECTAL / PERIANAL REGION: There is a 2.8 x 3.7 cm x 4.2 peroneal fluid collection along the anterior aspect of the anal canal inferior to the prostate and posterior to the base of the penis. There is peripheral rim enhancement around the collection. URINARY BLADDER: Decompressed REPRODUCTIVE ORGANS: Low-density structures either within or adjacent to the epididymis/traumatic cord, likely cysts. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Moderate to advanced degenerative endplate changes in the lower lumbar spine.
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2,607 |
RADIOLOGIC EXAM: CT Cervical Spine wo contrast CLINICAL INFORMATION: Fall. COMPARISON: None. TECHNIQUE: CT Cervical Spine wo contrastScan field of view: 155 mm. DLP: 1022 mGy cm. Following CT of the neck, reformatted images were produced to optimize visualization of the osseous structures of the cervical spine. STRUCTURED REPORT: CT Cervical Spine Trauma FINDINGS: Mild motion limited evaluation. 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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FINDINGS: Mild motion limited evaluation. 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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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Minimal dependent atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: A slight surface nodularity and prominence of the caudate lobe suggesting cirrhosis. Stable right lobe cyst. BILIARY TRACT: Mild intrahepatic biliary ductal dilatation. Extrahepatic biliary ductal dilatation with common bile duct measuring up to 1.7 cm in caliber. GALLBLADDER: Distended with choleliths and clearing sludge. Mild posterior wall thickening. PANCREAS: Normal. SPLEEN: Enlarged. ADRENALS: Normal. KIDNEYS: RIGHT KIDNEY: Right subcapsular hematoma has further increased in size in the interval, severely compressing the renal parenchyma. There is asymmetric hypoenhancement of the right kidney and extensive perinephric stranding. LEFT KIDNEY: Left percutaneous nephrostomy tube has been slightly retracted, with pigtail near the corticomedullary junction. Trace subcapsular hematoma along the interpolar region. No hydronephrosis. Scattered areas of cortical hypoattenuation noted. LYMPH NODES: Shotty retroperitoneal lymph nodes, similar to prior. STOMACH / SMALL BOWEL: Small bowel resection changes noted in the right side of the pelvis. Multiple small bowel loops communicate with the lower abdominal wall, consistent with known enterocutaneous fistula. COLON / APPENDIX: Sigmoid diverticulosis. Appendix is not visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: As above. VESSELS: Mild atherosclerosis. URINARY BLADDER: Anterior bladder wall closely approximates the ventral abdominal wall at the site of enterocutaneous fistula and contains foci of nondependent air. REPRODUCTIVE ORGANS: Absent uterus. BODY WALL: Enterocutaneous and vesicocutaneous fistula in the lower abdomen. MUSCULOSKELETAL: Diffuse muscular atrophy.
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2,608 |
EXAM: CT Chest High Resolution wo contrast CLINICAL INFORMATION: 78-year-old female with provided history of ILD. COMPARISON: No prior CT chest for comparison. Prior chest radiograph dated 12/15/2021 TECHNIQUE: CT Chest High Resolution wo contrast. Scan field of view: 263 mm. DLP: 157 mGy cm. High-resolution CT imaging of the chest was performed per protocol with inspiratory and expiratory technique in prone position. FINDINGS: Limitations: None. Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: There is coarse subpleural reticulation involving both upper and lower lobes with bibasilar predominance and associated mild traction bronchiectasis/bronchiolectasis. Small honeycombing like cystic changes in the periphery of both upper lobes. No significant architectural distortion or honeycombing. Interspersed groundglass opacities are also noted. No suspicious pulmonary nodules or masses. The trachea and main bronchi are patent. No pleural effusion. Expiratory images demonstrate mild focal areas of air trapping bilaterally. No evidence of tracheobronchomalacia. Thoracic inlet, heart, and mediastinum: No significant thoracic lymphadenopathy based on this noncontrasted study. The esophagus is nondilated. There is mild ectasia of the ascending aorta, measures 4.1 cm. Main pulmonary artery is dilated, measures 3.0 cm. There is mild left atrial enlargement. No pericardial effusion. Bones and soft tissues: No aggressive bone lesion. T9 vertebroplasty is noted. Mild wedge deformity of T12 vertebral body. Chest wall soft tissues are unremarkable. Upper abdomen: Postcholecystectomy changes. CONCLUSION: 1. Finding related to fibrotic interstitial lung disease (probable UIP pattern). 2. Mild air trapping. 3. Other findings as described.
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FINDINGS: Limitations: None. Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: There is coarse subpleural reticulation involving both upper and lower lobes with bibasilar predominance and associated mild traction bronchiectasis/bronchiolectasis. Small honeycombing like cystic changes in the periphery of both upper lobes. No significant architectural distortion or honeycombing. Interspersed groundglass opacities are also noted. No suspicious pulmonary nodules or masses. The trachea and main bronchi are patent. No pleural effusion. Expiratory images demonstrate mild focal areas of air trapping bilaterally. No evidence of tracheobronchomalacia. Thoracic inlet, heart, and mediastinum: No significant thoracic lymphadenopathy based on this noncontrasted study. The esophagus is nondilated. There is mild ectasia of the ascending aorta, measures 4.1 cm. Main pulmonary artery is dilated, measures 3.0 cm. There is mild left atrial enlargement. No pericardial effusion. Bones and soft tissues: No aggressive bone lesion. T9 vertebroplasty is noted. Mild wedge deformity of T12 vertebral body. Chest wall soft tissues are unremarkable. Upper abdomen: Postcholecystectomy changes.
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FINDINGS: Again noted is interval evolution of the extensive right MCA infarction status post right hemispheric craniectomy. Extracranial herniation of the brain material through the defect of craniectomy is again seen. There is interval size increase of the fluid collection superficial to the dural matter subject to the craniectomy location measuring 10 mm in maximum thickness. Also there is interval enlargement of the extra-axial hemorrhage in posterior portion of the craniectomy measuring 10 mm in thickness. There is no obvious midline shift. Ventricular system is within normal limit of size. There is interval evolution of the cortical infarction of the left frontotemporal lobe. The previously noted a small cortical based hypodensity and likely subacute infarction of the left parietal lobe is again seen however the previously noted associated trace subarachnoid hemorrhage is not well seen anymore. There is a retention cyst in left maxillary sinus.. The orbits are normal.
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2,609 |
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Constipation. Nausea COMPARISON: 12/30/2021 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 240 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. IV contrast injection rate: 2 ml per sec. Scan delay: 90 sec. Scan field of view: 409 mm. DLP: 1161 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Cirrhosis with hepatic steatosis. A minute subcentimeter hypodensity within the liver is technically indeterminate but unchanged. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Indeterminate right adrenal nodule is unchanged. KIDNEYS: Minute subcentimeter hypodensity within the left kidney is unchanged and appears to have fat density consistent with an angiomyolipoma. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Unusual configuration of the third portion of the duodenum which appears to have a dual channel wrapping around the vascular pedicle, unchanged. The small bowel is normal in caliber. COLON / APPENDIX: Worsening mucosal thickening and pericolonic stranding involving the distal colon from the splenic flexure through the rectosigmoid consistent with colitis. No pneumatosis or free air is identified. At the transition point between inflamed bowel and the transverse colon, there is a large stool ball which may be causing partial or early large bowel obstruction. The colon proximal to this portion is distended with fecal material. The appendix is not well-visualized but there are no secondary signs of appendicitis PERITONEUM / MESENTERY: Trace pelvic free fluid RETROPERITONEUM: Normal. VESSELS: Mild aortoiliac atherosclerosis without aneurysmal dilatation. URINARY BLADDER: Partially decompressed REPRODUCTIVE ORGANS: Hysterectomy changes. No adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Mild degenerative changes are seen within the spine. No focal destructive osseous lesion is identified. CONCLUSION: 1. Worsening distal colonic colitis involving the descending colon and sigmoid, possibly infectious/inflammatory. Ischemia is not excluded given the distribution. No pneumatosis or free air is identified. 2. Suspected evolving partial or early large bowel obstruction secondary to a large dense fecal ball, likely causing a ball-valve obstructive process at the transition point of the distal transverse colon and the distal colitis. 3. Unusual configuration of the third portion of the duodenum is again noted, which appears to have a dual lumen surrounding the mesenteric vascular pedicle, possibly an anatomic variant or postsurgical/postinflammatory. This could be further evaluated with nonemergent upper GI, as clinically indicated. 4. Cirrhosis and hepatic steatosis. 5. Indeterminate right adrenal nodule. Adrenal CT/MRI recommended as clinically indicated. 6. Additional findings above. Final report findings discussed with Dr. Amanda Smith at 1/6/2022 12:42 PM by Dr. Little by telephone.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Cirrhosis with hepatic steatosis. A minute subcentimeter hypodensity within the liver is technically indeterminate but unchanged. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Indeterminate right adrenal nodule is unchanged. KIDNEYS: Minute subcentimeter hypodensity within the left kidney is unchanged and appears to have fat density consistent with an angiomyolipoma. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Unusual configuration of the third portion of the duodenum which appears to have a dual channel wrapping around the vascular pedicle, unchanged. The small bowel is normal in caliber. COLON / APPENDIX: Worsening mucosal thickening and pericolonic stranding involving the distal colon from the splenic flexure through the rectosigmoid consistent with colitis. No pneumatosis or free air is identified. At the transition point between inflamed bowel and the transverse colon, there is a large stool ball which may be causing partial or early large bowel obstruction. The colon proximal to this portion is distended with fecal material. The appendix is not well-visualized but there are no secondary signs of appendicitis PERITONEUM / MESENTERY: Trace pelvic free fluid RETROPERITONEUM: Normal. VESSELS: Mild aortoiliac atherosclerosis without aneurysmal dilatation. URINARY BLADDER: Partially decompressed REPRODUCTIVE ORGANS: Hysterectomy changes. No adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Mild degenerative changes are seen within the spine. No focal destructive osseous lesion is identified.
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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. TREATED LIVER LESIONS: - Lesion Number: 1 - Description: Treated partially calcified lesion containing hyperattenuating soft tissue - Location: Segment(s) 4B - Size of largest enhancing portion of the mass: No enhancing portion is identified - Enhancement: No lesional enhancement - Additional features: - Arterial phase hyperenhancement: Not present. - Washout: Not present. - Enhancement similar to pretreatment: Not present. - Vascular invasion: No - LI-RADS: LR-TR Nonviable UNTREATED OR NEW LIVER LESION(S): Stable subcentimeter arterial hyperenhancing LR-3 focus in the medial segment left hepatic lobe. 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: Cholelithiasis. LYMPH NODES: None enlarged. SPLEEN: Normal size and appearance. PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Atrophic pancreas. ADRENALS: Stable small left adrenal adenoma. Right adrenal gland is unremarkable.. KIDNEYS: Stable simple right renal cyst. No radiopaque calculus, hydronephrosis or hydroureter. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered colonic diverticulosis. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: Aortic calcifications. Nonaneurysmal dilatation. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Moderate to severe degenerative changes in the lower thoracic/lumbar spine. Unchanged T12 vertebral compression deformity.
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2,610 |
EXAM: CT Chest with contrast CLINICAL INFORMATION: 51-year-old male follow-up gallbladder malignancy COMPARISON: No prior CT for comparison TECHNIQUE: CT Chest with contrast. Patient weight: 156 lbs. IV contrast: Omnipaque 350, 60 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 2 ml per sec. Scan delay: 35 sec. Scan field of view: 400 mm. DLP: 117.23 mGy cm. FINDINGS: No mediastinal, hilar or axillary adenopathy. Mild upper lobe dominant asymmetric emphysema with increased peribronchial thickening. A small subpleural noncalcified 4 mm nodule is present in the posterior segment of right upper lobe in image 48, series 2. There is no pleural or pericardial effusion and visualized bones and upper abdomen are unremarkable. CONCLUSION: Mild COPD and a 4 mm noncalcified indeterminate right upper lobe subpleural nodule. Recommend comparison with any prior remote CT and follow-up in 3-6 months
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FINDINGS: No mediastinal, hilar or axillary adenopathy. Mild upper lobe dominant asymmetric emphysema with increased peribronchial thickening. A small subpleural noncalcified 4 mm nodule is present in the posterior segment of right upper lobe in image 48, series 2. There is no pleural or pericardial effusion and visualized bones and upper abdomen are unremarkable.
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Findings: There is moderate enlargement of the bilateral thyroid gland, left greater than right, with homogeneous density. The subglottic trachea is slightly deviated to the right side. No substernal goitrous extension or tracheal stenosis is noted. The laryngeal framework and glottis are normally visualized. The aerodigestive tract and pharyngeal mucosal space are unremarkable. There is no cervical lymphadenopathy. Numerous dermal calcifications along the bilateral facial skin are additionally noted.
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2,611 |
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Stage III lung cancer. Treatment response evaluation. COMPARISON: 11/11/2021 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 199 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 78 sec. Scan field of view: 420 mm. DLP: 847.69 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered atherosclerosis. URINARY BLADDER: Decompressed. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: No destructive lesions. Degenerative changes in the spine. CONCLUSION: 1. No new evidence of metastatic disease in the abdomen or pelvis. 2. Other incidental and noncontributory findings as described above. Chest findings to be dictated separately; please see separate chest CT report same day.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered atherosclerosis. URINARY BLADDER: Decompressed. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: No destructive lesions. Degenerative changes in the spine.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis Chest findings to be dictated separately; please see separate CT chest report same day. ABDOMEN and PELVIS: LIVER: Focal fat deposition about the falciform ligament. The liver is normal in size and morphology. No suspicious hepatic lesion. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The colon is normal in caliber. There is mild circumferential wall thickening of the distal descending and sigmoid colon with minimal pericolonic fat stranding, possibly secondary to underdistention. Suspected asymmetric wall thickening at the rectosigmoid junction (image 434, series 2); however, nondistention limits evaluation. Scattered noninflamed few diverticula. The appendix is normal in caliber. PERITONEUM / MESENTERY: No ascites. No peritoneal nodularity. RETROPERITONEUM: Normal. VESSELS: Minimal scattered calcified atherosclerosis. Patent hepatic veins and portal venous system. Normal caliber of the IVC and abdominal aorta. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No destructive osseous lesion.
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2,612 |
CT Chest with contrast Clinical Information: 60-year-old male Stage III lung adenocarcinoma treatment response evaluation, C34.91 Malignant neoplasm of unspecified part of right bronchus or lung, R06.00 Dyspnea, unspecified Comparison: 11/11/2021 Technique: Following injection of non-ionic contrast 2.5 mm images were obtained through the chest. Abdominal findings will be reported separately. Patient weight: 199 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 35 sec. Scan field of view: 360 mm. DLP: 285.82 mGy cm. Findings: No enlarged intrathoracic nodes are present. There is dilatation of the mid to distal esophagus. Calcification is seen in the aortic valve leaflets with minimal calcification in the coronary arteries. The heart size and mediastinum are otherwise normal. No pleural effusions. Postsurgical findings of right upper lobectomy are unchanged. Narrowing with small focal stenosis of the bronchus to the medial segment of the right middle lobe is redemonstrated with focal atelectasis again noted. The lungs are otherwise normal with no new nodules or masses. No focal destructive osseous lesions identified. CT abdomen pelvis will be reported separately. Impression: Unchanged chest CT. No evidence of recurrence or intrathoracic metastases.
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Findings: No enlarged intrathoracic nodes are present. There is dilatation of the mid to distal esophagus. Calcification is seen in the aortic valve leaflets with minimal calcification in the coronary arteries. The heart size and mediastinum are otherwise normal. No pleural effusions. Postsurgical findings of right upper lobectomy are unchanged. Narrowing with small focal stenosis of the bronchus to the medial segment of the right middle lobe is redemonstrated with focal atelectasis again noted. The lungs are otherwise normal with no new nodules or masses. No focal destructive osseous lesions identified. CT abdomen pelvis will be reported separately.
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Findings: No enlarged intrathoracic nodes are present. Moderate to severe coronary artery calcification is seen. The esophagus is slightly dilated. Small pericardial effusion is noted. The heart size and mediastinum are otherwise normal. Tiny noncalcified nodule is seen in the right lung apex on series 2 image 45. A thin-walled cyst is present in the RML. The lungs are otherwise normal without additional nodules or masses. No pleural effusion. No focal destructive osseous lesions identified. CT the abdomen and pelvis will be reported separately.
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2,613 |
EXAM: CT Bone Pelvis w soft tissue no charge CLINICAL INFORMATION: Trauma. COMPARISON: Earlier same day pelvic radiograph. TECHNIQUE: CT Bone Pelvis w soft tissue no charge Scan field of view: 500 mm. FINDINGS: BONES/JOINTS: Comminuted right femoral neck fracture with anterior angulation of the fracture apex and mild posterior displacement of the distal fracture fragments. SOFT TISSUES: No large hematoma or fluid collection. Please see separately dictated and concurrently obtained CT chest abdomen and pelvis for intra-abdominal findings. CONCLUSION: Moderately displaced right basicervical femoral fracture. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: BONES/JOINTS: Comminuted right femoral neck fracture with anterior angulation of the fracture apex and mild posterior displacement of the distal fracture fragments. SOFT TISSUES: No large hematoma or fluid collection. Please see separately dictated and concurrently obtained CT chest abdomen and pelvis for intra-abdominal findings.
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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. SOFT TISSUES: Asymmetric thickening of the left temporalis muscle with overlying stranding, likely intramuscular hematoma. Surgical skin staples are noted in the occipital skin trace underlying hematoma.
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2,614 |
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 82-year-old female with hepatic abscess. COMPARISON: CT 1/1/2022 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 210 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 80sec Scan field of view: 413 mm. DLP: 1106 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Persistent drainage catheter coiled in the posterior hepatic abscess, with the abscess cavity now measuring 3.0 x 3.0 cm (image 186 series 2), previously 3.5 x 3.1 cm. Interval placement of a drainage catheter into the anterior right hepatic lobe abscess, with the cavity measuring 3.3 x 1.4 cm (image 182 series 2), previously 3.4 x 3.2 cm. There are specks of gas in this abscess cavity. There has been interval development of a 2.0 x 1.6 cm abscess more anteriorly in the right hepatic lobe (image 189 series 2). There is also been development of a septated 2.0 x 1.6 cm abscess cavity laterally in the right hepatic lobe (image 183 series 2). Incidental note is made of an accessory right hepatic vein draining the inferior right hepatic lobe. There are simple cysts in the left hepatic lobe. BILIARY TRACT: Normal. GALLBLADDER: Partially collapsed. PANCREAS: Unchanged small cyst in the pancreatic neck. SPLEEN: Normal. ADRENALS: Unchanged partially calcified right adrenal nodule. KIDNEYS: There are simple cysts in both kidneys. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: There is trace perihepatic fluid adjacent to the hepatic dome. RETROPERITONEUM: Normal. VESSELS: Moderate aortoiliac calcified atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is absent. BODY WALL: Mild rectus diastases. MUSCULOSKELETAL: There are degenerative changes of the lower lumbar spine and sacroiliac joints. There are mild degenerative changes of the hips. CONCLUSION: 1. Slight decrease in size of the posterior right hepatic lobe abscess cavity with persistent drainage tube in place. 2. Decrease in size of the anterior right hepatic lobe abscess cavity post interval placement of a drainage catheter. 3. Interval development of two smaller (2 cm) abscess cavities in the right hepatic lobe.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Persistent drainage catheter coiled in the posterior hepatic abscess, with the abscess cavity now measuring 3.0 x 3.0 cm (image 186 series 2), previously 3.5 x 3.1 cm. Interval placement of a drainage catheter into the anterior right hepatic lobe abscess, with the cavity measuring 3.3 x 1.4 cm (image 182 series 2), previously 3.4 x 3.2 cm. There are specks of gas in this abscess cavity. There has been interval development of a 2.0 x 1.6 cm abscess more anteriorly in the right hepatic lobe (image 189 series 2). There is also been development of a septated 2.0 x 1.6 cm abscess cavity laterally in the right hepatic lobe (image 183 series 2). Incidental note is made of an accessory right hepatic vein draining the inferior right hepatic lobe. There are simple cysts in the left hepatic lobe. BILIARY TRACT: Normal. GALLBLADDER: Partially collapsed. PANCREAS: Unchanged small cyst in the pancreatic neck. SPLEEN: Normal. ADRENALS: Unchanged partially calcified right adrenal nodule. KIDNEYS: There are simple cysts in both kidneys. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: There is trace perihepatic fluid adjacent to the hepatic dome. RETROPERITONEUM: Normal. VESSELS: Moderate aortoiliac calcified atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is absent. BODY WALL: Mild rectus diastases. MUSCULOSKELETAL: There are degenerative changes of the lower lumbar spine and sacroiliac joints. There are mild degenerative changes of the hips.
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FINDINGS: Isodense sellar/suprasellar lesion extending through sellar floor into the sphenoid sinus (for example series 6, image 31). The lesion measures 2.6 x 1.7 x 2.6 cm in CC by AP by TV (coronal series 5, image 31 and sagittal series 6, image 32), similar to prior. The suprasellar component measures 1.7 cm craniocaudally (sagittal series 6, image 32). The sagittal silhouette for dehiscence measures approximately 7 mm (series 5, image 31) with extension both sphenoid sinuses (series 4, image 83). No acute infarction, hemorrhage, or mass. Rest of paranasal sinuses are well-aerated. Bilateral mastoid air cells are clear. Normal soft tissues.Normal orbits.
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2,615 |
CT scan of the soft tissues of the neck with contrast. Clinical: Follow-up resection of right mandibular adenocystic carcinoma Technical: Soft tissue neck protocol with contrast. IV contrast: Omnipaque 350, 25 ml, per protocol. DLP: 744.33 mGy cm. Findings: Resection of the right hemimandible and fibula bone flap prosthesis are again noted. There is slight demineralization of the fibular cortex but no necrosis is seen. The fat graft in the floor the mouth is unchanged. There is resolution of prior right parapharyngeal mucosal thickening and along the lateral oropharyngeal wall. The tongue, oropharynx and supraglottic soft tissues are unremarkable. There is persistent opacification of the right maxillary sinus with thickening of its walls, chronic sinusitis. The nasopharynx is unremarkable and the oral cavity and tongue base appear normal. 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 are degenerative changes in the cervical spine but otherwise normal appearance. No intracranial abnormality is seen. --------------- Conclusion: Resolution of prior soft tissue swelling in the right parapharyngeal and lateral oropharyngeal wall. Stable postsurgical changes. No residual or recurrent tumor identified.
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Findings: Resection of the right hemimandible and fibula bone flap prosthesis are again noted. There is slight demineralization of the fibular cortex but no necrosis is seen. The fat graft in the floor the mouth is unchanged. There is resolution of prior right parapharyngeal mucosal thickening and along the lateral oropharyngeal wall. The tongue, oropharynx and supraglottic soft tissues are unremarkable. There is persistent opacification of the right maxillary sinus with thickening of its walls, chronic sinusitis. The nasopharynx is unremarkable and the oral cavity and tongue base appear normal. 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 are degenerative changes in the cervical spine but otherwise normal appearance. No intracranial abnormality is seen. ---------------
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FINDINGS: Interval resolution of the previously noted left tentorial subdural hemorrhage. No intraparenchymal hemorrhage, mass effect or edema. The gray white matter differentiation is maintained. The ventricles are within normal size limits and there is no midline shift. No acute osseous abnormality. Mucosal thickening involving the right maxillary sinus. The remaining paranasal sinuses and mastoid air cells are clear. The orbits are unremarkable. The visualized soft tissues are unremarkable.
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2,616 |
EXAM: CT Chest with contrast CLINICAL INFORMATION: 61-year-old female follow-up adenoid cystic carcinoma of the neck with invasion into right mandible COMPARISON: Noncontrast chest CT dated June 24, 2021 TECHNIQUE: CT Chest with contrast. Patient weight: 177 lbs. IV contrast: Omnipaque 350, 60 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 2 ml per sec. Scan delay: 35 sec. Scan field of view: 400 mm. DLP: 238.21 mGy cm. FINDINGS: Calcified anterior mediastinal soft tissue nodule is grossly unchanged. There is no other mediastinal or hilar adenopathy. Mild upper lobe dominant centrilobular emphysematous changes without discrete lung nodule or mass. There is no pleural or pericardial and visualized bones are unremarkable. CONCLUSION: Stable chest CT without intrathoracic metastasis or new disease
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FINDINGS: Calcified anterior mediastinal soft tissue nodule is grossly unchanged. There is no other mediastinal or hilar adenopathy. Mild upper lobe dominant centrilobular emphysematous changes without discrete lung nodule or mass. There is no pleural or pericardial and visualized bones are unremarkable.
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FINDINGS: Midthoracic dextroscoliosis with apex curvature at T6-T7 and diffuse osteopenia are redemonstrated. There is interbody osseous fusion at L1-L2. There is acute compression fracture involving the superior endplate and subchondral bone at T12, which shows mild anterior wedging deformity. Linear hypodensities in the right T12 pedicle and articular facet process likely represent pseudofracture. The middle and posterior column are otherwise intact. There is no retropulsion, epidural hemorrhage or spinal canal stenosis. Loss of disc space and vacuum disc degeneration are seen at T7-T8, T8-T9, and T9-T10. There is chronic focal compression in the superior endplate of T8. The cervicothoracic junction also shows advanced spondylosis.
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2,617 |
EXAM: CT Shoulder Right wo contrast CLINICAL INFORMATION: 69-year-old female with history of right total shoulder arthroplasty, right shoulder pain. Concern for infection. COMPARISON: Outside radiographs of the right shoulder 12/7/2021 TECHNIQUE: CT Shoulder Right wo contrast Scan field of view: 253 mm. DLP: 587.90 mGy cm. STRUCTURED REPORT: CT Bone vDec2021 FINDINGS: BONES/JOINTS: Right reverse total shoulder arthroplasty is intact. There is fracture of the anterior proximal humerus as well as fracture of the adjacent cement with adjacent periosteal reaction. Heterotopic ossification is present within the adjacent shoulder soft tissues. No appreciable joint effusion, without limitations of streak artifact from the arthroplasty hardware. SOFT TISSUES: No large hematoma or fluid collection. CONCLUSION: 1. Right reverse total shoulder arthroplasty is intact with periprosthetic fracture of the proximal humerus in the adjacent cement with associated periosteal reaction digesting chronicity. 2. No appreciable glenohumeral joint effusion or soft tissue collection given the limitations of the study related to arthroplasty hardware. There is continued concern for infection, ultrasound of the shoulder to evaluate for joint effusion is recommended. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: BONES/JOINTS: Right reverse total shoulder arthroplasty is intact. There is fracture of the anterior proximal humerus as well as fracture of the adjacent cement with adjacent periosteal reaction. Heterotopic ossification is present within the adjacent shoulder soft tissues. No appreciable joint effusion, without limitations of streak artifact from the arthroplasty hardware. SOFT TISSUES: No large hematoma or fluid collection.
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FINDINGS: RIGHT: The external auditory canal is normal. The tympanic membrane is intact. The right middle ear cavity is clear. The inner ear ossicles are normal. There is no scutal or ossicular erosion. There is normal development of the cochlea, vestibule, and semicircular canals. The otic capsule is normally mineralized. The vestibular and cochlear aqueducts are not enlarged. There are no variations in vascular or facial nerve anatomy. The internal auditory canal is normal in size and configuration. The mastoid air cells are well-developed and aerated. Small right sigmoid sinus diverticulum (series 2 image 155, series 201 image 207). LEFT: The external auditory canal is normal. The tympanic membrane is intact. The left middle ear cavity is clear. The inner ear ossicles are normal. There is no scutal or ossicular erosion. There is normal development of the cochlea, vestibule, and semicircular canals. The otic capsule is normally mineralized. The vestibular and cochlear aqueducts are not enlarged. There are no variations in vascular or facial nerve anatomy. The internal auditory canal is normal in size and configuration. The mastoid air cells are well-developed and aerated. OTHER: The imaged brain parenchyma and ventricular system are within normal limits. The imaged paranasal sinuses are clear. Both orbits are unremarkable. The visualized extracranial osseous and soft tissue structures are normal.
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2,618 |
EXAM: CT Chest with contrast CLINICAL INFORMATION: 69-year-old female follow-up lung cancer COMPARISON: October 7, 2021 TECHNIQUE: CT Chest with contrast. Patient weight: 11 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 2 ml per sec. Scan delay: 80 sec. Scan field of view: 440 mm. DLP: 481 mGy cm. FINDINGS: Postradiation changes are noted in the left perihilar location extending into the left lower lobe with associated bronchiectasis and lung architectural distortion. Residual ill-defined soft tissue remains surrounding the left hilar vasculature. There is no new lung nodule or mass. A subtle groundglass opacity in the right upper lobe along the mediastinal pleura persist. Subcentimeter size nodes in the mediastinum are unchanged. There is no pleural or pericardial effusion and visualized bones are unremarkable. CONCLUSION: Stable chest CT with post radiation changes in the left lung without new intrathoracic disease
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FINDINGS: Postradiation changes are noted in the left perihilar location extending into the left lower lobe with associated bronchiectasis and lung architectural distortion. Residual ill-defined soft tissue remains surrounding the left hilar vasculature. There is no new lung nodule or mass. A subtle groundglass opacity in the right upper lobe along the mediastinal pleura persist. Subcentimeter size nodes in the mediastinum are unchanged. There is no pleural or pericardial effusion and visualized bones are unremarkable.
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Findings: Precontrast scan of the head shows normal appearance of the parenchyma. The sella is largely empty, mostly filled with CSF. There is slight prominence of the optic nerve sheaths. No flattening of the ocular globes are completely opacified identified. Postcontrast scans show no abnormal enhancement. CT venograms show normal appearance of the dural sinuses and deep venous system. There are abundant cortical veins with expected appearance. Limited views of the circle of Willis show expected appearance of the proximal ACAs, MCA's and PCAs. The basilar artery and its branches are unremarkable. --------------- Conclusion: Essentially negative CT venogram of the head.
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2,619 |
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 69-year-old woman with history of lung cancer. Evaluate metastatic disease. COMPARISON: 10/7/2021 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 110 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 2 ml per sec. Scan delay: 80 sec. Scan field of view: 440 mm. DLP: 481 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Chest CT performed today will be reported separately. ABDOMEN and PELVIS: LIVER: A few focal cysts appear unchanged. Poorly marginated hypodensity adjacent to the fissure for the falciform ligament (image 231 series 3) likely represents focal fatty change. There is no convincing evidence of hepatic metastatic disease. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: The pancreatic head today is located to the left of the aorta, however the ductal anatomy appears normal in configuration, as before. No focal lesions are evident. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Few small cysts, normal otherwise. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: The abdominal aorta is normal in caliber, contains a few scattered calcified atherosclerotic plaques including at the origins of the major branches; however all appear patent at present. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. No evidence of metastatic disease in the abdomen or pelvis. Muscle skeletal diffuse bone demineralization. Degenerative change is seen in the lumbar spine and hips. No aggressive osseous lesions are identified. 2. Movement of the pancreatic head to the left of the aorta may be due to retroperitoneal fixation laxity, but results in no significant anatomic abnormality.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Chest CT performed today will be reported separately. ABDOMEN and PELVIS: LIVER: A few focal cysts appear unchanged. Poorly marginated hypodensity adjacent to the fissure for the falciform ligament (image 231 series 3) likely represents focal fatty change. There is no convincing evidence of hepatic metastatic disease. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: The pancreatic head today is located to the left of the aorta, however the ductal anatomy appears normal in configuration, as before. No focal lesions are evident. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Few small cysts, normal otherwise. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: The abdominal aorta is normal in caliber, contains a few scattered calcified atherosclerotic plaques including at the origins of the major branches; however all appear patent at present. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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2,620 |
EXAM: CT Chest wo contrast CLINICAL INFORMATION: 55-year-old female with history of right hand sarcoma COMPARISON: 10/11/2021. TECHNIQUE: CT Chest wo contrast. Scan field of view: 420 mm. DLP: 298.89 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. The enlarged upper right paratracheal node measures 17 x 23 mm on series 2 image 33 and was 6 x 12 mm on the prior. Small calcified right hilar nodes are present. No additional enlarged intrathoracic lymph nodes are identified. Small hiatal hernia is seen. The main pulmonary artery is borderline enlarged at 31 mm. Within the limits of a noncontrast exam, the heart size and the mediastinum are otherwise normal. No pleural effusion. Anterior noncalcified RUL nodule measures 17 x 17 mm on image 25 and was 3 mm on the prior. Tiny subpleural LUL nodule on image 28 is unchanged. Central LUL nodule on image 48 measures 7 x 8 mm and was approximately 2 mm on series 201 image 50 on the prior. A cluster of small nodules in the lingula on image 70 also appear new. Central LLL nodule measures 8 x 12 mm on image 65 and was barely visualized on the prior on series 2 image 66. There is also opacification and enlargement of the adjacent bronchus measuring approximately 11 x 14 mm on image 65 also concerning for neoplastic change. Small patchy area of groundglass density in the RLL best seen on coronal series 601 image 88 has also slightly increased The lungs are otherwise normal. Small low-attenuation posterior right hepatic lesion on image 111 is unchanged suggesting small cyst. Limited noncontrast images the upper abdomen are otherwise unremarkable. Fluid density nodular area in the paraspinal soft tissues at the level of the T1-T2 right neural foramen is unchanged and consistent with a perineural cyst. No focal destructive osseous lesions. CONCLUSION: 1. Four pulmonary nodules are seen in the RUL, LUL and LLL all increased in size from the previous exam consistent with metastatic disease. 2. Markedly enlarged right paratracheal node also consistent with metastatic disease.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. The enlarged upper right paratracheal node measures 17 x 23 mm on series 2 image 33 and was 6 x 12 mm on the prior. Small calcified right hilar nodes are present. No additional enlarged intrathoracic lymph nodes are identified. Small hiatal hernia is seen. The main pulmonary artery is borderline enlarged at 31 mm. Within the limits of a noncontrast exam, the heart size and the mediastinum are otherwise normal. No pleural effusion. Anterior noncalcified RUL nodule measures 17 x 17 mm on image 25 and was 3 mm on the prior. Tiny subpleural LUL nodule on image 28 is unchanged. Central LUL nodule on image 48 measures 7 x 8 mm and was approximately 2 mm on series 201 image 50 on the prior. A cluster of small nodules in the lingula on image 70 also appear new. Central LLL nodule measures 8 x 12 mm on image 65 and was barely visualized on the prior on series 2 image 66. There is also opacification and enlargement of the adjacent bronchus measuring approximately 11 x 14 mm on image 65 also concerning for neoplastic change. Small patchy area of groundglass density in the RLL best seen on coronal series 601 image 88 has also slightly increased The lungs are otherwise normal. Small low-attenuation posterior right hepatic lesion on image 111 is unchanged suggesting small cyst. Limited noncontrast images the upper abdomen are otherwise unremarkable. Fluid density nodular area in the paraspinal soft tissues at the level of the T1-T2 right neural foramen is unchanged and consistent with a perineural cyst. No focal destructive osseous lesions.
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Findings: Lines and Tubes: Right-sided PICC terminates in the mid-lower right atrium. This is posterior to several filling defects in the anterior aspect of the right atrium and in the right atrial appendage, one of these measuring 2.5 x 2.9 cm image 139 series 601. Body Wall and Abdomen: No destructive osseous lesions. CT of abdomen and pelvis will be reported separately. Mildly increased density within the subcutaneous fat. Lymph Nodes, Mediastinum and Neck: No axillary or mediastinal adenopathy. Lungs and Pleura: Small right pleural effusion. Central groundglass opacity is present bilaterally. Mild interlobular septal thickening and mild bronchial wall thickening. Subpleural band of left lower lobe dependent opacity. Cardiovascular: Moderate cardiomegaly. Small pericardial effusion. No central PTE. Dense coronary artery atherosclerotic calcifications are present. Mild-moderate aortic valve calcifications.
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2,621 |
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 88-year-old male with metastatic colon cancer. COMPARISON: CT 8/26/2021 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 205 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 90 sec. Scan field of view: 467 mm. DLP: 948 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: There is moderate liver surface nodularity. Persistent subcentimeter hypodensity in the right hepatic lobe near the porta hepatis (image 224 series 3). The segment 3 lesion measures 1.3 x 1.2 cm (image 226 series 3), previously 1.5 x 1.0 cm. Additional scattered tiny lesions are in the liver. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. PANCREAS: Normal. SPLEEN: There are calcified granuloma in the spleen. ADRENALS: Unchanged bilateral adrenal nodules, stable since 2018. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Colonic diverticulosis. Persistent thickening of the rectosigmoid junction and rectum. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Severe aortoiliac calcified atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostate is absent. BODY WALL: Tiny fat-containing bilateral inguinal hernias. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Persistent small liver metastases. No new sites of metastatic disease in the abdomen or pelvis. 2. Persistent proctitis of the rectosigmoid colon and rectum, probably due to postradiation change.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: There is moderate liver surface nodularity. Persistent subcentimeter hypodensity in the right hepatic lobe near the porta hepatis (image 224 series 3). The segment 3 lesion measures 1.3 x 1.2 cm (image 226 series 3), previously 1.5 x 1.0 cm. Additional scattered tiny lesions are in the liver. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. PANCREAS: Normal. SPLEEN: There are calcified granuloma in the spleen. ADRENALS: Unchanged bilateral adrenal nodules, stable since 2018. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Colonic diverticulosis. Persistent thickening of the rectosigmoid junction and rectum. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Severe aortoiliac calcified atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostate is absent. BODY WALL: Tiny fat-containing bilateral inguinal hernias. MUSCULOSKELETAL: No significant abnormality.
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Findings: There is a large amount of fluid distending the right iliac is bursa in the lower pelvis. The fluid extends distally through the iliopsoas bursa to the lesser trochanter insertion. It does appear to contact the anterior margin of the right femoral head and neck hardware. No gas is seen within the fluid. Femoral hardware shows no evidence of abnormal motion. There is no aggressive bone destruction.
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2,622 |
EXAM: CT Chest with contrast CLINICAL INFORMATION: 88-year-old male follow-up colorectal cancer COMPARISON: August 26, 2021 TECHNIQUE: CT Chest with contrast. Patient weight: 205 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 90 sec. Scan field of view: 467 mm. DLP: 948 mGy cm. FINDINGS: Few images are degraded due to respiratory motion artifact. Index lesions are measured in series 3. Central obstructing right upper lobe irregular slightly lobular soft tissue mass in image 89 is 72 x 62 mm, it was 58 x 40 mm. There is increasing heterogenous airspace opacities more distally in the right upper lobe along the mediastinal pleura as well as few additional nodules and minimal interlobular septal thickening superimposed on underlying asymmetric upper lobe dominant emphysema and lower lobe chronic interstitial lung disease. There is new moderate size right dependent pleural effusion. There are several borderline size nodes in the mediastinum especially paratracheal and subcarinal region. Main pulmonary artery is 35 mm in diameter. All cardiac chambers are dilated right more than left. There is no pericardial effusion. No focal lytic or sclerotic bone lesion. CONCLUSION: 1. Interval increased size of the right upper lobe centrally obstructing mass with surrounding interlobular septal thickening and several nodules and associated new right pleural effusion possibly due to lymphangitic spread. 2. Upper lobe dominant asymmetric emphysema and lower lobe dominant chronic interstitial lung disease
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FINDINGS: Few images are degraded due to respiratory motion artifact. Index lesions are measured in series 3. Central obstructing right upper lobe irregular slightly lobular soft tissue mass in image 89 is 72 x 62 mm, it was 58 x 40 mm. There is increasing heterogenous airspace opacities more distally in the right upper lobe along the mediastinal pleura as well as few additional nodules and minimal interlobular septal thickening superimposed on underlying asymmetric upper lobe dominant emphysema and lower lobe chronic interstitial lung disease. There is new moderate size right dependent pleural effusion. There are several borderline size nodes in the mediastinum especially paratracheal and subcarinal region. Main pulmonary artery is 35 mm in diameter. All cardiac chambers are dilated right more than left. There is no pericardial effusion. No focal lytic or sclerotic bone lesion.
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Findings: Complete interval resolution of the right cerebral convexity subdural hemorrhage. 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.
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2,623 |
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Suprapubic abdominal pain, interim history of Indiana pouch rupture status post repair. COMPARISON: 6/21/21 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 150 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 80 sec Scan field of view: 360 mm. DLP: 713 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Trace right pleural effusion. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Prior cholecystectomy. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Stable bilateral caliectasis, scattered renal cortical scarring and small renal cysts. Additional subcentimeter hypoattenuating renal lesions are too small to characterize but likely also cysts. Postoperative changes of prior urinary diversion and right lower quadrant urostomy formation. LYMPH NODES: No pathologic lymphadenopathy. A few mildly prominent retroperitoneal lymph nodes are unchanged. STOMACH / SMALL BOWEL: Small bowel wall thickening primarily involving the small bowel segments in the right abdomen. Moderate hiatal hernia. COLON / APPENDIX: Stable postoperative changes. No acute abnormality. PERITONEUM / MESENTERY: Small to moderate volume free fluid. No free air. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Surgically absent. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Tiny fat-containing parastomal hernia. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Small bowel wall thickening primarily involving small bowel segments in the mid and right abdomen suggesting infectious versus inflammatory enteritis. 2. Small to moderate free fluid. No wall defect within the urinary pouch or other convincing CT evidence of pouch rupture. 3. Stable postoperative changes of prior bladder resection and urinary diversion, moderate-sized hiatal hernia, and additional findings as above.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Trace right pleural effusion. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Prior cholecystectomy. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Stable bilateral caliectasis, scattered renal cortical scarring and small renal cysts. Additional subcentimeter hypoattenuating renal lesions are too small to characterize but likely also cysts. Postoperative changes of prior urinary diversion and right lower quadrant urostomy formation. LYMPH NODES: No pathologic lymphadenopathy. A few mildly prominent retroperitoneal lymph nodes are unchanged. STOMACH / SMALL BOWEL: Small bowel wall thickening primarily involving the small bowel segments in the right abdomen. Moderate hiatal hernia. COLON / APPENDIX: Stable postoperative changes. No acute abnormality. PERITONEUM / MESENTERY: Small to moderate volume free fluid. No free air. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Surgically absent. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Tiny fat-containing parastomal hernia. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Interval resolution of the previously seen bilateral groundglass opacities. Tiny pleural-based pulmonary nodule in the right lower lobe measuring 2 mm on series 5 image 73. Additional sub-5 mm pulmonary nodules are present in the left lower lobe best appreciated on series 8 image 27 and 29. No focal consolidation, pleural effusion, or pneumothorax. Mosaic attenuation in the left lower lobe. Central airways are patent. HEART / VESSELS: Heart size is normal. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Circumferential thickening of the lower esophagus. Air-fluid level extending from the distal esophagus to above the level of the carina. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Please see same day CT abdomen for abdomen findings. MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality. Chronic deformity of the left sixth through eighth ribs.
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2,624 |
EXAM: CT Chest High Resolution wo contrast CLINICAL INFORMATION: 80-year-old female with restrictive pulmonary function test and history of lung nodule COMPARISON: None. TECHNIQUE: CT Chest High Resolution wo contrast. Scan field of view: 320 mm. DLP: 512.27 mGy cm. High-resolution CT imaging of the chest was performed per protocol with inspiratory and expiratory technique in prone position. FINDINGS: Minimal bilateral lower lobe bronchiectasis with ill-defined 5 mm nodule in the medial basal segment of right lower lobe in image 129, series 2. No other discrete lung nodule or mass. An accessory right lower lobe superior accessory fissure is present. There is no other focal airspace or interstitial lung parenchymal abnormality. Dependent lung expiratory air trapping with significant reduction in the AP diameter of the distal trachea, both main bronchi and bronchus intermedius. Atherosclerotic calcification of all three coronary arteries without mediastinal adenopathy. The main pulmonary artery measures 37 mm in image 104, series 2. Small hiatal hernia is present There is no pleural or pericardial effusion. Visualized bones are unremarkable CONCLUSION: 1. Tracheobronchomalacia. 2. Mild bilateral lower lobe bronchiectasis and indeterminate 5 mm noncalcified right lower lobe nodule
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FINDINGS: Minimal bilateral lower lobe bronchiectasis with ill-defined 5 mm nodule in the medial basal segment of right lower lobe in image 129, series 2. No other discrete lung nodule or mass. An accessory right lower lobe superior accessory fissure is present. There is no other focal airspace or interstitial lung parenchymal abnormality. Dependent lung expiratory air trapping with significant reduction in the AP diameter of the distal trachea, both main bronchi and bronchus intermedius. Atherosclerotic calcification of all three coronary arteries without mediastinal adenopathy. The main pulmonary artery measures 37 mm in image 104, series 2. Small hiatal hernia is present There is no pleural or pericardial effusion. Visualized bones are unremarkable
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis CHEST: Chest findings will be reported separately. ABDOMEN and PELVIS: LIVER: Heterogenous enhancement of the liver with geographic areas of decreased attenuation. This could be related to focal hepatic steatosis. BILIARY TRACT: The common bile duct measures up to 1 cm (series 6 image 64) and tapers in the intrahepatic. Mild dilatation of the intrahepatic biliary tract in the right lobe of the liver (series 5 image 126). GALLBLADDER: No abnormality. No radiopaque calculi, wall thickening, or pericholecystic fluid. PANCREAS: Borderline enlargement of the pancreatic duct measuring 4 mm (series 6 image 60). SPLEEN: Normal. ADRENALS: Normal right adrenal gland. Left adrenal gland appears discoid in shape and is otherwise unremarkable. KIDNEYS: Left kidney is absent. Right kidney is normal. LYMPH NODES: None enlarged. Shotty periportal lymph nodes. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Appendix is not definitively visualized. PERITONEUM / MESENTERY: Normal. No ascites or free fluid. RETROPERITONEUM: Surgical clips in the left iliac fossa. VESSELS: Incidental note is made of duplicated infrarenal IVC. URINARY BLADDER: Normal. A urethral diverticulum is present. REPRODUCTIVE ORGANS: Interval removal of the large complex right adnexal mass. Uterus is absent. BODY WALL: Small fat-containing ventral hernia superior to the umbilicus. Foci of gas in the soft tissues overlying the right lower quadrant probably related to injections. MUSCULOSKELETAL: Mild degenerative changes of the lumbar spine. Lumbar dextroscoliosis and compensatory thoracic levoscoliosis. Right hip arthroplasty and left knee arthroplasty are seen. Severe degenerative change of the left hip has progressed from prior. No aggressive osseous lesion.
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2,625 |
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Evaluate melanoma. Follow-up examination. COMPARISON: CT abdomen and pelvis 12/30/2020 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 155 lbs. IV contrast: Omnipaque 350, 143 ml, per protocol. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 369 mm. DLP: 749 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis Chest findings to be dictated separately; please see separate CT chest report same day. ABDOMEN and PELVIS: LIVER: Similar appearance of hepatic cysts and Too small to characterize hypoattenuating lesions in both hepatic lobes. No new or enlarging hepatic lesion. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Partially duplicated left renal collecting system. No hydronephrosis or suspicious enhancing renal mass bilaterally. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Postsurgical changes of sleeve gastrectomy. No gastric or small bowel obstruction. COLON / APPENDIX: Normal caliber of the colon. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Heterogeneous enhancement of the mildly enlarged uterus, suggesting uterine fibroids. Tubal ligation clips bilaterally. No suspicious adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Tiny focus of sclerosis in the right sacrum is unchanged, possible bone island. No destructive osseous lesion. CONCLUSION: 1. No findings of metastatic disease in the abdomen or pelvis. 2. Additional incidental findings, as above. Please see separately dictated CT chest report same day.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis Chest findings to be dictated separately; please see separate CT chest report same day. ABDOMEN and PELVIS: LIVER: Similar appearance of hepatic cysts and Too small to characterize hypoattenuating lesions in both hepatic lobes. No new or enlarging hepatic lesion. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Partially duplicated left renal collecting system. No hydronephrosis or suspicious enhancing renal mass bilaterally. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Postsurgical changes of sleeve gastrectomy. No gastric or small bowel obstruction. COLON / APPENDIX: Normal caliber of the colon. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Heterogeneous enhancement of the mildly enlarged uterus, suggesting uterine fibroids. Tubal ligation clips bilaterally. No suspicious adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Tiny focus of sclerosis in the right sacrum is unchanged, possible bone island. No destructive osseous lesion.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: Slightly limited secondary to motion artifact LIVER: Cirrhotic without focal liver lesions on this portal venous phase only. Gastrohepatic and coronary varices noted. BILIARY TRACT: Normal. GALLBLADDER: Status post cholecystectomy PANCREAS: Normal. SPLEEN: Small hypodensity is likely a cyst and unchanged. Upper limits of normal in size ADRENALS: Normal. KIDNEYS: Nonobstructing right renal stone. Patchy enhancement of the kidneys bilaterally, which are small LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis. Appendix not definitely seen. Surgical clips seen near the cecal base. PERITONEUM / MESENTERY: Large amount of ascites is again seen. Intermediate attenuation material is again seen in the pelvis, perhaps slightly increased. Enhancement of the peritoneum. RETROPERITONEUM: Normal. VESSELS: Bilateral common femoral vein thrombus extending to the external iliac veins bilaterally. The left common iliac vein is very small. Thrombus extends into the right common iliac vein, more proximal than previously seen. IVC filter is seen with distal tip at the renal vein insertion and is very small caudally. Prominent anterior abdominal wall veins. URINARY BLADDER: Collapsed REPRODUCTIVE ORGANS: Uterus and left ovary, right adnexa are unremarkable.. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No destructive osseous lesions seen.
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2,626 |
EXAM: CT Chest with contrast CLINICAL INFORMATION: 54-year-old female with melanoma. COMPARISON: None. TECHNIQUE: CT Chest with contrast. Patient weight: 155 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 369 mm. FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Subcentimeter thyroid nodules, overall unchanged. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. Tiny nodule abutting the right major fissure on axial image 80 and another nodule abutting the minor fissure on axial image 56; series 307 appear overall unchanged. No new nodule. No pleural effusion. HEART / VESSELS: Normal sized cardiac chambers. No central PE. Trace pericardial fluid. MEDIASTINUM / ESOPHAGUS: Trace hiatal hernia. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Will be reported separately MUSCULOSKELETAL: No destructive osseous lesion. CONCLUSION: 1. Two tiny nodules along the fissures on the right, unchanged and represent fissural lymph nodes. No convincing evidence of intrathoracic metastasis. 2. Trace pericardial effusion and other incidental findings as above.
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Subcentimeter thyroid nodules, overall unchanged. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. Tiny nodule abutting the right major fissure on axial image 80 and another nodule abutting the minor fissure on axial image 56; series 307 appear overall unchanged. No new nodule. No pleural effusion. HEART / VESSELS: Normal sized cardiac chambers. No central PE. Trace pericardial fluid. MEDIASTINUM / ESOPHAGUS: Trace hiatal hernia. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Will be reported separately MUSCULOSKELETAL: No destructive osseous lesion.
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FINDINGS: Index lesions are measured on series 2: 1. Solid subpleural posterior basal right lower lobe nodule measuring 12 x 10 mm on image 84 measured 3 mm previously. 2. Solid 8 mm lateral basal right lower lobe nodule on image 87 measured 5 mm previously. 3. Solid 4 mm right lower lobe nodule and lateral basal segment on image 88 measured 3 mm previously. A focal subpleural areas of consolidation within the posterior basal left lower lobe is unchanged from the prior examination. There is a tiny 2 mm subpleural nodule within the left lung apex on image 19 and a tiny calcified granuloma in the right lower lobe on image 73. No pleural effusion or pleural thickening. The supraclavicular region is unremarkable. The central airways are patent. The thoracic aorta is nonaneurysmal. The pulmonary arteries are normal in caliber. The heart is not enlarged. Trace pericardial fluid is seen. There is mild to moderate coronary artery calcifications. The esophagus is not dilated. There is a small hiatal hernia. Small reactive appearing axillary lymph nodes are noted bilaterally. No enlarged thoracic lymph nodes. The large left renal mass is incompletely imaged and better assessed on the earlier CT of the abdomen and pelvis. No acute or aggressive osseous abnormality. Healed posterior left rib fractures.
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2,627 |
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 57-year-old male with worsening leukocytosis and concern for infection. COMPARISON: Multiple prior CTs of the abdomen pelvis, most recent 1/1/2022 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 162 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 78sec Scan field of view: 391 mm. DLP: 832.60 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis CT chest findings are reported separately. ABDOMEN and PELVIS: LIVER: Stable appearance of multiple hypodensities in the liver, indeterminate but most suggestive of cysts. A peripherally enhancing pericapsular collection along the posterior aspect of liver has decreased in size, now measuring only 3.1 x 1.4 cm on axial series 2, image 256. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Redemonstration of peripherally enhancing perisplenic fluid, grossly unchanged. ADRENALS: Normal. KIDNEYS: Couple of left renal cyst. Additional bilateral subcentimeter hypodensities are indeterminate but most suggestive of cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Diffuse thickening of the gastric and small bowel wall. COLON / APPENDIX: Diffuse bowel wall thickening. Bilateral hemiabdomen ostomies noted. PERITONEUM / MESENTERY: Moderate mesenteric vascular congestion. Small areas of simple appearing free fluid throughout the abdomen and pelvis. No organized fluid collection. Previously observed drainage catheters have been removed. RETROPERITONEUM: Normal. VESSELS: Normal caliber abdominal aorta. Moderate atherosclerotic disease. Mild-to-moderate atherosclerotic narrowing of bilateral common femoral arteries. URINARY BLADDER: Tip of a urinary catheter terminates within the bladder. Small amount of air within the bladder is likely iatrogenically introduced. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Moderate anasarca. Evidence of prior midline laparotomy with multiple skin staples in place. Several small lucent defects noted along the course of the incision. Bilateral hemiabdomen ostomies are noted. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Interval decrease in size of the peripherally enhancing perihepatic collections scribed above which likely reflects small abscesses. Additional peripherally enhancing perisplenic collection appears unchanged, perhaps representing an abscess. 2. Diffuse bowel wall thickening with moderate mesenteric vascular congestion and small volume of unorganized free fluid. 3. Bilateral hemiabdomen ostomies.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis CT chest findings are reported separately. ABDOMEN and PELVIS: LIVER: Stable appearance of multiple hypodensities in the liver, indeterminate but most suggestive of cysts. A peripherally enhancing pericapsular collection along the posterior aspect of liver has decreased in size, now measuring only 3.1 x 1.4 cm on axial series 2, image 256. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Redemonstration of peripherally enhancing perisplenic fluid, grossly unchanged. ADRENALS: Normal. KIDNEYS: Couple of left renal cyst. Additional bilateral subcentimeter hypodensities are indeterminate but most suggestive of cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Diffuse thickening of the gastric and small bowel wall. COLON / APPENDIX: Diffuse bowel wall thickening. Bilateral hemiabdomen ostomies noted. PERITONEUM / MESENTERY: Moderate mesenteric vascular congestion. Small areas of simple appearing free fluid throughout the abdomen and pelvis. No organized fluid collection. Previously observed drainage catheters have been removed. RETROPERITONEUM: Normal. VESSELS: Normal caliber abdominal aorta. Moderate atherosclerotic disease. Mild-to-moderate atherosclerotic narrowing of bilateral common femoral arteries. URINARY BLADDER: Tip of a urinary catheter terminates within the bladder. Small amount of air within the bladder is likely iatrogenically introduced. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Moderate anasarca. Evidence of prior midline laparotomy with multiple skin staples in place. Several small lucent defects noted along the course of the incision. Bilateral hemiabdomen ostomies are noted. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. There has been interval radiation therapy to the left lower lobe subpleural nodule which measures 8 x 11 mm on series 2 image 111 and was 7 x 8 mm on the prior. The more spiculated nodule slightly inferiorly in the left lower lobe on the prior exam is not definitively identified on the current exam but could be obscured by the postradiation findings. Fiducial clips are noted at the inferior aspect of the radiation changes. Postsurgical findings in the left upper lobe are unchanged. There is increased soft tissue density along the fissure of the remnant RUL as well as peripheral subpleural thickening in that area. The spiculated nodule posteriorly in the right lung base measures 13 x 18 mm on image 197 and was 16 x 25 mm on the prior exam on series 4 image 25 by my remeasurement. An adjacent small right pleural effusion is now seen. Fiducial markers are noted just above this nodule. Subpleural right lung nodule on series 2 image 87 measures 4 x 4 mm and was only approximately 2 mm on the prior exam. The posterior RLL nodule on image 148 measures 7 x 10 mm and was 4 x 6 mm on the prior. The right lung nodule on image 139 has slightly increased measuring 7 x 8 mm and this was 6 x 7 mm on the prior. RUL nodule on image 78 has changed in shape but decreased in size measuring 4 x 10 mm and was 6 x 8 mm on the prior. Part of this density is now groundglass . Additional small right lung nodules are unchanged. The area of cicatrization atelectasis adjacent to the right hilum is unchanged and most likely secondary to previous radiation therapy. Left lower lobe nodule on image 173 is visually increased in size from image 222 on the prior. Left upper lobe nodule on image 91 also appears increased with additional small left lung nodules unchanged. Enlarged lower right subcarinal node measures 16 x 26 mm on image 102 and was 25 x 26 mm on the prior by my remeasurement. No additional enlarged intrathoracic lymph nodes are identified. Moderate to large hiatal hernia is redemonstrated with dilatation of the upper esophagus. Calcific atherosclerosis is seen in the aorta and coronary arteries. Within the limits of a noncontrast exam, the heart size and the mediastinum are otherwise normal. Low-attenuation lesion in the lateral left hepatic lobe suggesting a cyst is unchanged. Limited noncontrast images of the upper abdomen are otherwise unremarkable. Sclerotic densities at T6-T7 and T8 are redemonstrated sclerotic lesion in the posterior right seventh rib is also unchanged. Focal blastic lesion is also seen in the upper right scapula similar to the prior.
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2,628 |
EXAM: CT Chest with contrast CLINICAL INFORMATION: 57-year-old male with provided history of worsening leukocytosis. COMPARISON: Chest CT 12/27/2021 TECHNIQUE: CT Chest with contrast. Patient weight: 162 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 78sec Scan field of view: 391 mm. FINDINGS: Limitations: None. Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: Moderate bilateral pleural effusion right greater than left, similar to prior with partial collapse of both lower lobes. Redemonstrated peripheral bronchovascular consolidative and groundglass opacities with septal thickening and traction bronchiectasis. The trachea and main bronchi are patent. Thoracic inlet, heart, and mediastinum: Redemonstrated multiple enlargement and subcentimeter mediastinal and hilar lymph nodes, similar to prior. The esophagus is nondilated. The thoracic aorta and main pulmonary arteries are normal in caliber. The overall heart size normal. No pericardial effusion. Moderate coronary calcification. Bones and soft tissues: No destructive bone lesion. Chest wall is unremarkable. Upper abdomen: Reported separately. CONCLUSION: 1. Redemonstrated moderate bilateral pleural effusion, right greater than left with partial collapse of both lower lobes. 2. Redemonstrated peripheral bronchovascular consolidative and groundglass opacities with septal thickening and traction bronchiectasis, may be related to sequelae of Covid pneumonia/organizing pneumonia. 3. Persistent mildly enlarged mediastinal and hilar lymph nodes, probably reactive.
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FINDINGS: Limitations: None. Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: Moderate bilateral pleural effusion right greater than left, similar to prior with partial collapse of both lower lobes. Redemonstrated peripheral bronchovascular consolidative and groundglass opacities with septal thickening and traction bronchiectasis. The trachea and main bronchi are patent. Thoracic inlet, heart, and mediastinum: Redemonstrated multiple enlargement and subcentimeter mediastinal and hilar lymph nodes, similar to prior. The esophagus is nondilated. The thoracic aorta and main pulmonary arteries are normal in caliber. The overall heart size normal. No pericardial effusion. Moderate coronary calcification. Bones and soft tissues: No destructive bone lesion. Chest wall is unremarkable. Upper abdomen: Reported separately.
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Findings: No enlarged hilar or mediastinal nodes are present. The mediastinum is normal. No suspicious pulmonary nodules. Mild interval increase in conspicuity of small 2-3 mm nodules in the right upper lobe (series 301 image 167, 159), left upper lobe (series 301 image 175), lingula (series 301 image 205). Substantial paraseptal and mild centrilobular emphysema bilaterally with bronchial wall thickening. Dependent atelectasis bilaterally with patchy groundglass densities in both lower and the left upper lobes. Areas of mosaic attenuation are also present bilaterally with mild subpleural reticulations in both upper lobes. Coronary artery calcification: The visual score of calcification is 7 (2 LM, LAD, LCx, 1 RCA). This was five on the prior exam. (Based on a publication by Kirsch et al (Detection of Coronary calcium During Standard Chest Computed Tomography Correlates With Multi-Detector Computed Tomography Coronary Artery Calcium score, Int J Cardiovasc Imaging (2012) 28:1249-1256), visual score >7 is associated with an Agatston score > 400 and independently validated increased incidence of cardiovascular mortality). Abdomen: No upper abdominal abnormality identified. Musculoskeletal: No soft tissue masses. Mild bilateral gynecomastia. Old healed fractures involving the right 3rd-7th ribs laterally. No aggressive appearing skeletal lesions.
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2,629 |
EXAM: CT Chest wo contrast CLINICAL INFORMATION: 82-year-old female with provided history of hilar mass. COMPARISON: No prior CT chests for comparison. Prior CT abdomen dated 12/2/2019 TECHNIQUE: CT Chest wo contrast. Scan field of view: 320 mm. DLP: 376 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. Limitations: Non-contrasted study. Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: There is diffuse mosaic attenuation in both lungs with areas of septal thickening, bronchial wall thickening and centrilobular nodules mainly involving the periphery of both upper lobes. Scattered calcified granulomas. Bibasilar linear subsegmental atelectasis/scarring are noted. There is complete collapse of the right middle lobe. The images taken during expiratory phase with collapse of the trachea and bronchi, suggestive of tracheal bronchomalacia. No pleural effusion. Thoracic inlet, heart, and mediastinum: No thoracic lymphadenopathy based on this noncontrasted study. The hilar region is limited in assessment secondary to noncontrast study. Small hiatal hernia. The thoracic aorta and main pulmonary arteries are normal in caliber. The overall heart size normal. Trace pericardial effusion. Scattered three-vessel coronary calcification. Blood appears hypodense relative to the interventricular septum, a finding which could be seen with anemia. Bones and soft tissues: No destructive bone lesion. Chest wall is unremarkable. Upper abdomen: Redemonstrated low-attenuation hepatic lesions, similar to prior. Splenic low-attenuation cystic lesion is unchanged. Redemonstrated left renal small calculi. CONCLUSION: 1. Diffuse mosaic attenuation in both lungs with associated septal thickening, bronchial wall thickening and centrilobular nodules mainly involving the periphery of both upper lobes. The differential include extensive changes with respiratory bronchiolitis, pulmonary edema, infectious/inflammatory process. 2. Evidence of tracheobronchomalacia and small airway disease. 3. No lung mass or hilar mass, however this is study is limited secondary to lack of contrast.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. Limitations: Non-contrasted study. Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: There is diffuse mosaic attenuation in both lungs with areas of septal thickening, bronchial wall thickening and centrilobular nodules mainly involving the periphery of both upper lobes. Scattered calcified granulomas. Bibasilar linear subsegmental atelectasis/scarring are noted. There is complete collapse of the right middle lobe. The images taken during expiratory phase with collapse of the trachea and bronchi, suggestive of tracheal bronchomalacia. No pleural effusion. Thoracic inlet, heart, and mediastinum: No thoracic lymphadenopathy based on this noncontrasted study. The hilar region is limited in assessment secondary to noncontrast study. Small hiatal hernia. The thoracic aorta and main pulmonary arteries are normal in caliber. The overall heart size normal. Trace pericardial effusion. Scattered three-vessel coronary calcification. Blood appears hypodense relative to the interventricular septum, a finding which could be seen with anemia. Bones and soft tissues: No destructive bone lesion. Chest wall is unremarkable. Upper abdomen: Redemonstrated low-attenuation hepatic lesions, similar to prior. Splenic low-attenuation cystic lesion is unchanged. Redemonstrated left renal small calculi.
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FINDINGS: LOWER CHEST: LUNG BASES / PLEURA: Consolidative opacities and tree-in-bud opacities in the imaged left lung base. No pleural effusion or pneumothorax.. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN AND PELVIS: STOMACH: Postsurgical changes of gastric bypass. No abnormal small bowel wall thickening or enhancement. SMALL BOWEL: No abnormal bowel wall thickening or enhancement. No dilated bowel loops. PERITONEUM / MESENTERY: No ascites or pneumoperitoneum. Multiple surgical staples in the upper abdomen. COLORECTAL: No abnormal bowel wall thickening or enhancement. APPENDIX: Normal. PERIANAL TISSUES: No fistula or abscess. LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. RETROPERITONEUM: Normal. VESSELS: Abdominal aorta is nonaneurysmal. Acute angulation of SMA-aorta with compression of left renal vein dilatation can be seen with URINARY BLADDER: Partially distended REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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2,630 |
EXAM: CT Abdomen with contrast CLINICAL INFORMATION: 34-year-old woman with history of pancreatic neuro endocrine tumor. COMPARISON: 7/2/2020, 3/18/2021 TECHNIQUE: CT Abdomen with contrast. Patient weight: 128 lbs. IV contrast: Omnipaque 350, 99 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 303 mm. DLP: 572.50 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Tiny focus of hyperenhancement in the superior dome (image 24 series 401) is unchanged (previously seen on image 18 series 4). However, the lesion previously measured at 9 mm in segment III (image 56 series 4) today is less well-circumscribed and measures 6 mm (image 58 series 401). No correlative focal lesion is seen on the venous phase images. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: The focal hyperenhancing lesion in the superior pancreatic head today measures 1.0 cm long axis (image 72 series 401); was 9 mm long axis (image 77 series 4) previously. The lesion continues to produce upstream main pancreatic duct dilation, maximum caliber today is 6 mm in the neck, unchanged. No peripancreatic stranding is noted. There is no peripancreatic vascular involvement. No additional focal lesions are evident. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality in visualized portions. COLON: No abnormality in visualized portions. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Small endocrine tumor in the pancreatic head producing upstream duct dilation. There is no significant growth since 3/18/2021. 2. Liver lesions remain indeterminate. While two subcentimeter hepatic lesions are visible as before, one has gotten smaller since 3/18/2021 and appears more similar in size to the 2020 CT.
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FINDINGS: STRUCTURED REPORT: CT Abdomen LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Tiny focus of hyperenhancement in the superior dome (image 24 series 401) is unchanged (previously seen on image 18 series 4). However, the lesion previously measured at 9 mm in segment III (image 56 series 4) today is less well-circumscribed and measures 6 mm (image 58 series 401). No correlative focal lesion is seen on the venous phase images. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: The focal hyperenhancing lesion in the superior pancreatic head today measures 1.0 cm long axis (image 72 series 401); was 9 mm long axis (image 77 series 4) previously. The lesion continues to produce upstream main pancreatic duct dilation, maximum caliber today is 6 mm in the neck, unchanged. No peripancreatic stranding is noted. There is no peripancreatic vascular involvement. No additional focal lesions are evident. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality in visualized portions. COLON: No abnormality in visualized portions. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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Findings: The gray-white matter differentiation is intact. There is no evidence of acute infarct, hemorrhage, mass or mass effect. The ventricular system and extra-axial spaces appear normal. The visualized paranasal sinuses and mastoid air cells are aerated. There is calcified atherosclerotic disease of the cavernous carotid arteries. No calvarial fracture is identified.
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2,631 |
EXAM: CT Foot Bilateral wo contrast CLINICAL INFORMATION: Fracture follow-up. COMPARISON: Radiograph 11/30/2021. TECHNIQUE: CT Foot Bilateral wo contrast Scan field of view: 261 mm. FINDINGS/CONCLUSION: Right: Subacute fractures of the plantar aspects of the middle and lateral cuneiforms. There is a mildly displaced chronic appearing fracture of the proximal aspect of the medial cuneiform involving the navicular cuneiform joint. Multiple well-corticated osseous fragments are present at the plantar aspect of the third metatarsal possibly representing sequela of prior trauma. The Lisfranc joint is maintained. Mild soft tissue swelling of the foot. Left: Progressive interval healing of the comminuted, intra-articular fracture of the calcaneus. There is decreased bone mineralization. Os navicularis. No new acute osseous abnormality. The joint spaces are maintained. There is a single round metallic density within the distal foreleg. Soft tissue swelling of the ankle and foot. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS/CONCLUSION: Right: Subacute fractures of the plantar aspects of the middle and lateral cuneiforms. There is a mildly displaced chronic appearing fracture of the proximal aspect of the medial cuneiform involving the navicular cuneiform joint. Multiple well-corticated osseous fragments are present at the plantar aspect of the third metatarsal possibly representing sequela of prior trauma. The Lisfranc joint is maintained. Mild soft tissue swelling of the foot. Left: Progressive interval healing of the comminuted, intra-articular fracture of the calcaneus. There is decreased bone mineralization. Os navicularis. No new acute osseous abnormality. The joint spaces are maintained. There is a single round metallic density within the distal foreleg. Soft tissue swelling of the ankle and foot. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: The right hilar node is decreased in size and is less then 10 mm in short axis. Calcified subcarinal and right hilar nodes are seen. No enlarged intrathoracic nodes are present. Calcific atherosclerosis is seen in the aorta. The heart size and mediastinum are otherwise normal. Centrilobular emphysema and findings of left upper lobe lobectomy are unchanged. The left lung is otherwise clear. Groundglass opacities in the right lung are unchanged. Postsurgical findings in the mid right lung are also unchanged. The small spiculated nodule in the medial right middle lobe is difficult to measure but is approximately 5 x 7 mm on series 2 image 158 similar to the prior on image 82 by my remeasurement. No new disease. Nodules are again seen in both breasts unchanged. No focal destructive osseous lesions identified. CT abdomen pelvis will be reported separately.
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2,632 |
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Right upper quadrant abdominal pain. COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 170 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. IV contrast injection rate: 3 ml per sec. Scan delay: 78 sec. Scan field of view: 396 mm. DLP: 400 mGy cm. 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: Uncomplicated cholelithiasis. PANCREAS: Normal. No peripancreatic inflammatory change or free fluid. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Nonobstructing 4 mm left renal stone. Otherwise unremarkable. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No free fluid or free air. RETROPERITONEUM: Normal. VESSELS: Mild aortoiliac atherosclerotic calcification. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. No evidence of acute abdominal or pelvic abnormality. Specifically, no CT findings of acute pancreatitis 2. Uncomplicated cholelithiasis and additional incidental findings as above.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Uncomplicated cholelithiasis. PANCREAS: Normal. No peripancreatic inflammatory change or free fluid. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Nonobstructing 4 mm left renal stone. Otherwise unremarkable. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No free fluid or free air. RETROPERITONEUM: Normal. VESSELS: Mild aortoiliac atherosclerotic calcification. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Left adrenal gland is unremarkable. Right adrenal nodule measures 2.1 x 2.1 cm on image 235 series 2, previously 2.1 x 1.9 cm on image 84 series 3, similar to prior. KIDNEYS: Subcentimeter hypodensities are statistically cysts but formally indeterminate, similar to prior. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis. PERITONEUM / MESENTERY: No ascites. RETROPERITONEUM: Normal. VESSELS: Severe atherosclerotic disease URINARY BLADDER: Collapsed REPRODUCTIVE ORGANS: Status post hysterectomy. Adnexa are unremarkable. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No destructive osseous lesions seen..
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2,633 |
EXAM: CT Chest with contrast CLINICAL INFORMATION: 59-year-old male follow-up neuroendocrine tumor COMPARISON: September 6, 2013 TECHNIQUE: CT Chest with contrast. Patient weight: 160 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: 72 sec. Scan field of view: 390 mm. DLP: 895.63 mGy cm. FINDINGS: The subpleural somewhat linear left lower lobe nodule in image 183 and along the major fissure in image 137, series 9 are both stable. A calcified granuloma is present in the right upper lobe. No new lung nodule or mass is noted. No mediastinal or hilar adenopathy. There is no pleural or pericardial effusion and visualized bones are unremarkable. CONCLUSION: Stable chest CT without intrathoracic metastasis or new disease
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FINDINGS: The subpleural somewhat linear left lower lobe nodule in image 183 and along the major fissure in image 137, series 9 are both stable. A calcified granuloma is present in the right upper lobe. No new lung nodule or mass is noted. No mediastinal or hilar adenopathy. There is no pleural or pericardial effusion and visualized bones are unremarkable.
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Findings: There is no evidence of acute intra- or extra-axial hemorrhage. There is no midline shift, mass effect, or other space-occupying lesion. Falx calcification/ossification seen. Additional extra axial calcification along the left frontal convexity likely from calcified meningiomas. Gray-white differentiation appears maintained. The ventricular system are normal in configuration. The basal cisterns are clear. Post administration of contrast material, There is no evidence of enhancing intracranial pathology. Extracranially, the visualized paranasal sinuses show scattered paranasal sinus mucosal thickening and mastoid air cells are clear of acute process. The visualized bones of the calvarium demonstrate no acute osseous abnormality.
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2,634 |
EXAM: CT Abdomen with contrast CLINICAL INFORMATION: 59-year-old male with history of small bowel neuroendocrine tumor status post resection; follow-up. COMPARISON: Multiple prior CTs of the abdomen pelvis, most recent 7/1/2021 TECHNIQUE: CT Abdomen with contrast. Patient weight: 160 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: Bolus Tracked. Scan field of view: 390 mm. FINDINGS: STRUCTURED REPORT: CT Abdomen CT chest findings are reported separately. ABDOMEN: LIVER: Stable appearance of an enhancing lesion in the hepatic dome, consistent with a hemangioma. No new suspicious hepatic lesion. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Stable appearance of bilateral adrenal adenomas. KIDNEYS: Subcentimeter hypodensities in the right kidney is technically indeterminate but most suggestive of a cyst. Additional hypodensity in the interpolar region of the left kidney demonstrates Hounsfield unit suggestive of fat and likely represents a subcentimeter angiomyolipoma. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Anastomotic suture lines noted in the right hemiabdomen. No evidence of local recurrence. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Postsurgical changes associated with prior partial small bowel resection. No evidence of local recurrence or metastatic disease within the abdomen or pelvis.
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FINDINGS: STRUCTURED REPORT: CT Abdomen CT chest findings are reported separately. ABDOMEN: LIVER: Stable appearance of an enhancing lesion in the hepatic dome, consistent with a hemangioma. No new suspicious hepatic lesion. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Stable appearance of bilateral adrenal adenomas. KIDNEYS: Subcentimeter hypodensities in the right kidney is technically indeterminate but most suggestive of a cyst. Additional hypodensity in the interpolar region of the left kidney demonstrates Hounsfield unit suggestive of fat and likely represents a subcentimeter angiomyolipoma. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Anastomotic suture lines noted in the right hemiabdomen. No evidence of local recurrence. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: SOFT TISSUES: Normal. LYMPH NODES: No pathologic adenopathy by imaging size criteria. AERODIGESTIVE STRUCTURES: Lymphoid tissue of the base of tongue appears prominent in size but without discrete mass lesion. There is a 16 x 16 x 19 mm hypodense structure located in the left aspect of epiglottis with obliteration of the left vallecula. Density of the central portion of the lesion is compatible with fluid collection but there is peripheral rim enhancement. PAROTID GLANDS: Normal. SUBMANDIBULAR GLANDS: Normal. THYROID GLAND: Normal. VASCULAR STRUCTURES: There is advanced calcified atherosclerotic plaques of the aortic arch and at origin of the main arteries. It appears that there is at least severe narrowing at the origin of the left subclavian artery. The patient is status post vascular grafting between the left common carotid artery and the left subclavian artery however no obvious enhancement within the graft is noted compatible with thrombosis. There are scattered foci of atherosclerosis in the bilateral common carotid arteries without obvious narrowing. Advanced calcified atherosclerotic plaques are present in the carotid bifurcations bilaterally with mild narrowing at origin of left internal carotid artery and moderate narrowing at origin of the right internal carotid artery. Intracranial atherosclerosis is seen within the bilateral carotid siphons. OSSEOUS STRUCTURES: No fracture, dislocation, or destructive lesion. There is diffuse osteopenia. ORBITS: Normal. PARANASAL SINUSES AND MASTOID AIR CELLS: Clear. PARTIALLY VISUALIZED INTRACRANIAL STRUCTURES: Mild diffuse volume loss is noted. LUNG APICES: There is mild diffuse emphysema in the lung apices. Scar formation of the lung apices is seen. There is trace right and mild left pleural effusion.
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2,635 |
EXAM: CT Chest with contrast CLINICAL INFORMATION: 66-year-old male follow-up renal cell carcinoma COMPARISON: Outside CT dated December 8, 2020 TECHNIQUE: CT Chest with contrast. Patient weight: 269 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 90 sec. Scan field of view: 500 mm. DLP: 1968 mGy cm. FINDINGS: No mediastinal, hilar or axillary adenopathy is seen. No discrete lung nodule or mass, airspace consolidation or interstitial abnormality. There is no pleural or pericardial effusion and visualized are unremarkable. CONCLUSION: Stable chest CT without intrathoracic metastasis or new disease.
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FINDINGS: No mediastinal, hilar or axillary adenopathy is seen. No discrete lung nodule or mass, airspace consolidation or interstitial abnormality. There is no pleural or pericardial effusion and visualized are unremarkable.
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FINDINGS: LINES AND TUBES: None. LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Small left greater than right pleural effusion. Minimal biapical pleural-parenchymal scarring. Bibasilar dependent consolidations/atelectasis. Bronchial wall thickening. Minimal layering secretions within the right mainstem bronchus. Subtle reticulation within the right middle lobe posteriorly. No suspicious nodules or masses. Trace paraseptal emphysematous changes. Diffuse bronchial wall thickening. HEART / VESSELS: Moderate to severe coronary artery calcifications. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Hepatic hypodensities which are too small to characterize although likely benign. Colonic wall thickening is better appreciated on recent CT from 1/22/2022. Minimal perisplenic edema. MUSCULOSKELETAL: No significant abnormality.
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2,636 |
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Renal cell carcinoma surveillance. COMPARISON: CT abdomen and pelvis 9/30/2021 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 269 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 90 sec. Scan field of view: 500 mm. DLP: 1968 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis Chest findings to be dictated separately; please see separate CT chest report same day. ABDOMEN and PELVIS: LIVER: Similar appearance of hepatic transplant changes. No suspicious hepatic lesion. Similar appearance of fluid attenuating well-circumscribed caudate lobe hepatic cyst. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Postsurgical changes of prior left nephrectomy. Soft tissue anterior to the left psoas muscle along the course of the left ureter appears decreased in size since the prior examination measuring approximately 1.4 x 0.8 cm (image 322, series 11), previously measured 1.7 x 1.5 cm (9/30/2021). No enlarging or new nodularity within the left nephrectomy bed. Unchanged anterior right subcentimeter suspected simple renal cyst. Additional too small to characterize hypoattenuating focus in the right kidney lateral lower pole, possible additional cyst. No right hydronephrosis or suspicious enhancing renal mass. Similar mild right pelviectasis versus extrarenal pelvis. LYMPH NODES: Similar appearance of 1.0 cm left periaortic lymph node (image 273, series 11). No new or enlarging lymphadenopathy. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The colon is normal in caliber. The appendix is normal in caliber. Few scattered noninflamed colonic diverticula. PERITONEUM / MESENTERY: Similar appearance of nodular densities in the anterior omentum favoring sequela of small omental infarctions (image 235, image 238 and image 256, series 11). No new or enlarging peritoneal nodularity. No ascites. RETROPERITONEUM: No other abnormality. VESSELS: Moderate atherosclerotic calcifications of the normal in caliber abdominal aorta. The IVC is normal in caliber. Patent hepatic veins and portal venous system. URINARY BLADDER: Urinary bladder is incompletely distended with circumferential bladder wall thickening, possibly related to underdistention. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Fat-containing left inguinal hernia. Fat-containing small umbilical hernia. Nonobstructed segment of small bowel containing left ventral hernia with fascial defect measuring approximately 3.1 cm (image 292, series 11), unchanged. Additional midline superior fat-containing ventral hernia with subcentimeter fascial defect (image two eight, series 11). MUSCULOSKELETAL: Degenerative changes of the imaged thoracolumbar spine. No destructive osseous lesion. CONCLUSION: 1. Overall, similar findings to prior CT examination 9/30/2021. Similar size and appearance of soft tissue nodularity within or adjacent to the remnant left distal ureter, as detailed. Similar size of prominent left periaortic lymph node. No new or enlarging findings to suggest metastatic disease. 2. Similar post liver transplant changes. 3. Left ventral abdominal wall hernia containing nonobstructed segment of small bowel, unchanged. Additional incidental findings, as detailed. Please see separately dictated CT chest report same day.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis Chest findings to be dictated separately; please see separate CT chest report same day. ABDOMEN and PELVIS: LIVER: Similar appearance of hepatic transplant changes. No suspicious hepatic lesion. Similar appearance of fluid attenuating well-circumscribed caudate lobe hepatic cyst. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Postsurgical changes of prior left nephrectomy. Soft tissue anterior to the left psoas muscle along the course of the left ureter appears decreased in size since the prior examination measuring approximately 1.4 x 0.8 cm (image 322, series 11), previously measured 1.7 x 1.5 cm (9/30/2021). No enlarging or new nodularity within the left nephrectomy bed. Unchanged anterior right subcentimeter suspected simple renal cyst. Additional too small to characterize hypoattenuating focus in the right kidney lateral lower pole, possible additional cyst. No right hydronephrosis or suspicious enhancing renal mass. Similar mild right pelviectasis versus extrarenal pelvis. LYMPH NODES: Similar appearance of 1.0 cm left periaortic lymph node (image 273, series 11). No new or enlarging lymphadenopathy. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The colon is normal in caliber. The appendix is normal in caliber. Few scattered noninflamed colonic diverticula. PERITONEUM / MESENTERY: Similar appearance of nodular densities in the anterior omentum favoring sequela of small omental infarctions (image 235, image 238 and image 256, series 11). No new or enlarging peritoneal nodularity. No ascites. RETROPERITONEUM: No other abnormality. VESSELS: Moderate atherosclerotic calcifications of the normal in caliber abdominal aorta. The IVC is normal in caliber. Patent hepatic veins and portal venous system. URINARY BLADDER: Urinary bladder is incompletely distended with circumferential bladder wall thickening, possibly related to underdistention. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Fat-containing left inguinal hernia. Fat-containing small umbilical hernia. Nonobstructed segment of small bowel containing left ventral hernia with fascial defect measuring approximately 3.1 cm (image 292, series 11), unchanged. Additional midline superior fat-containing ventral hernia with subcentimeter fascial defect (image two eight, series 11). MUSCULOSKELETAL: Degenerative changes of the imaged thoracolumbar spine. No destructive osseous lesion.
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Findings: There is slight diffuse atrophy but the ventricles are nonenlarged. There is no mass, hemorrhage, visible infarct or extracerebral collection. The posterior fossa contents are unremarkable. Paranasal sinuses, mastoids and middle ears are clear. No defect is seen in the calvarium or skull base. ----------------
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2,637 |
RADIOLOGIC EXAM: CT Head wo contrast CLINICAL INFORMATION: Fall COMPARISON: None. TECHNIQUE: CT Head wo contrastScan field of view: 223 mm. DLP: 1464.20 mGy cm. STRUCTURED REPORT: CT Head FINDINGS: BRAIN PARENCHYMA: There is no acute intracranial hemorrhage or acute infarct. No brain edema or mass effect. Moderate chronic white matter microangiopathic change and volume loss. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. CONCLUSION: No acute intracranial process.
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FINDINGS: BRAIN PARENCHYMA: There is no acute intracranial hemorrhage or acute infarct. No brain edema or mass effect. Moderate chronic white matter microangiopathic change and volume loss. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal.
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Findings: ". Scan quality is limited due to photon starvation artifacts in the lower neck. There is a 7 x 9 x 13 mm nodule which is hypoattenuating relative to the thyroid parenchyma on noncontrast images shows intense arterial phase enhancement and washout on delayed/venous phase imaging (series 3 image 44, series 4 image 326 and CT six image 321). It lies inferior to the right lobe of thyroid with a fat plane separating it (series 602 image 29). It is located in the right tracheoesophageal groove about 5.5 cm from the anterior skin surface and about 9 mm medial to the right common carotid artery at C7 level. The other subcentimeter candidate nodules described on the ultrasound could not be characterized on this suboptimal study. The thyroid gland shows mild heterogeneous enhancement with multiple subcentimeter parenchymal nodules which are better evaluated/characterized on the ultrasound . The nasopharynx appears normal. Airway is patent. The suprahyoid neck including the oropharynx, oral cavity, parapharyngeal spaces and retropharyngeal spaces are unremarkable. The epiglottis and aryepiglottic folds appear unremarkable. The infrahyoid neck including the larynx, hypopharynx and supraglottis appears normal. The thyroid gland and salivary glands appear unremarkable. There is no cervical lymphadenopathy. The visualized vascular structures appear unremarkable. The osseous structures appear unremarkable. The orbits, paranasal sinuses and skull base appear unremarkable. The lung apices appear unremarkable.
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2,638 |
RADIOLOGIC EXAM: CT Lumbar Spine wo contrast, CT Cervical Spine wo contrast, CT Thoracic Spine wo contrast CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Lumbar Spine wo contrast, CT Cervical Spine wo contrast, CT Thoracic Spine wo contrastScan field of view: 180 mm. (accession CT220003148), Scan field of view: 232 mm. DLP: 261.40 mGy cm. (accession CT220003147), Scan field of view: 155 mm. DLP: 601.10 mGy cm. (accession CT220003149) Following CT of the abdomen and pelvis, reformatted images were produced to optimize visualization of the osseous structures of the thoracic aorta lumbar spine. STRUCTURED REPORT: CT Lumbar Spine Trauma; CT Thoracic Spine Trauma FINDINGS: STRUCTURED REPORT: CT Cervical Spine Trauma 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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FINDINGS: STRUCTURED REPORT: CT Cervical Spine Trauma 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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Findings: Comparison: 9/23/2021 from medical West Lungs and Pleura: Basilar dependent subpleural reticulations and peripheral bronchiolectasis are present. Geographic regions of groundglass opacity are present in both lower lobes within regions of fibrosis. Several nodular calcifications or ossifications are present in both lung bases. Fibrotic changes demonstrate a similar magnitude compared to the previous. No honeycombing. Nodule along the lower left major fissure measures 12 x 9 mm image 199, previously 13 x 7 mm. Expiratory images show no air trapping. Lymph Nodes, Mediastinum and Neck: A few partially calcified mediastinal lymph nodes have a similar appearance. No axillary or mediastinal adenopathy. Cardiovascular: Heart size is normal. Main pulmonary artery has a normal caliber. No pericardial effusion or dense coronary artery atherosclerotic calcifications. Body Wall and Abdomen: No destructive osseous lesions. Expiratory images reveal hiatal hernia and patulous esophagus. The included portions of the upper abdomen have an unremarkable appearance, most completely included on the expiratory images.
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2,639 |
RADIOLOGIC EXAM: CT Lumbar Spine wo contrast, CT Cervical Spine wo contrast, CT Thoracic Spine wo contrast CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Lumbar Spine wo contrast, CT Cervical Spine wo contrast, CT Thoracic Spine wo contrastScan field of view: 180 mm. (accession CT220003148), Scan field of view: 232 mm. DLP: 261.40 mGy cm. (accession CT220003147), Scan field of view: 155 mm. DLP: 601.10 mGy cm. (accession CT220003149) Following CT of the abdomen and pelvis, reformatted images were produced to optimize visualization of the osseous structures of the thoracic aorta lumbar spine. STRUCTURED REPORT: CT Lumbar Spine Trauma; CT Thoracic Spine Trauma FINDINGS: STRUCTURED REPORT: CT Cervical Spine Trauma 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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FINDINGS: STRUCTURED REPORT: CT Cervical Spine Trauma 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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FINDINGS: The study is moderately degraded by metallic streak artifact from lumbar spinal fixation hardware. VERTEBRA: No fracture. Interval postsurgical changes from removal of posterior spinal fixation hardware spanning L2-L3 with left lateral interbody plate-and-screw fixation. Heterotopic ossification with partial L2-L3 interbody fusion. Stable L3-S1 posterior spinal fixation without evidence of hardware complication. Interval near-complete L5-S1 interbody fusion. DISC SPACES AND FACET JOINTS: Interval postsurgical changes from prior to L2-L3 intervertebral disc spacer placement. Multilevel degenerative discogenic disease and facet arthropathy without significant spinal canal or neuroforaminal stenosis. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. The imaged paraspinal and retroperitoneal soft tissues are within normal limits.
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2,640 |
RADIOLOGIC EXAM: CT Lumbar Spine wo contrast, CT Cervical Spine wo contrast, CT Thoracic Spine wo contrast CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Lumbar Spine wo contrast, CT Cervical Spine wo contrast, CT Thoracic Spine wo contrastScan field of view: 180 mm. (accession CT220003148), Scan field of view: 232 mm. DLP: 261.40 mGy cm. (accession CT220003147), Scan field of view: 155 mm. DLP: 601.10 mGy cm. (accession CT220003149) Following CT of the abdomen and pelvis, reformatted images were produced to optimize visualization of the osseous structures of the thoracic aorta lumbar spine. STRUCTURED REPORT: CT Lumbar Spine Trauma; CT Thoracic Spine Trauma FINDINGS: STRUCTURED REPORT: CT Cervical Spine Trauma 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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FINDINGS: STRUCTURED REPORT: CT Cervical Spine Trauma 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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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Bibasilar groundglass opacities. A more solid nodule in the right lower lobe measures 6 mm (series 201, image 37). DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Cardiomegaly with partially visualized defibrillator leads. ABDOMEN and PELVIS: LIVER: No suspicious lesions within limits of noncontrast technique. BILIARY TRACT: No abnormality. GALLBLADDER: Gallbladder surgically absent with surgical clips in the gallbladder fossa. PANCREAS: Fatty infiltration of pancreas. Otherwise normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Small right lower pole simple renal cysts. Otherwise, kidneys are normal for technique. There is no hydronephrosis bilaterally. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Mild diverticulosis without diverticulitis. The appendix is unremarkable. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: No abnormality. VESSELS: Calcific atherosclerosis of the abdominal aorta which is normal in caliber, including at the ostia of the SMA and celiac trunk, and iliac arteries. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostatomegaly. BODY WALL: Moderate stranding in the soft tissues of the right lower quadrant abdominal wall with swelling but no loculated fluid collection. Mild stranding in the soft tissues of the left lower quadrant abdominal wall. No definite intramuscular hematomas are visualized. MUSCULOSKELETAL: Mild degenerative changes of the upper lumbar spine. No aggressive osseous lesion.
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2,641 |
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Right retroperitoneal liposarcoma COMPARISON: Abdomen pelvis CT 11/15/2021 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 283 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 100 sec. Scan field of view: 480 mm. DLP: 1404.91 mGy cm. FINDINGS: 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. Liver is otherwise unremarkable BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Suspected subcentimeter hypodensity in the pancreatic uncinate seen on axial series 2, image 142. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: Mildly prominent bilateral inguinal lymph nodes. A borderline enlarged node just below the aortic bifurcation measuring 9 mm is also unchanged (series 2 image 254). Nonenlarged bilateral external iliac nodes are stable. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered colonic diverticulosis. Rectal anastomotic suture line is noted. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Scattered surgical clips are again observed within the right retroperitoneum inferior to the kidney. Mild stable thickening of the right posterior renal fascia. VESSELS: Mild aortic atherosclerosis without aneurysm. Stenosis of the celiac origin is observed, unchanged.. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Right testicle is surgically absent. BODY WALL: Prior ventral laparotomy surgical changes. MUSCULOSKELETAL: Multilevel degenerative changes are observed in the lumbar spine. CONCLUSION: 1. No evidence of recurrent or metastatic disease in the abdomen or pelvis. 2. Suspected subcentimeter hypodensity in the pancreatic uncinate with normal caliber main pancreatic duct. This is not well evaluated but may reflect a sidebranch IPMN. Recommend attention on follow-up. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. Liver is otherwise unremarkable BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Suspected subcentimeter hypodensity in the pancreatic uncinate seen on axial series 2, image 142. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: Mildly prominent bilateral inguinal lymph nodes. A borderline enlarged node just below the aortic bifurcation measuring 9 mm is also unchanged (series 2 image 254). Nonenlarged bilateral external iliac nodes are stable. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered colonic diverticulosis. Rectal anastomotic suture line is noted. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Scattered surgical clips are again observed within the right retroperitoneum inferior to the kidney. Mild stable thickening of the right posterior renal fascia. VESSELS: Mild aortic atherosclerosis without aneurysm. Stenosis of the celiac origin is observed, unchanged.. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Right testicle is surgically absent. BODY WALL: Prior ventral laparotomy surgical changes. MUSCULOSKELETAL: Multilevel degenerative changes are observed in the lumbar spine.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Small left and trace right pleural effusions. Bibasilar subsegmental atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Normal in size with no pericardial effusion. Significant coronary artery atherosclerotic calcification. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Intra and extra hepatic biliary dilatation again observed and appears slightly more prominent compared to prior examination. Common bile duct today measures about 1.4 cm (series 4 image 61). GALLBLADDER: Diffuse gallbladder wall thickening. No radiopaque gallstones are identified. PANCREAS: Native pancreas is atrophic. Right abdominal pancreatic transplant is observed, partially obscured by streak artifact from adjacent surgical clips. A small fluid collection in this region measures about 2.5 cm (series 3 image 173) which may have slightly enlarged compared to the prior examination however is not well evaluated due to the significant streak artifact. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Native kidneys are atrophic bilaterally. Left lower quadrant transplant kidney is observed. Small amount of gas is observed in the transplant renal collecting system as well as within the urinary bladder, presumably related to urinary tract instrumentation. Transplant kidney is otherwise unremarkable. No transplant hydronephrosis or peritransplant fluid collection is visualized. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. Gastric stimulator leads are seen along the anterior gastric antrum. COLON / APPENDIX: Prior right hemicolectomy. Scattered colonic diverticula. Contrast opacifies the colon PERITONEUM / MESENTERY: Mild diffuse mesenteric edema. Trace free intraperitoneal fluid within the pelvis. No free intraperitoneal air. RETROPERITONEUM: Presacral soft tissue thickening, increased compared to prior examination. VESSELS: Severe aortobiiliac atherosclerotic calcifications. Filter is observed within the infrarenal IVC. URINARY BLADDER: Gas in urinary bladder, presumably related to recent urinary tract instrumentation. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Moderate diffuse anasarca. Gastric stimulator device is observed in the left abdominal wall, similar to prior examination. Prior ventral laparotomy changes. There is a small fat-containing midline supraumbilical ventral abdominal hernia. MUSCULOSKELETAL: No significant abnormality.
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2,642 |
EXAM: CT Chest wo contrast CLINICAL INFORMATION: 43-year-old male with history of chondrosarcoma. COMPARISON: CT chest dated 6/14/2021. TECHNIQUE: CT Chest wo contrast. Scan field of view: 369 mm. DLP: 329 mGy cm. 3 mm axial, coronal and sagittal reformats with 8mm axial MIP reformats were made and reviewed. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. LOWER NECK: No significant abnormality. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. Minimal reticular opacities in the posterolateral right lower lobe, overall unchanged and again represent postradiation changes. No suspicious pulmonary nodule. No pleural effusion. HEART / VESSELS: Normal sized cardiac chambers. No pericardial effusion. Mild LAD calcifications. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Postsurgical changes in the right posterolateral chest wall, with postsurgical seroma/resolving hematoma. No definite mass is identified within the limitations of noncontrast technique. UPPER ABDOMEN: No significant abnormality. MUSCULOSKELETAL: No destructive osseous lesion. CONCLUSION: 1. Posttreatment changes with evolving seroma/hematoma in the right chest wall soft tissues adjacent to the scapula, without definite soft tissue mass, given the limitations of noncontrast technique. 2. No suspicious pulmonary nodule.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. LOWER NECK: No significant abnormality. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. Minimal reticular opacities in the posterolateral right lower lobe, overall unchanged and again represent postradiation changes. No suspicious pulmonary nodule. No pleural effusion. HEART / VESSELS: Normal sized cardiac chambers. No pericardial effusion. Mild LAD calcifications. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Postsurgical changes in the right posterolateral chest wall, with postsurgical seroma/resolving hematoma. No definite mass is identified within the limitations of noncontrast technique. UPPER ABDOMEN: No significant abnormality. MUSCULOSKELETAL: No destructive osseous lesion.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis Chest findings to be dictated separately; please see separate CT chest report same day. ABDOMEN and PELVIS: LIVER: Extensive hepatic metastatic disease appears worsened compared to the prior examination with suspected involvement of the gallbladder. Detailed evaluation is challenging without intravenous contrast. In conglomerate hypoattenuating confluence in the right hepatic lobe measures approximately 16.4 x 12 cm (image 156, series 3), previously measured 14.5 x 10.5 cm. BILIARY TRACT: No extrahepatic biliary ductal dilation. GALLBLADDER: Mass involvement of the gallbladder is suspected. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Left adrenal gland is surgically absent. The right adrenal gland is normal in size. KIDNEYS: Similar appearance of fluid attenuating renal cysts. No hydronephrosis. LYMPH NODES: Ill-defined hepatic hilar adenopathy appears similar. STOMACH / SMALL BOWEL: No gastric or small bowel obstruction. COLON / APPENDIX: No colonic obstruction. Wall thickening of the ascending colon, possibly reactive, given adjacent ascites and suspected carcinomatosis. The gallbladder is normal in caliber. PERITONEUM / MESENTERY: Increasing volume of small volume ascites since the prior examination. Omental stranding in the right upper abdomen is suspicious for carcinomatosis. RETROPERITONEUM: No other abnormality. VESSELS: Mild aortobiiliac atherosclerotic disease without aneurysm. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Post hysterectomy. No suspicious adnexal masses. BODY WALL: Fat-containing umbilical hernia appears similar. MUSCULOSKELETAL: Degenerative changes in the thoracolumbar spine. No destructive osseous lesion.
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2,643 |
CT Angio Head wo+w contrast HISTORY: 70-year-old patient with history of anterior communicating artery aneurysm Technique: After the administration of IV contrast bolus, 2.5 mm images were obtained and reformatted in the 1.4 mm overlapping images. 3-D CT MIP and Volume rendered angiographic images were generated In postprocessing from the axial data set. "Sliding MIP" images were also generated in the sagittal, axial, and coronal planes. COMPARISON: CT 4/20/2021. FINDINGS: Noncontrast head CT: Right parietotemporal encephalomalacia most likely from remote infarct. Advanced white matter microangiopathic changes suspected left pontine lacunar infarct. No intracranial hemorrhage. Normal orbits. Paranasal sinuses and mastoid air cells are clear. CT angiography: Unchanged 2 mm left A-comm infundibulum (coronal series 603 image 77). Otherwise, intracranial vessels show no significant flow limiting stenosis or aneurysms. Mild internal carotid siphon atherosclerotic disease. IMPRESSION: 1. No acute intracranial abnormality. 2. Unchanged 2 mm left A-comm infundibulum. No new angiographic abnormality. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: Noncontrast head CT: Right parietotemporal encephalomalacia most likely from remote infarct. Advanced white matter microangiopathic changes suspected left pontine lacunar infarct. No intracranial hemorrhage. Normal orbits. Paranasal sinuses and mastoid air cells are clear. CT angiography: Unchanged 2 mm left A-comm infundibulum (coronal series 603 image 77). Otherwise, intracranial vessels show no significant flow limiting stenosis or aneurysms. Mild internal carotid siphon atherosclerotic disease.
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Findings: Lines and Tubes: Right IJ port tip terminates in the SVC, similar. Body Wall and Abdomen: No destructive osseous lesions. Multilevel disc degenerative disease. The thecal sac narrowing is most notable at T9-T10. CT of abdomen and pelvis will be reported separately. Lymph Nodes, Mediastinum and Neck: Low density nodule in the remaining right thyroid lobe is similar. The left thyroid lobe appears to have been removed. Lower left paratracheal lymph node measures 16 x 12 mm image 63 series 3, previously 16 x 11 mm. Lungs and Pleura: New small right pleural effusion. 1. Subpleural right apical nodule measures approximately 13 x 11 mm, previously 10 x 8 mm. 2. Right upper lobe nodule along the minor fissure measures 16 x 11 mm image 79, previously 13 x 11 mm. 3. Subpleural right lower lobe nodule measures 13 x 8 mm image 88, previously 15 x 8 mm. 4. Nodule along left major fissure measures 8 x 6 mm image 89, previously 13 x 9 mm. 5. Right lower lobe nodule measures 15 x 12 mm image 102, previously 16 x 12 mm. Other nodules have a similar appearance. Ill-defined right lower lobe opacities are new. Cardiovascular: Heart size is normal. No large pericardial effusion.
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2,644 |
EXAM: CT Chest wo contrast CLINICAL INFORMATION: 69-year-old female follow-up lung nodule COMPARISON: August 27, 2021 TECHNIQUE: CT Chest wo contrast. Scan field of view: 290 mm. DLP: 243 mGy cm. FINDINGS: Index lesions are measured in series 3. Left upper lobe mixed density focal nodular lesion in image 15 measures 16 x 13 mm and was approximately 15 x 13 mm in image 46 series 3 by my measurements. A noncalcified left lower lobe discrete nodule in image 88 appear stable measuring 5 mm. Mild upper lobe dominant emphysema. No enlarged nodes are seen in the mediastinum. Small right axillary nodes are present with evidence of prior right axillary nodal dissection. There is no pleural or pericardial and visualized bones are unremarkable. CONCLUSION: Persistent perhaps borderline increased size of the left upper lobe predominantly groundglass density semisolid nodule. Recommend continue follow-up in 3-6 months.
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FINDINGS: Index lesions are measured in series 3. Left upper lobe mixed density focal nodular lesion in image 15 measures 16 x 13 mm and was approximately 15 x 13 mm in image 46 series 3 by my measurements. A noncalcified left lower lobe discrete nodule in image 88 appear stable measuring 5 mm. Mild upper lobe dominant emphysema. No enlarged nodes are seen in the mediastinum. Small right axillary nodes are present with evidence of prior right axillary nodal dissection. There is no pleural or pericardial and visualized bones are unremarkable.
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FINDINGS/CONCLUSION: Comminuted fracture of the proximal ulna extending into the glenohumeral joint. There is mild lateral displacement of the distal fracture fragments without significant distraction. No acute displaced fracture of the radial head. There is a large mature ossification arising from the anteromedial aspect of the distal humerus extending towards joint, possibly representing a large supracondylar spur. Moderate elbow joint effusion. Lateral soft tissue swelling of the elbow.
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2,645 |
CT Cervical Spine wo contrast Clinical: Follow-up fusion. Technical: CT C-spine protocol DLP: 458.60 mGy cm. Comparison: Prior CT C-spine scan on 12/10/2020. Findings: There is expected appearance of the new ACDF at C5-6 with metal plate and screws and disc spacer. Alignment is anatomical. The paraspinal soft tissues are unremarkable. No disc defect is seen and there is no stenosis. Bone texture is normal with no lytic or blastic lesion. --------------- Conclusion: Status post C5-6 ACDF.
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Findings: There is expected appearance of the new ACDF at C5-6 with metal plate and screws and disc spacer. Alignment is anatomical. The paraspinal soft tissues are unremarkable. No disc defect is seen and there is no stenosis. Bone texture is normal with no lytic or blastic lesion. ---------------
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. LINES AND TUBES: Two left-sided chest tubes are visualized. The lateral chest tube terminates and courses within the major fissure. An anterior one terminates adjacent to the right middle lobe. LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Collapse of the right upper lobe with moderate sized right apical hydropneumothorax with predominant air component and some loculations. Multiple endobronchial valves are noted. Severe apical predominant emphysematous changes are visualized. Trace right basilar pleural effusion and dependent consolidation. HEART / VESSELS: Minimal coronary artery calcifications. The aorta is normal in caliber. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. Unchanged prominent mediastinal lymph nodes. Evaluation of hila is limited due to lack of intravenous contrast. CHEST WALL: Extensive subcutaneous gas overlying the right chest wall which is likely postprocedural in nature. UPPER ABDOMEN: No acute abnormalities MUSCULOSKELETAL: No significant abnormality.
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EXAM: CT Abdomen with contrast CLINICAL INFORMATION: 54-year-old man with history of pancreatic neuro endocrine tumor, undergoing surveillance COMPARISON: 10/15/2020, 11/19/2018 TECHNIQUE: CT Abdomen with contrast. Patient weight: 240 lbs. IV contrast: Omnipaque 350, 180 ml, per protocol. Water: 16 oz. Saline flush: 20 ml. IV contrast injection rate: 4 ml per sec. Scan delay: Bolus Tracked. Scan field of view: 430 mm. DLP: 1749.96 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: The previously noted peripherally calcified enhancing lesion in the pancreatic body today measures 1.6 x 1.5 cm (image 96 series 4); was 1.4 x 1.3 cm (image 75 series 10) on 10/15/2020 and was 1.7 x 1.5 cm (image 99 series 9) on 11/19/2018. There is no main pancreatic duct dilation or peripancreatic stranding. No additional focal pancreatic lesions are identified. The peripancreatic vessels appear uninvolved. In addition, a second lesion is suspected in the midline posterior gland at the body neck junction. Today this lesion measures 1.0 x 0.8 cm (image 88 series 9) and in retrospect was seen previously on both the 2020 and 2018 studies (image 71 series 10 and image 98 series 9, respectively) though measured under 1 cm. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Unchanged bilateral nonobstructing nephrolithiasis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality in visualized portions. COLON: No abnormality in visualized portions. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Mild degenerative change in the lumbar spine. No aggressive osseous lesions. CONCLUSION: 1. Two focal relatively hyperenhancing lesions in the pancreas appear present and are compatible with neuroendocrine tumors. The larger of the two lesions is stable dating back to 2018; the small lesion (seen in retrospect on prior studies) measures less than 1 cm. 2. Other incidental findings as above, stable.
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FINDINGS: STRUCTURED REPORT: CT Abdomen LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: The previously noted peripherally calcified enhancing lesion in the pancreatic body today measures 1.6 x 1.5 cm (image 96 series 4); was 1.4 x 1.3 cm (image 75 series 10) on 10/15/2020 and was 1.7 x 1.5 cm (image 99 series 9) on 11/19/2018. There is no main pancreatic duct dilation or peripancreatic stranding. No additional focal pancreatic lesions are identified. The peripancreatic vessels appear uninvolved. In addition, a second lesion is suspected in the midline posterior gland at the body neck junction. Today this lesion measures 1.0 x 0.8 cm (image 88 series 9) and in retrospect was seen previously on both the 2020 and 2018 studies (image 71 series 10 and image 98 series 9, respectively) though measured under 1 cm. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Unchanged bilateral nonobstructing nephrolithiasis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality in visualized portions. COLON: No abnormality in visualized portions. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Mild degenerative change in the lumbar spine. No aggressive osseous lesions.
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FINDINGS: SOFT TISSUES: Redemonstrated heterogeneously enhancing mass appearing to arise from the left parotid gland and involves both the superficial and deep aspects of the left parotid with widening of the stylo-mandibular space on the left with comparison to the right. There appear to be cystic/necrotic region centrally as well as scattered calcifications within its deeper portions. There is associated invasion and displacement of the left parapharyngeal space and mass effect on the posterior nasopharynx and oropharynx. There is invasion and mass effect involving the medial aspect of the left masticator space. This is associated with thinning/resorption of the left mandibular ramus as well as apparent resorption/destruction of the medial and lateral left pterygoid plates. Suspected tumor extension superiorly to involve and widened the left foramen ovale which may represent a component of perineural spread. (coronal series 9 image 114). Mass effect is noted on the cranial left carotid space without interval change. There is significant compression of the internal jugular vein is noted at this level with patency of both cranially and caudally. No intraluminal filling defect is noted. The retropharyngeal, sublingual, and submandibular spaces appear uninvolved. LYMPH NODES: No pathologic adenopathy by imaging size criteria. AERODIGESTIVE STRUCTURES: Slight rightward shift of the nasopharynx and oropharynx secondary to mass effect from the previously described left parotid mass. Otherwise No asymmetric contrast enhancement or asymmetric soft tissue nodularity. No definitive aerodigestive invasion is identified. PAROTID GLANDS/SUBMANDIBULAR GLANDS: Large left parotid mass as described above. There is mass effect upon the left submandibular gland but no frank invasion. The right parotid gland and right submandibular glands are normal. THYROID GLAND: Scattered subcentimeter hypoattenuating nodules throughout both thyroid lobes. VASCULAR STRUCTURES: Mass effect and suspected invasion of the left carotid space with near complete compression of the cranial left internal jugular vein. Otherwise no acute vascular abnormality is identified. OSSEOUS STRUCTURES: Scalloping/resorption of the left mandibular ramus and the left medial/lateral pterygoid plates as described above. Associated widening of the left foramen ovale. No other acute osseous abnormality. ORBITS: Unremarkable. PARANASAL SINUSES AND MASTOID AIR CELLS: Clear. PARTIALLY VISUALIZED INTRACRANIAL STRUCTURES: Unremarkable. LUNG APICES: Ill-defined opacity at the anterior aspect of the right apex is unchanged from prior.
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EXAM: CT Chest wo contrast CLINICAL INFORMATION: 72-year-old male follow-up oral cancer COMPARISON: February 4, 2021 TECHNIQUE: CT Chest wo contrast. Scan field of view: 390 mm. DLP: 214.48 mGy cm. FINDINGS: Small subcentimeter size nodes are present in the right paratracheal region, unchanged. A small hiatal hernia is again noted. A small 6 mm noncalcified nodule in the right upper lobe appears stable in image 83, series 2. There are few additional subpleural opacities noted in the right upper lobe for example two, image 76 and 77. There is no pleural or pericardial effusion. No focal lytic or sclerotic bone lesion is seen. CONCLUSION: Indeterminate right upper lobe subpleural ill-defined airspace and nodular opacities one of which is is new since prior study. Recommend continue follow-up
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FINDINGS: Small subcentimeter size nodes are present in the right paratracheal region, unchanged. A small hiatal hernia is again noted. A small 6 mm noncalcified nodule in the right upper lobe appears stable in image 83, series 2. There are few additional subpleural opacities noted in the right upper lobe for example two, image 76 and 77. There is no pleural or pericardial effusion. No focal lytic or sclerotic bone lesion is seen.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Bibasilar subsegmental atelectasis. Trace left pleural effusion. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Small pericardial effusion. No significant abnormality. ABDOMEN and PELVIS: LIVER: Small hemangioma in the inferior right hepatic lobe is again observed. Liver is otherwise unremarkable. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. Small accessory spleen. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Decompressed around a Foley balloon. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Interval development of a decubitus necrotizing soft tissue infection. There is extensive soft tissue inflammatory stranding and numerous foci of gas. There is a fluid collection with foci of gas centered over the midline sacrum in this region consistent with abscess formation. This measures approximately 15.6 x 3.8 x 12.0 cm (series 2 image 221 and series 80313 image 58). This fluid collection extends caudally where it abuts the ischial tuberosity bilaterally. Findings are more extensive on the left where the fluid collections extend into the soft tissues of the proximal posterior left thigh where there is extensive surrounding inflammatory stranding. MUSCULOSKELETAL: Soft tissue infection described above closely abuts the posterior sacrum and both ischial tuberosities without overt osseous destructive changes. There are bilateral L5-S1 pars defects with 1 cm of anterolisthesis.
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CT Chest with contrast Clinical Information: 53-year-old female clonal B cell, LAD, thymic bed nodule, D72.820 Lymphocytosis (symptomatic), R59.1 Generalized enlarged lymph nodes, E32.8 Other diseases of thymus Spec Inst: Assess stability. Comparison: 7/1/2021 Technique: Following injection of non-ionic contrast 2.5 mm images were obtained through the chest. Abdominal findings will be reported separately. Patient weight: 175 lbs. IV contrast: Omnipaque 350, 60 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 2 ml per sec. Scan delay: 35 sec. Scan field of view: 430 mm. DLP: 290.31 mGy cm. Findings: The borderline enlarged left subpectoral lymph node measures 8 x 13 mm on series 2 image 17 essentially unchanged from the 8 x 14 mm on the prior. The fluid density nodule in the anterior mediastinal thymic bed measures 8 x 13 mm on image 33 and was 10 x 13 mm on the prior. The right pericardial node has a fatty hilum rather than necrosis and is only 8 mm in short axis. A few small mediastinal and right hilar nodes are redemonstrated. No enlarged intrathoracic nodes are present. Mild dilatation of the distal esophagus is seen. Minimal coronary artery calcification is noted. The heart size and mediastinum are otherwise normal. A tiny noncalcified nodule is seen in the RUL on series 2 image 32 unchanged from the prior. Tiny nodule along the right minor fissure on image 50 remains unchanged. Tiny RLL nodule on image 66 is also unchanged. Tiny calcified granuloma is present in the left lower lobe on image 96 with additional tiny LLL noncalcified nodule on image 48, unchanged. The lingular subpleural nodule on image 71 is also unchanged 5 mm noncalcified smooth bordered nodule in the left lung apex on image 24 is unchanged from image 41 on the prior. The lungs are otherwise normal. No pleural effusion. No focal destructive osseous lesions identified. Limited images of the upper abdomen are unremarkable. Impression: 1. Tiny calcified granuloma in the left lower lobe. Scattered tiny noncalcified nodules are present bilaterally unchanged from the prior. This may all reflect the previous granulomatous disease but metastatic disease would also be in the differential. Continued attention on follow-up is needed. 2. Left subpectoral lymph node is unchanged. The fluid density nodule in the anterior mediastinal thymic bed is the same or slightly decreased in size. The right pericardial node is slightly decreased in size and appears to have a fatty hilum rather than a necrotic center. No definitive evidence of intrathoracic lymphoma.
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Findings: The borderline enlarged left subpectoral lymph node measures 8 x 13 mm on series 2 image 17 essentially unchanged from the 8 x 14 mm on the prior. The fluid density nodule in the anterior mediastinal thymic bed measures 8 x 13 mm on image 33 and was 10 x 13 mm on the prior. The right pericardial node has a fatty hilum rather than necrosis and is only 8 mm in short axis. A few small mediastinal and right hilar nodes are redemonstrated. No enlarged intrathoracic nodes are present. Mild dilatation of the distal esophagus is seen. Minimal coronary artery calcification is noted. The heart size and mediastinum are otherwise normal. A tiny noncalcified nodule is seen in the RUL on series 2 image 32 unchanged from the prior. Tiny nodule along the right minor fissure on image 50 remains unchanged. Tiny RLL nodule on image 66 is also unchanged. Tiny calcified granuloma is present in the left lower lobe on image 96 with additional tiny LLL noncalcified nodule on image 48, unchanged. The lingular subpleural nodule on image 71 is also unchanged 5 mm noncalcified smooth bordered nodule in the left lung apex on image 24 is unchanged from image 41 on the prior. The lungs are otherwise normal. No pleural effusion. No focal destructive osseous lesions identified. Limited images of the upper abdomen are unremarkable.
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FINDINGS: Contrast opacification of the pulmonary arteries is excellent. No intraluminal filling defects are noted in the visualized bony arteries and its branches. The main pulmonary artery is normal in size. Bilateral patchy groundglass parenchymal changes in the subpleural and peribronchial vascular distribution involving all five lobes with mild bronchiectasis especially in the lower lobes and right middle lobe. No discrete lung nodule or mass is noted. Small dependent left pleural effusion. Pericardium is normal in thickness without effusion. No mediastinal or hilar adenopathy. Significant elevation of the right hemidiaphragm due to presence of large ascites. Cirrhotic morphology of the liver. There is no focal lytic or sclerotic bone lesion. Both IJ central venous lines are in the lower SVC/are a junction.
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CT Cardiac with contrast CLINICAL INFORMATION: 82-year-old female with aortic stenosis undergoing evaluation for transcatheter aortic valve replacement. COMPARISON: No prior relevant study available for comparison. TECHNIQUE: Pre contrast images were obtained to assess aortic valve and mitral annular calcifications. The postcontrast CT was performed using retrospective cardiac gating, followed by helical non gated CTA of the chest, abdomen and pelvis using single bolus of contrast. Images reviewed in multiple phases of the cardiac cycle. Source images, multiplanar reformatted images and volume rendered images were also reviewed. Patient was not given any medication Patient weight: 141 lbs. IV contrast: Omnipaque 350, 40 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 3 ml per sec. Scan delay: bolus tracked Scan field of view: 216 mm. Heart Rate: 72 bpm. DLP: 1403.40 mGy cm. FINDINGS: The quality of study is excellent for evaluation of aortic root and was not tailored for coronary artery evaluation. There is severe calcification of the tricuspid aortic leaflets with restricted opening during systole. The aortic root measurements done in systolic phase 30% are as follows (all using double oblique method): Annulus Dimensions: 23 x 28 mm Approximate Annulus Area: 483 mm2 Annulus Perimeter: 83 mm Distance of the left main (LM) coronary artery from Annulus: 10 mm Distance of the right coronary artery (RCA) from Annulus: 18 mm Left coronary sinus height: 20 mm Right coronary sinus height: 21 mm Aortic sinuses of Valsalva dimensions: 32 x 32 x 34 mm Sinotubular junction dimensions: 31 x 31 mm Mid ascending aorta dimensions: 38 x 39 mm Suitable Valve deployment angle: LAO = 15, cranial = 13 Aortic valve calcification score: 1920 LEFT VENTRICULAR VOLUMES AND SYSTOLIC FUNCTION: LVEF: 71 % LVED volume: 89 ml LVES volume: 26 ml LV Stroke volume: 63 ml The right thyroid lobe and isthmus are nonvisualized, and could've been surgically removed. The left thyroid lobe shows an inferiorly located heterogeneous left thyroid nodule measuring up to 2.1 cm, that shows mild retrosternal extension. The central airways are patent. No focal airspace opacities or suspicious pulmonary nodules or masses. Mild dependent atelectasis in the left lung. No pleural effusions. Basal septal hypertrophy versus sigmoid septum is noted. Dense mitral annular calcification. The left atrium is mildly dilated. No evidence of left atrial, left atrial appendage or left ventricular thrombi. No pericardial effusion. Moderate to severe coronary artery atherosclerotic calcifications. The main pulmonary artery and thoracic aorta are normal in caliber. Small hiatal hernia. The mediastinum is otherwise unremarkable. No pathologically enlarged lymph nodes. Small left breast calcification. The chest wall is otherwise unremarkable. Decreased osseous mineralization. Moderate multilevel degenerative changes and diffuse idiopathic skeletal hyperostosis of the thoracic spine. The CT of the abdomen and pelvis will be reported separately. CONCLUSION: 1. Calcific aortic stenosis with measured annulus size of 23 x 28 mm, annulus area of 483 sq mm. 2. The distances of LM \T\ RCA to annulus are 10 mm and 18 mm, respectively. 3. Other measurements for percutaneous TAVR planning as above. 4. The right thyroid lobe and isthmus are nonvisualized, and could've been surgically removed. The left thyroid lobe shows an inferiorly located heterogeneous left thyroid nodule measuring up to 2.1 cm, that shows mild retrosternal extension. Recommend follow-up outpatient thyroid ultrasound for further evaluation. 5. Small hiatal hernia and other incidental findings as described. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: The quality of study is excellent for evaluation of aortic root and was not tailored for coronary artery evaluation. There is severe calcification of the tricuspid aortic leaflets with restricted opening during systole. The aortic root measurements done in systolic phase 30% are as follows (all using double oblique method): Annulus Dimensions: 23 x 28 mm Approximate Annulus Area: 483 mm2 Annulus Perimeter: 83 mm Distance of the left main (LM) coronary artery from Annulus: 10 mm Distance of the right coronary artery (RCA) from Annulus: 18 mm Left coronary sinus height: 20 mm Right coronary sinus height: 21 mm Aortic sinuses of Valsalva dimensions: 32 x 32 x 34 mm Sinotubular junction dimensions: 31 x 31 mm Mid ascending aorta dimensions: 38 x 39 mm Suitable Valve deployment angle: LAO = 15, cranial = 13 Aortic valve calcification score: 1920 LEFT VENTRICULAR VOLUMES AND SYSTOLIC FUNCTION: LVEF: 71 % LVED volume: 89 ml LVES volume: 26 ml LV Stroke volume: 63 ml The right thyroid lobe and isthmus are nonvisualized, and could've been surgically removed. The left thyroid lobe shows an inferiorly located heterogeneous left thyroid nodule measuring up to 2.1 cm, that shows mild retrosternal extension. The central airways are patent. No focal airspace opacities or suspicious pulmonary nodules or masses. Mild dependent atelectasis in the left lung. No pleural effusions. Basal septal hypertrophy versus sigmoid septum is noted. Dense mitral annular calcification. The left atrium is mildly dilated. No evidence of left atrial, left atrial appendage or left ventricular thrombi. No pericardial effusion. Moderate to severe coronary artery atherosclerotic calcifications. The main pulmonary artery and thoracic aorta are normal in caliber. Small hiatal hernia. The mediastinum is otherwise unremarkable. No pathologically enlarged lymph nodes. Small left breast calcification. The chest wall is otherwise unremarkable. Decreased osseous mineralization. Moderate multilevel degenerative changes and diffuse idiopathic skeletal hyperostosis of the thoracic spine. The CT of the abdomen and pelvis will be reported separately.
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Findings: There is a relatively ulcerated mass in the left cervical soft tissues extending from the surface from C2-3 to C5-6 with foci of dense calcification along the margins. This was not ulcerated on the prior CT C-spine on 11/15/2020. The thyroid is enlarged bilaterally, apparent goiter, with calcifications on the right and a 1.4 x 1.8 nodule on the left. Deformities of the left shoulder are cut off the left margin of the field-of-view. There is a 3 x 3.6 cm mass invading the left side of the aortic arch and inferior space densities in both upper lung fields. CT scan of the chest is suggested. The nasopharynx is unremarkable and the oral cavity and tongue base appear normal. 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. ---------------
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EXAM: CT Angio Abdomen and Pelvis CLINICAL INFORMATION: 80-year-old woman with clinical history of tavr Spec Inst: TAVR protocol per Dr. Singh COMPARISON: None. TECHNIQUE: CT Angio Abdomen and Pelvis. Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 141 lbs. IV contrast: Omnipaque 350, 40 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 3 ml per sec. Scan delay: bolus tracked Scan field of view: 338 mm. Heart Rate: 72 bpm. FINDINGS: STRUCTURED REPORT: CTA TAVR Protocol VASCULATURE: Large amount of atherosclerotic calcification present throughout the infrarenal abdominal aorta. ABDOMINAL AORTA: No significant abnormality. CELIAC AXIS: No significant abnormality. SMA: Moderate to severe stenosis at the ostium. RIGHT RENAL: No significant abnormality. LEFT RENAL: Critically stenotic origin with poststenotic aneurysmal dilatation. IMA: No significant abnormality. RIGHT ILIAC ARTERIES: Large amount of atherosclerotic calcification present in the right common iliac artery. There is scattered atherosclerotic calcification present in the internal iliac artery. RIGHT COMMON FEMORAL ARTERY: Scattered atherosclerotic calcification present at the bifurcation of the common femoral artery. LEFT ILIAC ARTERIES: No significant abnormality. LEFT COMMON FEMORAL ARTERY: Scattered atherosclerotic calcifications present throughout the common femoral artery and its branches. MEASUREMENTS: Right Common iliac dimensions: avg = 9, min = 9, max = 10 mm. Right External iliac dimensions: avg = 8, min = 8, max = 8 mm. Right Common femoral dimensions: avg = 9, min = 7, max = 10 mm. Left Common iliac dimensions: avg = 10, min = 8, max = 11 mm. Left External iliac dimensions: avg = 9, min = 8, max = 9 mm. Left Common femoral dimensions: avg = 9, min = 8, max = 9 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: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Focus of hyperattenuation could represent a transient hyperattenuating defect. ADRENALS: Normal. KIDNEYS: Marked atrophy of the left kidney. There is no evidence of hydronephrosis in either kidney. Possible 1.6 cm mass in the mid left kidney. A few scattered punctate calcifications in the right kidney, which may reflect small nonobstructing stones. There is compensatory hypertrophy of the right kidney. STOMACH / SMALL BOWEL: Small sliding hiatal hernia. COLON / APPENDIX: Diverticulosis without evidence of diverticulitis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: No lymph node enlargement. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Normal. MUSCULOSKELETAL: Multilevel discogenic degenerative arthrosis present throughout the vertebral column. There is marked facet DJD present throughout the vertebral column. Levoconvex scoliotic curvature centered at L3 vertebral body. CONCLUSION: The aorta, bilateral common iliac, external iliac, and common femoral arteries are patent. The internal diameters of these vessels are provided above. Critical stenosis of the left renal artery with resultant severe atrophy of the left kidney. Recommend renal mass protocol CT or MRI for further characterization. Possible 1.6 cm renal mass in the mid left kidney. Moderate to severe stenosis of the superior mesenteric artery at its origin. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CTA TAVR Protocol VASCULATURE: Large amount of atherosclerotic calcification present throughout the infrarenal abdominal aorta. ABDOMINAL AORTA: No significant abnormality. CELIAC AXIS: No significant abnormality. SMA: Moderate to severe stenosis at the ostium. RIGHT RENAL: No significant abnormality. LEFT RENAL: Critically stenotic origin with poststenotic aneurysmal dilatation. IMA: No significant abnormality. RIGHT ILIAC ARTERIES: Large amount of atherosclerotic calcification present in the right common iliac artery. There is scattered atherosclerotic calcification present in the internal iliac artery. RIGHT COMMON FEMORAL ARTERY: Scattered atherosclerotic calcification present at the bifurcation of the common femoral artery. LEFT ILIAC ARTERIES: No significant abnormality. LEFT COMMON FEMORAL ARTERY: Scattered atherosclerotic calcifications present throughout the common femoral artery and its branches. MEASUREMENTS: Right Common iliac dimensions: avg = 9, min = 9, max = 10 mm. Right External iliac dimensions: avg = 8, min = 8, max = 8 mm. Right Common femoral dimensions: avg = 9, min = 7, max = 10 mm. Left Common iliac dimensions: avg = 10, min = 8, max = 11 mm. Left External iliac dimensions: avg = 9, min = 8, max = 9 mm. Left Common femoral dimensions: avg = 9, min = 8, max = 9 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: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Focus of hyperattenuation could represent a transient hyperattenuating defect. ADRENALS: Normal. KIDNEYS: Marked atrophy of the left kidney. There is no evidence of hydronephrosis in either kidney. Possible 1.6 cm mass in the mid left kidney. A few scattered punctate calcifications in the right kidney, which may reflect small nonobstructing stones. There is compensatory hypertrophy of the right kidney. STOMACH / SMALL BOWEL: Small sliding hiatal hernia. COLON / APPENDIX: Diverticulosis without evidence of diverticulitis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: No lymph node enlargement. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Normal. MUSCULOSKELETAL: Multilevel discogenic degenerative arthrosis present throughout the vertebral column. There is marked facet DJD present throughout the vertebral column. Levoconvex scoliotic curvature centered at L3 vertebral body.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: A 4.7 cm simple left hepatic lobe cyst. No suspicious enhancing hepatic lesions. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Appears normal in size and demonstrate normal enhancement. Pancreatic duct is nondilated. No suspicious hepatic lesions. SPLEEN: Normal. ADRENALS: Bilateral adrenal gland hyperplasia without any discrete measurable nodules. KIDNEYS: Both kidneys demonstrate symmetric enhancement. Small simple exophytic renal cyst in the right renal lower pole. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Small hiatal hernia. Stomach and duodenum are partially distended COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Nonaneurysmal dilatation of infrarenal aorta, measuring about 3.5 x 3.1 cm with small amount of intramural thrombus. Origins of celiac trunk, superior mesenteric arteries and renal arteries unremarkable. URINARY BLADDER: Partially distended REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute osseous findings. Posterior disc bulges at L3-L4 and L4-L5 with mild spinal canal stenosis.
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EXAM: CT Chest with contrast CLINICAL INFORMATION: Squamous cell lung cancer surveillance. COMPARISON: Multiple prior CT chest, most recently 10/7/2021. TECHNIQUE: CT Chest with contrast. Patient weight: 206 lbs. IV contrast: Omnipaque 350, 117 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 1.50 ml per sec. Scan delay: 100 sec. Scan field of view: 420 mm. Contrast Extravasation: Yes DLP: 1392.07 mGy cm. FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Post pneumonectomy changes with filling of the left hemithorax with fluid redemonstrated with slight increase in the volume of fluid.. Stable appearance of multiple small noncalcified pulmonary nodules. The largest is in the right lower lobe, appears irregular, and measures 11 mm x 8 mm along the linear scarring essentially unchanged.. A few tiny pleural-based nodules in the right middle lobe appear unchanged since 8/2/2020. No new suspicious nodule or mass. Scattered calcified granulomas. Minimal right dependent atelectasis. Upper lobe predominant centrilobular and paraseptal emphysematous is redemonstrated.. Central airways are patent. No pneumothorax or right pleural effusion. HEART / VESSELS: Normal heart size. Increased fluid within the left pneumonectomy space mildly impresses on the left atrium and left ventricle. The fluid also displaces the left diaphragm inferiorly. Small pericardial effusion is new. Minimal calcified atherosclerosis of the thoracic aorta and coronary arteries. MEDIASTINUM / ESOPHAGUS: Small amount of fluid/ingested material in the dilated esophagus, likely secondary to reflux. Small hiatal hernia. LYMPH NODES: Borderline enlarged subcarinal lymph node measuring 10 mm, previously 12 mm. Multiple calcified mediastinal and hilar lymph nodes. CHEST WALL: Postsurgical change in the left ribs. UPPER ABDOMEN: Please see separately reported same day CT abdomen and pelvis. MUSCULOSKELETAL: No aggressive osseous lesions. CONCLUSION: 1. Stable small noncalcified pulmonary nodules, the largest in the right lower lobe, and borderline enlarged subcarinal lymph node. 2. Increased fluid within the left pneumonectomy space with compressive effect on the left atrium and left ventricle and the left diaphragm. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Post pneumonectomy changes with filling of the left hemithorax with fluid redemonstrated with slight increase in the volume of fluid.. Stable appearance of multiple small noncalcified pulmonary nodules. The largest is in the right lower lobe, appears irregular, and measures 11 mm x 8 mm along the linear scarring essentially unchanged.. A few tiny pleural-based nodules in the right middle lobe appear unchanged since 8/2/2020. No new suspicious nodule or mass. Scattered calcified granulomas. Minimal right dependent atelectasis. Upper lobe predominant centrilobular and paraseptal emphysematous is redemonstrated.. Central airways are patent. No pneumothorax or right pleural effusion. HEART / VESSELS: Normal heart size. Increased fluid within the left pneumonectomy space mildly impresses on the left atrium and left ventricle. The fluid also displaces the left diaphragm inferiorly. Small pericardial effusion is new. Minimal calcified atherosclerosis of the thoracic aorta and coronary arteries. MEDIASTINUM / ESOPHAGUS: Small amount of fluid/ingested material in the dilated esophagus, likely secondary to reflux. Small hiatal hernia. LYMPH NODES: Borderline enlarged subcarinal lymph node measuring 10 mm, previously 12 mm. Multiple calcified mediastinal and hilar lymph nodes. CHEST WALL: Postsurgical change in the left ribs. UPPER ABDOMEN: Please see separately reported same day CT abdomen and pelvis. MUSCULOSKELETAL: No aggressive osseous lesions.
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Findings: Lines and Tubes: None. Body Wall and Abdomen: Small sclerotic focus in the right anterior fifth rib image 69 series 3 is unchanged. Included portions of the upper abdomen have an unremarkable appearance. Lymph Nodes, Mediastinum and Neck: New shotty left axillary lymph nodes. One of these measures 1.5 x 1.2 cm image 26. Another, posterior to the pectoralis minor measures 10 x 9 mm image 21. No right axillary adenopathy. Mild heterogeneous thyroid is similar. Lungs and Pleura: No pleural effusion. Subpleural left lower lobe nodule is smaller measuring 15 x 11 mm image 83, previously 20 x 17 mm. A few subpleural nodular opacities in the right upper lobe and the right lower lobe superior segment are moderately smaller. Groundglass density opacities in the anterior aspect of the right upper lobe, middle lobe, and lingula have resolved. Small lymph node along the minor fissure image 57 is similar. Cardiovascular: Heart size is normal. No pericardial effusion or dense coronary artery atherosclerotic calcifications.
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EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Squamous cell lung cancer surveillance COMPARISON: CT abdomen and pelvis 10/7/2021 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 206 lbs. IV contrast: Omnipaque 350, 117 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 1.50 ml per sec. Scan delay: 100 sec. Scan field of view: 420 mm. Contrast Extravasation: Yes DLP: 1392.07 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis Chest findings to be dictated separately; please see separate CT chest report same day. ABDOMEN and PELVIS: LIVER: The liver is normal in size and morphology. Multiple hypoattenuating subcentimeter hepatic lesions appear similar, technically indeterminate, but given stability, possible hepatic cysts. No new or enlarging hepatic lesion. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal in size. ADRENALS: Mild bilateral nodular thickening without discrete nodule, unchanged. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Small hiatal hernia. No gastric or small bowel obstruction. COLON / APPENDIX: Moderate volume colonic stool extending to the cecum, which is nonspecific, but can be seen with constipation. The colon and appendix are normal in caliber. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic calcifications of the normal in caliber abdominal aorta. The IVC is normal in caliber. Patent hepatic veins and portal venous system. URINARY BLADDER: Small right bladder diverticulum. REPRODUCTIVE ORGANS: Mildly enlarged prostate gland. BODY WALL: Small fat-containing umbilical hernia. No significant abnormality. MUSCULOSKELETAL: Diffuse osteopenia. Degenerative changes in the imaged thoracolumbar spine. Degenerative changes in the sacroiliac joints bilaterally. No destructive osseous lesion. CONCLUSION: 1. Overall, similar findings to prior examination 10/7/2021. No evidence of metastatic disease in the abdomen or pelvis. Please see separately dictated CT chest report same day. 2. Additional incidental findings, as detailed.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis Chest findings to be dictated separately; please see separate CT chest report same day. ABDOMEN and PELVIS: LIVER: The liver is normal in size and morphology. Multiple hypoattenuating subcentimeter hepatic lesions appear similar, technically indeterminate, but given stability, possible hepatic cysts. No new or enlarging hepatic lesion. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal in size. ADRENALS: Mild bilateral nodular thickening without discrete nodule, unchanged. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Small hiatal hernia. No gastric or small bowel obstruction. COLON / APPENDIX: Moderate volume colonic stool extending to the cecum, which is nonspecific, but can be seen with constipation. The colon and appendix are normal in caliber. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic calcifications of the normal in caliber abdominal aorta. The IVC is normal in caliber. Patent hepatic veins and portal venous system. URINARY BLADDER: Small right bladder diverticulum. REPRODUCTIVE ORGANS: Mildly enlarged prostate gland. BODY WALL: Small fat-containing umbilical hernia. No significant abnormality. MUSCULOSKELETAL: Diffuse osteopenia. Degenerative changes in the imaged thoracolumbar spine. Degenerative changes in the sacroiliac joints bilaterally. No destructive osseous lesion.
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Findings: Post surgical changes related to left hemiglossectomy and bilateral lymph node dissection. No evidence of recurrent lesion. No worrisome neck node identified. The nasopharynx appears normal. Airway is patent. The suprahyoid neck including the oropharynx, oral cavity, parapharyngeal spaces and retropharyngeal spaces are unremarkable. The epiglottis and aryepiglottic folds appear unremarkable. The infrahyoid neck including the larynx, hypopharynx and supraglottis appears normal. The thyroid gland and salivary glands appear unremarkable. There is no worrisome cervical lymphadenopathy. The visualized vascular structures appear unremarkable. The osseous structures show no worrisome lesions. Scattered paranasal sinus mucosal thickening. The orbits and skull base appear unremarkable. The lung apices appear unremarkable.
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CT Cardiac with contrast CLINICAL INFORMATION: 70-year-old female with history of aortic stenosis undergoing evaluation for transcatheter aortic valve replacement. COMPARISON: No prior relevant studies available for comparison. TECHNIQUE: Pre contrast images were obtained to assess aortic valve and mitral annular calcifications. The postcontrast CT was performed using retrospective cardiac gating, followed by helical non gated CTA of the chest, abdomen and pelvis using single bolus of contrast. Images reviewed in multiple phases of the cardiac cycle. Source images, multiplanar reformatted images and volume rendered images were also reviewed. Patient was not given any medication Patient weight: 180 lbs. IV contrast: Omnipaque 350, 70 ml, per protocol. Saline flush: 60 ml. IV contrast injection rate: 3 ml per sec. Scan delay: Bolus Tracked. Scan field of view: 170 mm. Heart Rate: 57 bpm. DLP: 1518 mGy cm. FINDINGS: The quality of study is excellent for evaluation of aortic root and was not tailored for coronary artery evaluation. There is moderate calcification of the tricuspid aortic leaflets with restricted opening during systole. The aortic root measurements done in systolic phase 30% are as follows (all using double oblique method): Annulus Dimensions: 18 x 24 mm Approximate Annulus Area: 337 mm2 Annulus Perimeter: 70 mm Distance of the left main (LM) coronary artery from Annulus: 13 mm Distance of the right coronary artery (RCA) from Annulus: 13 mm Left coronary sinus height: 19 mm Right coronary sinus height: 20 mm Aortic sinuses of Valsalva dimensions: 24 x 26 x 27 mm Sinotubular junction dimensions: 27 x 27 mm Mid ascending aorta dimensions: 30 x 32 mm Suitable Valve deployment angle: LAO = 25, cranial = 20 Aortic valve calcification score: 817 LEFT VENTRICULAR VOLUMES AND SYSTOLIC FUNCTION: LVEF: 85 % LVED volume: 101 ml LVES volume: 16 ml LV Stroke volume: 85 ml The imaged lower neck is unremarkable. The central airways are patent and clear. Expiratory exam with mosaic attenuation in the left greater than right lungs. Calcified granulomas in the right middle lobe. Mild bilateral dependent atelectasis. Concentric left ventricular hypertrophy. Cardiac chambers are normal in size. No pericardial effusion. Moderate multivessel coronary artery atherosclerotic calcifications. Severe mitral annular calcification is also seen. The main pulmonary artery and thoracic aorta are normal in caliber. There is left-sided aortic arch with normal branching pattern and separate origin of the left vertebral artery directly from the arch. The esophagus is unremarkable. Multiple calcified mediastinal lymph nodes are noted. Few prominent noncalcified mediastinal lymph nodes are noted, for example: right paratracheal lymph node measures 1.2 cm in short access (series 9, image 27), likely reactive. The chest wall soft tissues are unremarkable. No aggressive osseous lesion. Moderate multilevel degenerative changes of the thoracic spine. The CT of the abdomen and pelvis will be reported separately. CONCLUSION: 1. Calcific aortic stenosis with measured annulus size of 18 x 24 mm, annulus area of 337 sq mm and adequate distances of LM \T\ RCA to annulus. 2. Other measurements for percutaneous TAVR planning as above. 3. Other incidental findings as described. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: The quality of study is excellent for evaluation of aortic root and was not tailored for coronary artery evaluation. There is moderate calcification of the tricuspid aortic leaflets with restricted opening during systole. The aortic root measurements done in systolic phase 30% are as follows (all using double oblique method): Annulus Dimensions: 18 x 24 mm Approximate Annulus Area: 337 mm2 Annulus Perimeter: 70 mm Distance of the left main (LM) coronary artery from Annulus: 13 mm Distance of the right coronary artery (RCA) from Annulus: 13 mm Left coronary sinus height: 19 mm Right coronary sinus height: 20 mm Aortic sinuses of Valsalva dimensions: 24 x 26 x 27 mm Sinotubular junction dimensions: 27 x 27 mm Mid ascending aorta dimensions: 30 x 32 mm Suitable Valve deployment angle: LAO = 25, cranial = 20 Aortic valve calcification score: 817 LEFT VENTRICULAR VOLUMES AND SYSTOLIC FUNCTION: LVEF: 85 % LVED volume: 101 ml LVES volume: 16 ml LV Stroke volume: 85 ml The imaged lower neck is unremarkable. The central airways are patent and clear. Expiratory exam with mosaic attenuation in the left greater than right lungs. Calcified granulomas in the right middle lobe. Mild bilateral dependent atelectasis. Concentric left ventricular hypertrophy. Cardiac chambers are normal in size. No pericardial effusion. Moderate multivessel coronary artery atherosclerotic calcifications. Severe mitral annular calcification is also seen. The main pulmonary artery and thoracic aorta are normal in caliber. There is left-sided aortic arch with normal branching pattern and separate origin of the left vertebral artery directly from the arch. The esophagus is unremarkable. Multiple calcified mediastinal lymph nodes are noted. Few prominent noncalcified mediastinal lymph nodes are noted, for example: right paratracheal lymph node measures 1.2 cm in short access (series 9, image 27), likely reactive. The chest wall soft tissues are unremarkable. No aggressive osseous lesion. Moderate multilevel degenerative changes of the thoracic spine. The CT of the abdomen and pelvis will be reported separately.
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FINDINGS: Aortic arch: Patent without flow-limiting stenosis. Normal three vessel aortic arch is noted. Right carotid: Patent without flow-limiting stenosis. Left carotid: Dense atherosclerotic calcification of the distal left common carotid artery extending into the carotid bifurcation, resulting in moderate distal common carotid and mild proximal left ICA luminal narrowing. Otherwise, remains patent without flow-limiting stenosis. Right vertebral artery: Patent without flow-limiting stenosis. Left vertebral artery: Slightly dominant. Patent without flow-limiting stenosis. Intracranial arteries: Dense atherosclerotic calcifications of the bilateral cavernous and supraclinoid ICAs, resulting in moderate focal luminal narrowing of the right supraclinoid ICA. Aplastic right A1 segment. The bilateral ACAs, MCAs and PCAs appear patent, without flow-limiting stenoses or discrete aneurysms. The vertebrobasilar axis is mildly tortuous, without flow-limiting stenoses. NONVASCULAR FINDINGS: Mild frontal age-appropriate brain parenchymal volume loss is seen. The white-gray matter differentiation is preserved. There is no abnormal enhancement, acute intracranial hemorrhage, midline shift, basal cistern effacement, hydrocephalus or abnormal extra-axial fluid collections. Air-fluid levels in the bilateral sphenoid sinuses with scattered ethmoid air cell mucosal thickening. The visualized paranasal sinuses, mastoid air cells and orbits appear otherwise unremarkable. The oral cavity, nasopharynx, oropharynx, and laryngopharynx have normal appearance. No intrinsic abnormality is seen within the larynx or trachea. The true and false vocal cords are without focal abnormality. The superficial soft tissues of the neck have a normal appearance with no enhancing lesion identified. No enlarged lymph nodes are seen. The parotid and submandibular glands are normal in appearance. The thyroid gland is without focal abnormality. Partially visualized right greater than left airspace disease in the lung apices.
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EXAM: CT Angio Chest wo+w contrast CLINICAL INFORMATION: COVID confirmed hypoxia COMPARISON: 8/26/2011. TECHNIQUE: CT Angio Chest wo+w contrast. Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 115 lbs. IV contrast: Omnipaque 350, 60 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 4 ml per sec. Scan delay: BT sec. Scan field of view: 276 mm. KVP: 100 DLP: 219.10 mGy cm. FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Moderately suboptimal quality with incomplete evaluation of segmental and subsegmental pulmonary arteries. Evaluation of the segmental and subsegmental pulmonary arteries is limited due to respiratory motion, particularly within the lung bases. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: There are diffuse groundglass opacities with superimposed alveolar consolidation involving the basilar segments of the right lower lobe. Groundglass opacities with scattered alveolar consolidation is also seen within the left lower lobe and left upper lobe. There is bilateral lower lobe bronchiectasis. There is also bronchiectasis seen within the right middle lobe with bronchial occlusion likely secondary to mucous plugging. No large pneumothorax or pleural effusion. HEART / OTHER VESSELS: Aortic valve prosthesis is noted. The heart size is normal without pericardial effusion. MEDIASTINUM / ESOPHAGUS: There is a large hiatal hernia. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Unremarkable MUSCULOSKELETAL: There is is a severe dextroscoliotic deformity to the thoracic spine. There are prior sternotomy changes. There is a thoracolumbar fusion construct, incompletely imaged. No displaced fracture seen. CONCLUSION: 1. Moderately limited exam due to respiratory motion. No central pulmonary thromboembolism is identified. 2. Bilateral groundglass and alveolar consolidations concerning for multifocal pneumonia. Viral pneumonia is a consideration. 3. Bilateral bronchiectasis with a large amount of mucus plugging in the right middle lobe, as described. Large hiatal hernia. This raises concern for chronic aspiration. 4. Scoliosis, and additional findings above.
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FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Moderately suboptimal quality with incomplete evaluation of segmental and subsegmental pulmonary arteries. Evaluation of the segmental and subsegmental pulmonary arteries is limited due to respiratory motion, particularly within the lung bases. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: There are diffuse groundglass opacities with superimposed alveolar consolidation involving the basilar segments of the right lower lobe. Groundglass opacities with scattered alveolar consolidation is also seen within the left lower lobe and left upper lobe. There is bilateral lower lobe bronchiectasis. There is also bronchiectasis seen within the right middle lobe with bronchial occlusion likely secondary to mucous plugging. No large pneumothorax or pleural effusion. HEART / OTHER VESSELS: Aortic valve prosthesis is noted. The heart size is normal without pericardial effusion. MEDIASTINUM / ESOPHAGUS: There is a large hiatal hernia. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Unremarkable MUSCULOSKELETAL: There is is a severe dextroscoliotic deformity to the thoracic spine. There are prior sternotomy changes. There is a thoracolumbar fusion construct, incompletely imaged. No displaced fracture seen.
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FINDINGS: Aortic arch: Patent without flow-limiting stenosis. Normal three vessel aortic arch is noted. Right carotid: Patent without flow-limiting stenosis. Left carotid: Dense atherosclerotic calcification of the distal left common carotid artery extending into the carotid bifurcation, resulting in moderate distal common carotid and mild proximal left ICA luminal narrowing. Otherwise, remains patent without flow-limiting stenosis. Right vertebral artery: Patent without flow-limiting stenosis. Left vertebral artery: Slightly dominant. Patent without flow-limiting stenosis. Intracranial arteries: Dense atherosclerotic calcifications of the bilateral cavernous and supraclinoid ICAs, resulting in moderate focal luminal narrowing of the right supraclinoid ICA. Aplastic right A1 segment. The bilateral ACAs, MCAs and PCAs appear patent, without flow-limiting stenoses or discrete aneurysms. The vertebrobasilar axis is mildly tortuous, without flow-limiting stenoses. NONVASCULAR FINDINGS: Mild frontal age-appropriate brain parenchymal volume loss is seen. The white-gray matter differentiation is preserved. There is no abnormal enhancement, acute intracranial hemorrhage, midline shift, basal cistern effacement, hydrocephalus or abnormal extra-axial fluid collections. Air-fluid levels in the bilateral sphenoid sinuses with scattered ethmoid air cell mucosal thickening. The visualized paranasal sinuses, mastoid air cells and orbits appear otherwise unremarkable. The oral cavity, nasopharynx, oropharynx, and laryngopharynx have normal appearance. No intrinsic abnormality is seen within the larynx or trachea. The true and false vocal cords are without focal abnormality. The superficial soft tissues of the neck have a normal appearance with no enhancing lesion identified. No enlarged lymph nodes are seen. The parotid and submandibular glands are normal in appearance. The thyroid gland is without focal abnormality. Partially visualized right greater than left airspace disease in the lung apices.
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EXAM: CT Angio Abdomen and Pelvis CLINICAL INFORMATION: tavr eval, I35.0 Nonrheumatic aortic (valve) stenosis Spec Inst: TAVR protocol per Dr. Singh COMPARISON: None. TECHNIQUE: CT Angio Abdomen and Pelvis. Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 180 lbs. IV contrast: Omnipaque 350, 70 ml, per protocol. Saline flush: 60 ml. IV contrast injection rate: 3 ml per sec. Scan delay: Bolus Tracked. Scan field of view: 490 mm. FINDINGS: STRUCTURED REPORT: CTA TAVR Protocol VASCULATURE: Mild scattered atherosclerotic calcifications throughout the arterial system. Note is made of a retroaortic left renal vein. 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 ARTERIES: No significant abnormality. RIGHT COMMON FEMORAL ARTERY: No significant abnormality. LEFT ILIAC ARTERIES: No significant abnormality. LEFT COMMON FEMORAL ARTERY: No significant abnormality. MEASUREMENTS: Right Common iliac dimensions: avg = 8, min = 7, max = 9 mm. Right External iliac dimensions: avg = 6, min = 6, max = 7 mm. Right Common femoral dimensions: avg = 6, min = 6, max = 7 mm. Left Common iliac dimensions: avg = 8, min = 6, max = 9 mm. Left External iliac dimensions: avg = 6, min = 6, max = 7 mm. Left Common femoral dimensions: avg = 6, min = 6, max = 7 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: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: No lymph node enlargement. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Normal. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. The aorta, bilateral common iliac, external iliac, and common femoral arteries are patent. The internal diameters of these vessels are provided above.
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FINDINGS: STRUCTURED REPORT: CTA TAVR Protocol VASCULATURE: Mild scattered atherosclerotic calcifications throughout the arterial system. Note is made of a retroaortic left renal vein. 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 ARTERIES: No significant abnormality. RIGHT COMMON FEMORAL ARTERY: No significant abnormality. LEFT ILIAC ARTERIES: No significant abnormality. LEFT COMMON FEMORAL ARTERY: No significant abnormality. MEASUREMENTS: Right Common iliac dimensions: avg = 8, min = 7, max = 9 mm. Right External iliac dimensions: avg = 6, min = 6, max = 7 mm. Right Common femoral dimensions: avg = 6, min = 6, max = 7 mm. Left Common iliac dimensions: avg = 8, min = 6, max = 9 mm. Left External iliac dimensions: avg = 6, min = 6, max = 7 mm. Left Common femoral dimensions: avg = 6, min = 6, max = 7 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: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: No lymph node enlargement. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Normal. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. The airways are patent with minimal bronchial wall thickening is seen. Calcified granuloma are present bilaterally. Diffuse mosaic attenuation is noted. No subpleural reticulation, traction bronchiectasis or honeycombing is identified. Thin-walled cyst is present in the left upper lobe. Scattered bilateral tiny nodules are present with the largest two in the right lower lobe measuring 5 mm on series 2, images 118 and 168. Linear scarring is seen anteriorly in the RML and the LUL. No pleural effusion. A few calcified mediastinal nodes are seen. Some enlarged mediastinal nodes are present such as in the left paratracheal region measuring 12 x 16 mm on image 76 and in the right paraesophageal space measuring 14 x 17 mm on image 103. Enlarged hilar nodes are suspected but difficult to define without IV contrast. There's have been previous bilateral axillary node dissections. The upper esophagus is dilated with a small air-fluid level. Mild calcific atherosclerosis is present in the descending aorta the main pulmonary artery is enlarged at 32 mm. Within the limits of a noncontrast exam, the heart size and the mediastinum are otherwise normal. Calcified granuloma are seen in the spleen. Two calcified splenic artery aneurysms are noted. The gallbladder has been surgically removed. Limited noncontrast images of the upper abdomen are otherwise unremarkable. No previous right mastectomy with apparent lobectomy on the left with marked skin thickening is seen. No focal lytic or blastic osseous lesions.
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EXAM: CT Chest wo contrast CLINICAL INFORMATION: Left hand sarcoma post surgery and radiation with small lung nodules being followed COMPARISON: 7/6/2021. TECHNIQUE: CT Chest wo contrast. Scan field of view: 380 mm. DLP: 188 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. Left axillary node measures just at 11 mm in short axis on series 3 image 53 similar to the previous exam. No other enlarged intrathoracic lymph nodes are identified. Within the limits of a noncontrast exam, the heart size and the mediastinum are otherwise normal. No pleural effusions. Mild upper lobe paraseptal emphysema is redemonstrated. Scattered tiny noncalcified nodules on series 3 images 34, 43, 48, 50, 86 and 93 are unchanged. The largest unchanged nodule is in the peripheral RLL on image 142 measuring 5 x 7 mm on both the current and prior exam. A few small nodules along the left major fissure are also unchanged and consistent with intrapulmonary lymph nodes. Bilateral mild bronchial wall thickening is similar to the previous exam. The lungs are otherwise normal. Limited noncontrast images of the upper abdomen are unremarkable. No focal destructive osseous lesions. CONCLUSION: 1. Scattered noncalcified nodules measuring up to 5 x 7 mm in size are unchanged. Continued attention on follow-up will be needed. 2. Borderline enlarged left axillary node is also unchanged. No new adenopathy.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. Left axillary node measures just at 11 mm in short axis on series 3 image 53 similar to the previous exam. No other enlarged intrathoracic lymph nodes are identified. Within the limits of a noncontrast exam, the heart size and the mediastinum are otherwise normal. No pleural effusions. Mild upper lobe paraseptal emphysema is redemonstrated. Scattered tiny noncalcified nodules on series 3 images 34, 43, 48, 50, 86 and 93 are unchanged. The largest unchanged nodule is in the peripheral RLL on image 142 measuring 5 x 7 mm on both the current and prior exam. A few small nodules along the left major fissure are also unchanged and consistent with intrapulmonary lymph nodes. Bilateral mild bronchial wall thickening is similar to the previous exam. The lungs are otherwise normal. Limited noncontrast images of the upper abdomen are unremarkable. No focal destructive osseous lesions.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Heart is mildly enlarged in size. Aortic prosthesis is seen in place. There is no pericardial effusion. Severe coronary calcifications seen. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Ill-defined hypoattenuating area within the splenic parenchyma probably related to old infarct. Spleen is otherwise unremarkable. ADRENALS: Mild thickening of both adrenal glands without any discrete measurable nodules. KIDNEYS: Atrophic bilateral kidneys containing several simple fluid density cortical hypoattenuating lesions representing simple cysts. Also seen are renal vascular calcifications and nonspecific perinephric stranding. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach and duodenum are partially distended. There is no abnormal dilatation of small bowel loops. COLON / APPENDIX: Uncomplicated colonic diverticulosis.. PERITONEUM / MESENTERY: No ascites or pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: Due to severe aortic calcifications. Aorta is nonaneurysmal. There is mild calcifications of bilateral distal external iliac arteries. Mid/proximal bilateral external iliac arteries are devoid of any calcifications. URINARY BLADDER: Empty REPRODUCTIVE ORGANS: Surgically absent uterus. Small hyperattenuating lesion measuring 1.4 cm in the right hemipelvis, similar to prior CT from 2017. BODY WALL: Peripherally calcified right breast mass, partially imaged. Small focal disc calcification also seen along with multiple vascular calcifications in both the breast parenchyma. MUSCULOSKELETAL: Generalized bony demineralization. Multilevel moderate degenerative changes in lumbar spine. Lumbar vertebrae demonstrate normal height.
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CT angiogram of the brain Clinical: Follow-up aneurysm. Technical: CT scan of the brain before contrast. Delayed postcontrast CT scan of the brain. During the injection of Omnipaque 350, 100 ml, per protocol, 0.67 mm axial CT scans were obtained. Sagittal, axial and coronal MIP angiograms were generated. 3-D color surface rendered angiograms were directed on an independent workstation. DLP: 3680.37 mGy cm. Comparison: Outside MRA of the head on 12/8/2021. Findings: CTA head: The exam is severely degraded by motion. The small left superior hypophyseal aneurysm is shown only on the coronal MIP series 605 #75 directed medially and slightly inferiorly. This is not significantly changed compared to the outside MR angiogram on 12/8/2021. CT scan of the of the brain shows normal appearance of the parenchyma on the precontrast scan. No abnormal enhancement is seen. --------------- Conclusion: Marginal CT angiogram of the head, severely degraded by motion. Small right superior hypophyseal aneurysm shown only a very on the coronal MIP series 605 #75 with no significant change compared to the outside MR angiogram on 12/8/2021. No parenchymal abnormality identified.
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Findings: CTA head: The exam is severely degraded by motion. The small left superior hypophyseal aneurysm is shown only on the coronal MIP series 605 #75 directed medially and slightly inferiorly. This is not significantly changed compared to the outside MR angiogram on 12/8/2021. CT scan of the of the brain shows normal appearance of the parenchyma on the precontrast scan. No abnormal enhancement is seen. ---------------
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP LOWER NECK: Unremarkable. CHEST: LUNGS / AIRWAYS / PLEURA: There are scattered bilateral 2 to 3 mm tree-in-bud nodules. There is a small left pleural effusion with associated atelectasis. Multiple right-sided calcified granulomata. The central airways are patent. HEART / VESSELS: The remaining of moderate pericardial effusion. There is an LVAD in place. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: There is a prevascular, paratracheal and probable right hilar adenopathy. CHEST WALL: The patient is status post median sternotomy. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. BILIARY TRACT: Normal. GALLBLADDER: Probable cholelithiasis. PANCREAS: Normal noncontrast appearance. SPLEEN: Spleen is enlarged measuring 13.7 cm in AP dimension. ADRENALS: Normal. KIDNEYS: No hydronephrosis or nephrolithiasis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: The stomach appears unremarkable. The loops small bowel are normal in caliber. COLON / APPENDIX: No evidence of acute colonic pathology. The appendix appears unremarkable. PERITONEUM / MESENTERY: No free air or free fluid. RETROPERITONEUM: Normal. VESSELS: Mild scattered calcified atherosclerotic disease. URINARY BLADDER: Unremarkable. REPRODUCTIVE ORGANS: Unremarkable. BODY WALL: Multiple small ventral fat-containing hernias are noted. MUSCULOSKELETAL: There are degenerative changes of the spine.
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2,658 |
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 45-year-old woman with history of follicular lymphoma COMPARISON: 9/20/2011 contrast enhanced CT, 12/8/2020 PET/CT TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 195 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 80 sec. Scan field of view: 380 mm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Chest CT performed today will be reported separately. ABDOMEN and PELVIS: LIVER: A well-circumscribed focal 2 cm hypodensity in segment IV B corresponds to an area of non-FDG avidity on the prior PET and a smaller area of hypovascularity on the 2011 CT, may represent treated residual/and active disease. A less well marginated area of hypodensity bordering segments five and six in the right hepatic lobe (image 24 series 2) corresponds to region that had previously been hyperenhancing on the 2011 CT and again was non-FDG avid on 12/8/2020. No new focal hepatic lesions are identified. The liver is not enlarged. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal size, no focal lesions are evident. ADRENALS: Normal. KIDNEYS: A few subcentimeter cysts are noted, normal otherwise. LYMPH NODES: No pathologically enlarged lymph nodes are present in the abdomen or pelvis. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: An IUD is in place. A cervical nabothian cyst is present. The adnexa appear normal. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Degenerative change is seen at the lumbosacral junction. There are no aggressive osseous lesions. CONCLUSION: 1. No evidence of active lymphoma in the abdomen or pelvis. 2. Focal liver lesions are nonspecific but might reflect residua/inactive lesions from prior disease.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Chest CT performed today will be reported separately. ABDOMEN and PELVIS: LIVER: A well-circumscribed focal 2 cm hypodensity in segment IV B corresponds to an area of non-FDG avidity on the prior PET and a smaller area of hypovascularity on the 2011 CT, may represent treated residual/and active disease. A less well marginated area of hypodensity bordering segments five and six in the right hepatic lobe (image 24 series 2) corresponds to region that had previously been hyperenhancing on the 2011 CT and again was non-FDG avid on 12/8/2020. No new focal hepatic lesions are identified. The liver is not enlarged. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal size, no focal lesions are evident. ADRENALS: Normal. KIDNEYS: A few subcentimeter cysts are noted, normal otherwise. LYMPH NODES: No pathologically enlarged lymph nodes are present in the abdomen or pelvis. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: An IUD is in place. A cervical nabothian cyst is present. The adnexa appear normal. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Degenerative change is seen at the lumbosacral junction. There are no aggressive osseous lesions.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP LOWER NECK: Unremarkable. CHEST: LUNGS / AIRWAYS / PLEURA: There are scattered bilateral 2 to 3 mm tree-in-bud nodules. There is a small left pleural effusion with associated atelectasis. Multiple right-sided calcified granulomata. The central airways are patent. HEART / VESSELS: The remaining of moderate pericardial effusion. There is an LVAD in place. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: There is a prevascular, paratracheal and probable right hilar adenopathy. CHEST WALL: The patient is status post median sternotomy. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. BILIARY TRACT: Normal. GALLBLADDER: Probable cholelithiasis. PANCREAS: Normal noncontrast appearance. SPLEEN: Spleen is enlarged measuring 13.7 cm in AP dimension. ADRENALS: Normal. KIDNEYS: No hydronephrosis or nephrolithiasis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: The stomach appears unremarkable. The loops small bowel are normal in caliber. COLON / APPENDIX: No evidence of acute colonic pathology. The appendix appears unremarkable. PERITONEUM / MESENTERY: No free air or free fluid. RETROPERITONEUM: Normal. VESSELS: Mild scattered calcified atherosclerotic disease. URINARY BLADDER: Unremarkable. REPRODUCTIVE ORGANS: Unremarkable. BODY WALL: Multiple small ventral fat-containing hernias are noted. MUSCULOSKELETAL: There are degenerative changes of the spine.
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2,659 |
CT Chest with contrast Clinical Information: 45-year-old female surveillance CTs, C82.00 Follicular lymphoma grade I, unspecified site Comparison: 9/20/2011 Technique: Following injection of non-ionic contrast 2.5 mm images were obtained through the chest. Abdominal findings will be reported separately. Patient weight: 195 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 80 sec. Scan field of view: 380 mm. DLP: 1346.82 mGy cm. Findings: A borderline enlarged left axillary node measures 10 x 11 mm on series 2 image 42. No additional enlarged intrathoracic nodes are present. Small hiatal hernia is present. The heart size and mediastinum are otherwise normal. A tiny RUL nodule is seen on series 2 image 85 unchanged back to 2011 consistent with a benign nodule. The lungs are otherwise normal without suspicious nodules or masses. No pleural effusion. The previous left-sided port catheter has been removed. A nodular area suggesting fat necrosis with calcified rim is seen in the upper right breast may have been the site of another previous port catheter. No focal destructive osseous lesions identified. CT abdomen pelvis will be reported separately. Impression: 1. A borderline enlarged left axillary node is seen. No other findings to suggest intrathoracic lymphoma.. 2. Incidental findings as above.
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Findings: A borderline enlarged left axillary node measures 10 x 11 mm on series 2 image 42. No additional enlarged intrathoracic nodes are present. Small hiatal hernia is present. The heart size and mediastinum are otherwise normal. A tiny RUL nodule is seen on series 2 image 85 unchanged back to 2011 consistent with a benign nodule. The lungs are otherwise normal without suspicious nodules or masses. No pleural effusion. The previous left-sided port catheter has been removed. A nodular area suggesting fat necrosis with calcified rim is seen in the upper right breast may have been the site of another previous port catheter. No focal destructive osseous lesions identified. CT abdomen pelvis will be reported separately.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. The appendix is visualized and is normal. PERITONEUM / MESENTERY: No free fluid or free air. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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2,660 |
RADIOLOGIC EXAM: CT Head wo contrast CLINICAL INFORMATION: Seizure COMPARISON: 12/25/21 TECHNIQUE: CT Head wo contrastScan field of view: 216 mm. DLP: 1453.90 mGy cm. STRUCTURED REPORT: CT Head FINDINGS: BRAIN PARENCHYMA: There is no acute intracranial hemorrhage or acute infarct. No brain edema or mass effect. Stable volume loss. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Stable postoperative changes right orbit. Left orbit is normal. SINUSES: Normal. CONCLUSION: No acute intracranial process or significant interval change.
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FINDINGS: BRAIN PARENCHYMA: There is no acute intracranial hemorrhage or acute infarct. No brain edema or mass effect. Stable volume loss. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Stable postoperative changes right orbit. Left orbit is normal. SINUSES: Normal.
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FINDINGS: Chest CT: There are multifocal ill-defined subpleural airspace opacities in the dependent right lower lobe with minimal associated peribronchial thickening. No other discrete lung nodule or mass is noted. Only small subcentimeter size nodes are present in the mediastinum. There is no pleural or pericardial effusion. No focal lytic or sclerotic bone lesion is seen. Bilateral subpectoral breast implants are intact. Abdomen/pelvic CT: The visualized liver, spleen, pancreas, gallbladder, both adrenal glands, kidneys and visualized bowel loops are unremarkable. There is no free fluid or air in the abdomen. Subcentimeter size retroperitoneal nodes are present in the upper abdominal para-aortic region. The urinary bladder is well distended and appears unremarkable. There is focal calcification in the behind the urinary bladder in this patient status post prior vaginal hysterectomy. No focal lytic or sclerotic bone lesion.
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2,661 |
CT Head wo contrast 1/6/2022 5:05 PM Clinical information: PUI for COVID AMS Comparison: CT head 12/15/2021 Technique: 5 mm axial images were obtained without contrast from the base of the skull to the vertex with sagittal and coronal reformats. Scan field of view: 230 mm. DLP: 1474.20 mGy cm. Findings: Image quality is degraded due to motion. There is no evidence of acute intracranial hemorrhage, infarction, brain edema, mass effect or hydrocephalus. Stable diffuse brain atrophy. Small fluid in the right sphenoid and left maxillary sinuses and mild mucosal thickening in the ethmoid air cells. The remaining visualized paranasal sinuses, mastoid air cells and middle ear cavities are clear. Both orbits appear normal. Impression: No CT evidence of acute intracranial abnormality. No significant change compared to prior head CT from 12/15/2021.
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Findings: Image quality is degraded due to motion. There is no evidence of acute intracranial hemorrhage, infarction, brain edema, mass effect or hydrocephalus. Stable diffuse brain atrophy. Small fluid in the right sphenoid and left maxillary sinuses and mild mucosal thickening in the ethmoid air cells. The remaining visualized paranasal sinuses, mastoid air cells and middle ear cavities are clear. Both orbits appear normal.
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FINDINGS: Chest CT: There are multifocal ill-defined subpleural airspace opacities in the dependent right lower lobe with minimal associated peribronchial thickening. No other discrete lung nodule or mass is noted. Only small subcentimeter size nodes are present in the mediastinum. There is no pleural or pericardial effusion. No focal lytic or sclerotic bone lesion is seen. Bilateral subpectoral breast implants are intact. Abdomen/pelvic CT: The visualized liver, spleen, pancreas, gallbladder, both adrenal glands, kidneys and visualized bowel loops are unremarkable. There is no free fluid or air in the abdomen. Subcentimeter size retroperitoneal nodes are present in the upper abdominal para-aortic region. The urinary bladder is well distended and appears unremarkable. There is focal calcification in the behind the urinary bladder in this patient status post prior vaginal hysterectomy. No focal lytic or sclerotic bone lesion.
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2,662 |
CT Head wo contrast 1/6/2022 2:39 PM Clinical Information: Shunt infection, T85.730A Infection and inflammatory reaction due to ventricular intracranial (communicating) shunt, initial encounter Comparison: Brain MRI 1/4/2022 Technique: Unenhanced axial brain CT with coronal and sagittal reconstructions. Scan field of view: 218 mm. DLP: 958.60 mGy cm. Findings: There is a right frontal approach ventricular catheter terminating in the right foramen of Monro region. The ventricles are minimally enlarged in size. There are postsurgical changes from left frontal craniotomy for underlying mass excision. Underlying heterogeneous density with edema in the left frontal lobe, adjacent anterior corpus callosum and basal ganglia is again noted. There is a prominent gas fluid level in the left frontal region, similar to the prior exam. Residual calcifications in the left frontal lobe are again noted There is right frontal periventricular and pericatheter edema as well. There is trace amount of hemorrhage surrounding the frontal catheter tract. There is trace dependent intraventricular hemorrhage. No new hemorrhage, evidence of acute infarction or other mass effect is seen. Gas and fluid in the left temporal scalp postsurgical changes is also similar. The visualized paranasal sinuses and mastoid air cells are clear. Impression: 1. Minimal increase in lateral ventricular size. Stable right frontal approach ventricular catheter. 2. Similar appearance of left frontal postsurgical changes with residual air-fluid level and adjacent heterogeneous density, as detailed above.
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Findings: There is a right frontal approach ventricular catheter terminating in the right foramen of Monro region. The ventricles are minimally enlarged in size. There are postsurgical changes from left frontal craniotomy for underlying mass excision. Underlying heterogeneous density with edema in the left frontal lobe, adjacent anterior corpus callosum and basal ganglia is again noted. There is a prominent gas fluid level in the left frontal region, similar to the prior exam. Residual calcifications in the left frontal lobe are again noted There is right frontal periventricular and pericatheter edema as well. There is trace amount of hemorrhage surrounding the frontal catheter tract. There is trace dependent intraventricular hemorrhage. No new hemorrhage, evidence of acute infarction or other mass effect is seen. Gas and fluid in the left temporal scalp postsurgical changes is also similar. The visualized paranasal sinuses and mastoid air cells are clear.
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FINDINGS: CT of the head with and without contrast: There is no acute infarction, hemorrhage, or cerebral edema. The gray-white matter differentiation is maintained. Subcortical periventricular hypodensities likely representing microangiopathic changes. The cerebral cortical volume is appropriate for patient's age. There is no space occupying intracranial lesion or hydrocephalus. No enhancing intracranial abnormality. There is no acute osseous or orbital abnormality. The right mastoid air cells are partially opacified, likely representing effusion. The paranasal sinuses and left mastoid air cells are clear. CT angiogram of the brain: RIGHT CAROTID: Mild atherosclerotic calcifications of the carotid artery siphon. There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: Mild atherosclerotic calcifications of the carotid artery siphon. There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Unremarkable. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Normal. Mild scattered atherosclerotic calcifications. RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. Moderate atherosclerotic calcifications of the C1 segment of the internal carotid artery without significant stenosis. RIGHT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. SOFT TISSUES: No soft tissue abnormality within the neck.
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2,663 |
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Elevated lipase, history of pancreatitis COMPARISON: 10/16/21 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 180 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 86 sec. Scan field of view: 364 mm. DLP: 533 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Stable right hepatic lobe cyst and additional unchanged subcentimeter hypoattenuating liver lesions which remain too small to characterize but likely also cysts. Otherwise normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Mild peripancreatic inflammatory change and trace unorganized peripancreatic fluid. No organized peripancreatic fluid collections. Subcentimeter low attenuating lesion within the uncinate process on image 113, series 201/ Increased in size since prior.. Unchanged punctate calcification in the lower pancreatic head. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Stable nonobstructing right renal stone. Stable small right renal cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Trace pelvic free fluid, RETROPERITONEUM: Normal. VESSELS: Moderate aortoiliac atherosclerotic disease. URINARY BLADDER: REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Acute interstitial pancreatitis 2. Subcentimeter cystic lesion in the pancreatic uncinate process. Consider further evaluation with nonemergent outpatient MRI recommended following resolution of acute symptoms. 3. Stable nonobstructing right renal stone and additional chronic/incidental findings as above.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Stable right hepatic lobe cyst and additional unchanged subcentimeter hypoattenuating liver lesions which remain too small to characterize but likely also cysts. Otherwise normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Mild peripancreatic inflammatory change and trace unorganized peripancreatic fluid. No organized peripancreatic fluid collections. Subcentimeter low attenuating lesion within the uncinate process on image 113, series 201/ Increased in size since prior.. Unchanged punctate calcification in the lower pancreatic head. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Stable nonobstructing right renal stone. Stable small right renal cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Trace pelvic free fluid, RETROPERITONEUM: Normal. VESSELS: Moderate aortoiliac atherosclerotic disease. URINARY BLADDER: REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: CT of the head with and without contrast: There is no acute infarction, hemorrhage, or cerebral edema. The gray-white matter differentiation is maintained. Subcortical periventricular hypodensities likely representing microangiopathic changes. The cerebral cortical volume is appropriate for patient's age. There is no space occupying intracranial lesion or hydrocephalus. No enhancing intracranial abnormality. There is no acute osseous or orbital abnormality. The right mastoid air cells are partially opacified, likely representing effusion. The paranasal sinuses and left mastoid air cells are clear. CT angiogram of the brain: RIGHT CAROTID: Mild atherosclerotic calcifications of the carotid artery siphon. There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: Mild atherosclerotic calcifications of the carotid artery siphon. There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Unremarkable. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Normal. Mild scattered atherosclerotic calcifications. RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. Moderate atherosclerotic calcifications of the C1 segment of the internal carotid artery without significant stenosis. RIGHT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. SOFT TISSUES: No soft tissue abnormality within the neck.
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2,664 |
EXAM: CT Sinus wo contrast CLINICAL INFORMATION: Female patient 68 years with chronic sinusitis, GPA, J32.9 Chronic sinusitis, unspecified, M31.30 Wegener s granulomatosis without renal involvement Spec Inst: sinus stealth protocol TECHNIQUE: 0.6 mm thick serial axial images were obtained through the paranasal sinuses without intravenous contrast. Sagittal and coronal reformatted views were also obtained. Technique: Scan field of view: 160 mm. DLP: 1415.08 mGy cm. COMPARISON: 1/12/2021 FINDINGS: The frontal sinuses are clear. There is minimal mucosal thickening within the left greater than right ethmoid air cells. There is also a very small osteoma within the left anterior ethmoid air cells. The sphenoid sinuses are patent. There is suggestion of some diffuse sclerosis involving the walls of the right sphenoid sinus suggesting chronic inflammation. There is complete opacification of the maxillary sinuses bilaterally with hyperdense secretions. There is also circumferential diffuse thickening and sclerosis of the walls of the maxillary sinuses representing chronic sinusitis. Walls of the paranasal sinuses are intact. There is complete occlusion of the ostiomeatal complexes bilaterally secondary to inflammatory changes. Both frontal sinuses outflow tracts are patent. There is mild leftward deviation of the nasal septum. No mass lesion is identified within the nasal cavities. There is no acute abnormality of the orbits. Visualized mastoid air cells are clear. CONCLUSION: 01. Bilateral chronic maxillary sinusitis without significant interval change. Hyperdense secretions suggest proteinaceous secretions secondary to fungal sinusitis 02. Remainder of the paranasal sinuses are clear. Note is made of tiny stable incidental left ethmoid osteoma
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FINDINGS: The frontal sinuses are clear. There is minimal mucosal thickening within the left greater than right ethmoid air cells. There is also a very small osteoma within the left anterior ethmoid air cells. The sphenoid sinuses are patent. There is suggestion of some diffuse sclerosis involving the walls of the right sphenoid sinus suggesting chronic inflammation. There is complete opacification of the maxillary sinuses bilaterally with hyperdense secretions. There is also circumferential diffuse thickening and sclerosis of the walls of the maxillary sinuses representing chronic sinusitis. Walls of the paranasal sinuses are intact. There is complete occlusion of the ostiomeatal complexes bilaterally secondary to inflammatory changes. Both frontal sinuses outflow tracts are patent. There is mild leftward deviation of the nasal septum. No mass lesion is identified within the nasal cavities. There is no acute abnormality of the orbits. Visualized mastoid air cells are clear.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. LINES AND TUBES: None. LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Left upper lobe solid nodule has decreased in size measuring 2.5 x 1.6 cm x 1.6cm (previously 3.1 x 2.3 x 2.2 cm). No residual cavitation is appreciated. Fluid within the right major fissure has decreased with small residual consolidation. Trace right pleural effusion has resolved. Minimal bilateral subpleural bandlike areas of organizing pneumonia have improved with minimal residual. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Enlarged paratracheal lymph node is stable. Other scattered prominent mediastinal lymph nodes are stable. Evaluation of the hila is limited due to lack of intravenous contrast. CHEST WALL: No significant abnormality. UPPER ABDOMEN: No acute abnormalities. MUSCULOSKELETAL: No significant abnormality.
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2,665 |
EXAM: CT Chest wo contrast CLINICAL INFORMATION: 67-year-old male with non-small cell lung cancer. COMPARISON: CT chest without contrast dated 10/7/2021. TECHNIQUE: CT Chest wo contrast. Scan field of view: 428 mm. DLP: 426.40 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. Stable postsurgical changes in the left lower lobe. No residual mass or suspicious pulmonary nodule. Mild centrilobular emphysema. A few calcified nodules again noted. No pleural effusion. HEART / VESSELS: Normal sized cardiac chambers. Mild LAD calcifications. Normal caliber pulmonary artery and thoracic aorta. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: A few scattered nonenlarged mediastinal lymph nodes again seen. CHEST WALL: No significant abnormality. UPPER ABDOMEN: No significant abnormality. MUSCULOSKELETAL: No destructive osseous lesion. CONCLUSION: Postsurgical changes from interval left lower lobe wedge resection, without evidence of residual/recurrent disease.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. Stable postsurgical changes in the left lower lobe. No residual mass or suspicious pulmonary nodule. Mild centrilobular emphysema. A few calcified nodules again noted. No pleural effusion. HEART / VESSELS: Normal sized cardiac chambers. Mild LAD calcifications. Normal caliber pulmonary artery and thoracic aorta. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: A few scattered nonenlarged mediastinal lymph nodes again seen. CHEST WALL: No significant abnormality. UPPER ABDOMEN: No significant abnormality. MUSCULOSKELETAL: No destructive osseous lesion.
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FINDINGS: BRAIN PARENCHYMA: There is no acute intracranial hemorrhage or acute infarct. No brain edema or mass effect. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Small mucous retention cyst in the right frontal sinus.
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2,666 |
EXAM: CT Rsh Body with contrast METRIC CLINICAL INFORMATION: 66-year-old man with history of head and neck cancer participating in therapeutic clinical trial COMPARISON: There are no prior abdominal CTs performed at UAB for comparison. A PET/CT from 11/30/2021 was reviewed. TECHNIQUE: CT Rsh Body with contrast METRIC. Patient weight: 146 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 78 sec Scan field of view: 441 mm. DLP: 317 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Chest CT performed today will be reported separately. ABDOMEN and PELVIS: LIVER: Focal well-circumscribed hypodensity in the inferior right hepatic lobe is compatible with a cyst. No lesions suspicious for metastatic disease are identified. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: PEG tube appears in satisfactory position. No abnormalities otherwise. COLON / APPENDIX: Diverticula are seen throughout the sigmoid colon without evidence of inflammation at present. The appendix is not well seen. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: A 7 mm soft tissue nodule in the right retroperitoneum inferomedial to the medial adrenal limb is nonspecific. There was no FDG avidity on the recent PET/CT. VESSELS: No significant abnormality. URINARY BLADDER: Mild diffuse wall thickening likely on the basis of chronic partial outlet obstruction. REPRODUCTIVE ORGANS: The prostate is enlarged with median lobe hypertrophy producing elevation bladder base. Coarse calcifications are consistent with prior episodes of prostatitis. BODY WALL: Small fat-containing right inguinal hernia. Very small fat-containing umbilical hernia. Midline low abdominal wall mesh anchors are present. MUSCULOSKELETAL: Degenerative change in the hips and lumbar spine. No aggressive osseous lesions. CONCLUSION: 1. No convincing evidence of metastatic disease in the abdomen or pelvis. 2. Subcentimeter upper abdominal right retroperitoneal soft tissue nodule is nonspecific, contained no FDG avidity on the recent PET/CT. 3. Incidental findings as above. This patient is participating in a clinical trial and a separate Tumor Metrics report will be provided and include tumor measurements as applicable for response assessment.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Chest CT performed today will be reported separately. ABDOMEN and PELVIS: LIVER: Focal well-circumscribed hypodensity in the inferior right hepatic lobe is compatible with a cyst. No lesions suspicious for metastatic disease are identified. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: PEG tube appears in satisfactory position. No abnormalities otherwise. COLON / APPENDIX: Diverticula are seen throughout the sigmoid colon without evidence of inflammation at present. The appendix is not well seen. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: A 7 mm soft tissue nodule in the right retroperitoneum inferomedial to the medial adrenal limb is nonspecific. There was no FDG avidity on the recent PET/CT. VESSELS: No significant abnormality. URINARY BLADDER: Mild diffuse wall thickening likely on the basis of chronic partial outlet obstruction. REPRODUCTIVE ORGANS: The prostate is enlarged with median lobe hypertrophy producing elevation bladder base. Coarse calcifications are consistent with prior episodes of prostatitis. BODY WALL: Small fat-containing right inguinal hernia. Very small fat-containing umbilical hernia. Midline low abdominal wall mesh anchors are present. MUSCULOSKELETAL: Degenerative change in the hips and lumbar spine. No aggressive osseous lesions.
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FINDINGS: 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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2,667 |
EXAM: CT Chest wo contrast CLINICAL INFORMATION: Lung nodule, greater than 8 mm, patient also history of acute myeloblastic leukemia. COMPARISON: Chest radiograph dated 12/21/2021 TECHNIQUE: CT Chest wo contrast. Scan field of view: 370 mm. DLP: 353.69 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. Surgical clips are seen in the right axillary region. No enlarged intrathoracic lymph nodes are identified. Calcific atherosclerosis is seen in the aorta and coronary arteries. The main pulmonary artery is enlarged at 42 mm consistent with pulmonary arterial hypertension. The heart size is normal with a small pericardial effusion seen and also probably anterior pericardial thickening. Pacing leads are in appropriate position. Within the limits of a noncontrast exam, the heart size and the mediastinum are otherwise normal. No pleural effusion. The right upper lobe lobulated soft tissue mass with spiculated borders measures 60 x 61 mm on series 4 image 66 and is 64 mm craniocaudal on sagittal series 602 image 53. Extensions of the tumor are seen to the apical and lateral pleura including the portion of the upper right mediastinal pleura. Additional linear tags to the lateral pleura are also noted. The mass contains a few tiny eccentric calcifications. An 11 mm RLL nodule on image 166 contains macroscopic fat suggesting a hamartoma. . Centrilobular emphysema is noted. Secretions are seen in the distal trachea to the level the carina. There is mild bronchial wall thickening. No additional nodules or masses. Limited noncontrast images of the upper abdomen are unremarkable. No focal destructive osseous lesions. CONCLUSION: 1. Lobulated and spiculated right upper lobe mass measuring 6 x 6.1 x 6.4 cm. Extensions to the pleura and to the mediastinal pleura are seen. No adenopathy. 2. 11 mm RLL nodule contains macroscopic fat consistent with this being a benign hamartoma. 3. Centrilobular emphysema. 4. Dilated main pulmonary artery consistent with pulmonary arterial hypertension. Small pericardial effusion with evidence of pericardial thickening.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. Surgical clips are seen in the right axillary region. No enlarged intrathoracic lymph nodes are identified. Calcific atherosclerosis is seen in the aorta and coronary arteries. The main pulmonary artery is enlarged at 42 mm consistent with pulmonary arterial hypertension. The heart size is normal with a small pericardial effusion seen and also probably anterior pericardial thickening. Pacing leads are in appropriate position. Within the limits of a noncontrast exam, the heart size and the mediastinum are otherwise normal. No pleural effusion. The right upper lobe lobulated soft tissue mass with spiculated borders measures 60 x 61 mm on series 4 image 66 and is 64 mm craniocaudal on sagittal series 602 image 53. Extensions of the tumor are seen to the apical and lateral pleura including the portion of the upper right mediastinal pleura. Additional linear tags to the lateral pleura are also noted. The mass contains a few tiny eccentric calcifications. An 11 mm RLL nodule on image 166 contains macroscopic fat suggesting a hamartoma. . Centrilobular emphysema is noted. Secretions are seen in the distal trachea to the level the carina. There is mild bronchial wall thickening. No additional nodules or masses. Limited noncontrast images of the upper abdomen are unremarkable. No focal destructive osseous lesions.
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FINDINGS: 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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2,668 |
EXAM: CT Chest with contrast CLINICAL INFORMATION: 51-year-old female with provided history of rectal cancer. COMPARISON: Chest CT 6/10/2020 TECHNIQUE: CT Chest with contrast. Patient weight: 260 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. IV contrast injection rate: 3 ml per sec. Scan delay: 35 sec. Scan field of view: 380 mm. DLP: 2765 mGy cm. FINDINGS: Limitations: None. Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: No consolidation. A tiny 2 mm left upper lobe nodule is unchanged (image 34, series 2). No new or enlarging suspicious pulmonary nodule. Bilateral dependent atelectasis. No pleural effusion. Central airways are patent. Thoracic inlet, heart, and mediastinum: No lymphadenopathy in the axillary, mediastinal, or hilar regions. The esophagus is nondilated. Fat interspersed thymic tissue in the anterior mediastinum, similar to prior. The thoracic aorta and main pulmonary artery are normal in caliber. The cardiac chambers are normal in size. No coronary artery atherosclerotic calcifications are noted, although the study is not optimized for coronary assessment. No pericardial effusion. Bones and soft tissues: No destructive bone lesion. Chest wall is unremarkable. Upper abdomen: Reported separately. CONCLUSION: No evidence of intrathoracic metastases.
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FINDINGS: Limitations: None. Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: No consolidation. A tiny 2 mm left upper lobe nodule is unchanged (image 34, series 2). No new or enlarging suspicious pulmonary nodule. Bilateral dependent atelectasis. No pleural effusion. Central airways are patent. Thoracic inlet, heart, and mediastinum: No lymphadenopathy in the axillary, mediastinal, or hilar regions. The esophagus is nondilated. Fat interspersed thymic tissue in the anterior mediastinum, similar to prior. The thoracic aorta and main pulmonary artery are normal in caliber. The cardiac chambers are normal in size. No coronary artery atherosclerotic calcifications are noted, although the study is not optimized for coronary assessment. No pericardial effusion. Bones and soft tissues: No destructive bone lesion. Chest wall is unremarkable. Upper abdomen: Reported separately.
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FINDINGS: 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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2,669 |
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 51-year-old female with history of rectal cancer; follow-up. COMPARISON: Multiple prior CTs of the abdomen pelvis, most recent 8/5/2020 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 260 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. IV contrast injection rate: 3 ml per sec. Scan delay: 80 sec. Scan field of view: 380 mm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis CT chest findings are reported separately. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: Large gallstones with otherwise normal appearance of the gallbladder. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Slight interval enlargement of a left adrenal lesion which currently measures 3.6 x 2.6 cm on axial series 302, image 97 (previously 3.5 x 2.4 cm). Right adrenal gland is normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Post surgical changes associated with ileostomy reversal. COLON / APPENDIX: Stable postsurgical changes associated with prior LAR. No evidence of local recurrence. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is surgically absent. BODY WALL: Small focal bulge in the lower right anterior abdominal wall, likely at a site of prior ostomy. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Interval ileostomy reversal with stable post surgical changes associated with prior low anterior resection. No evidence of local recurrence or metastatic disease elsewhere in the abdomen or pelvis. 2. Stable left adrenal adenoma. 3. Cholelithiasis without evidence of acute cholecystitis.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis CT chest findings are reported separately. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: Large gallstones with otherwise normal appearance of the gallbladder. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Slight interval enlargement of a left adrenal lesion which currently measures 3.6 x 2.6 cm on axial series 302, image 97 (previously 3.5 x 2.4 cm). Right adrenal gland is normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Post surgical changes associated with ileostomy reversal. COLON / APPENDIX: Stable postsurgical changes associated with prior LAR. No evidence of local recurrence. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is surgically absent. BODY WALL: Small focal bulge in the lower right anterior abdominal wall, likely at a site of prior ostomy. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: 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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2,670 |
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: History of stage IV rectal cancer, concern for SBO with intractable nausea/vomiting. COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 186 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 86 sec Scan field of view: 454 mm. DLP: 746.10 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately reported chest CT. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. No concerning hepatic lesion or mass. BILIARY TRACT: Stable mild intra and extrahepatic biliary ductal dilation. No radiopaque obstructing biliary calculus visualized. GALLBLADDER: No abnormality. PANCREAS: Diffuse fatty atrophy. SPLEEN: Normal. ADRENALS: There is a new hypoenhancing nodule involving the left adrenal gland that measures approximately 1.9 x 1.7 cm (series 201, image 215). The right adrenal gland is unremarkable. KIDNEYS: There is a radiopaque calculus measuring approximately 5 mm seen near the right ureteropelvic junction with mildly increased prominence of the right renal pelvis. There are scattered bilateral subcentimeter hypoattenuating lesions, likely simple renal cysts. LYMPH NODES: Multiple reactive appearing pelvic lymph nodes. STOMACH / SMALL BOWEL / LARGE BOWEL: Postsurgical changes related to partial distal colectomy. Left lower quadrant colostomy is again seen with resolution of gaseous distention of upstream small bowel loops. The suture lines are unremarkable without evidence of local recurrence. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Worsening presacral fluid and gas accumulation, now with a discrete presacral fluid and gas collection with an enhancing rim, concerning for developing abscess. This area measures approximately 4.7 x 2.9 cm (series 201 image 429). VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is surgically absent. No adnexal masses visualized. BODY WALL: Mild stranding surrounding the left lower quadrant ostomy site. Small fat-containing umbilical hernia. No acute abnormality. MUSCULOSKELETAL: No acute or aggressive osseous abnormality. Mild to moderate degenerative changes involving the bilateral hip joints, sacroiliac joints, and lumbar spine. CONCLUSION: 1. There is a new hypoenhancing left adrenal gland nodule, concerning for new metastatic disease. 2. Approximately 5mm calculus near the right ureterovesicular junction with mildly increased prominence of the right renal pelvis raising concern for element of obstruction. 3. Well-circumscribed presacral fluid and gas collection, consistent with abscess. 4. Otherwise, stable postsurgical changes related to partial colectomy and colostomy with interval resolution of small bowel distention. 5. Other 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.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately reported chest CT. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. No concerning hepatic lesion or mass. BILIARY TRACT: Stable mild intra and extrahepatic biliary ductal dilation. No radiopaque obstructing biliary calculus visualized. GALLBLADDER: No abnormality. PANCREAS: Diffuse fatty atrophy. SPLEEN: Normal. ADRENALS: There is a new hypoenhancing nodule involving the left adrenal gland that measures approximately 1.9 x 1.7 cm (series 201, image 215). The right adrenal gland is unremarkable. KIDNEYS: There is a radiopaque calculus measuring approximately 5 mm seen near the right ureteropelvic junction with mildly increased prominence of the right renal pelvis. There are scattered bilateral subcentimeter hypoattenuating lesions, likely simple renal cysts. LYMPH NODES: Multiple reactive appearing pelvic lymph nodes. STOMACH / SMALL BOWEL / LARGE BOWEL: Postsurgical changes related to partial distal colectomy. Left lower quadrant colostomy is again seen with resolution of gaseous distention of upstream small bowel loops. The suture lines are unremarkable without evidence of local recurrence. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Worsening presacral fluid and gas accumulation, now with a discrete presacral fluid and gas collection with an enhancing rim, concerning for developing abscess. This area measures approximately 4.7 x 2.9 cm (series 201 image 429). VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is surgically absent. No adnexal masses visualized. BODY WALL: Mild stranding surrounding the left lower quadrant ostomy site. Small fat-containing umbilical hernia. No acute abnormality. MUSCULOSKELETAL: No acute or aggressive osseous abnormality. Mild to moderate degenerative changes involving the bilateral hip joints, sacroiliac joints, and lumbar spine.
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FINDINGS: 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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2,671 |
CT Chest with contrast Clinical Information: 54-year-old female intractable NV Spec Inst: hx of stage 4 rectal ca sp palliative APR, hx of SBO concern for obstruction Comparison: None Technique: Following injection of non-ionic contrast 2.5 mm images were obtained through the chest. Abdominal findings will be reported separately. Patient weight: 186 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 2.80 ml per sec. Scan delay: 86 sec Scan field of view: 454 mm. Findings: Enlarged lower right paraesophageal node measures 15 x 39 mm on series 201 image 118. Enlarged right hilar node is 19 mm in short axis on image 122. No additional enlarged intrathoracic nodes are present. Small hiatal hernia is present. The heart size and mediastinum are otherwise normal. No pleural effusion. Multiple bilateral pulmonary nodules of varying sizes are present. For example RUL nodule measures 18 x 20 mm on image 97. RLL nodule measures 18 x 25 mm on image 178 and LUL nodule is 20 x 20 mm on image 94. The airways are patent. No focal destructive osseous lesions identified. CT abdomen and pelvis will be reported separately. Impression: Multiple noncalcified bilateral pulmonary nodules consistent with metastatic disease. Enlarged right hilar and lower right paraesophageal nodes are also consistent with metastasis.
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Findings: Enlarged lower right paraesophageal node measures 15 x 39 mm on series 201 image 118. Enlarged right hilar node is 19 mm in short axis on image 122. No additional enlarged intrathoracic nodes are present. Small hiatal hernia is present. The heart size and mediastinum are otherwise normal. No pleural effusion. Multiple bilateral pulmonary nodules of varying sizes are present. For example RUL nodule measures 18 x 20 mm on image 97. RLL nodule measures 18 x 25 mm on image 178 and LUL nodule is 20 x 20 mm on image 94. The airways are patent. No focal destructive osseous lesions identified. CT abdomen and pelvis will be reported separately.
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FINDINGS: 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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2,672 |
EXAM: CT Chest wo contrast CLINICAL INFORMATION: Upper respiratory infection COMPARISON: Chest radiograph 1/5/2022 TECHNIQUE: CT Chest wo contrast. Scan field of view: 315 mm. DLP: 146.60 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Small right and trace left pleural effusions with adjacent atelectasis. Diffuse bilateral groundglass opacities and septal thickening with scattered areas of dense airspace opacities, most prominent in the right upper lobe and middle lobe. HEART / VESSELS: Normal heart size. Small pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Mildly prominent mediastinal lymph nodes, for example a precarinal lymph node measuring up to 1.0 cm, likely reactive. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Small right and trace left pleural effusions, diffuse groundglass opacities and scattered areas of septal thickening bilaterally, likely represent pulmonary edema versus atypical infection. The dense airspace opacities predominantly in the right upper lobe likely superimposed infection.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Small right and trace left pleural effusions with adjacent atelectasis. Diffuse bilateral groundglass opacities and septal thickening with scattered areas of dense airspace opacities, most prominent in the right upper lobe and middle lobe. HEART / VESSELS: Normal heart size. Small pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Mildly prominent mediastinal lymph nodes, for example a precarinal lymph node measuring up to 1.0 cm, likely reactive. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: 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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2,673 |
EXAM: CT Chest wo contrast CLINICAL INFORMATION: Covid confirmed, dyspnea COMPARISON: None. TECHNIQUE: CT Chest wo contrast. Scan field of view: 374 mm. DLP: 442.90 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Patchy and confluent peripheral predominant bilateral groundglass opacities. No pneumothorax or pleural effusion. Moderate upper lobe predominant emphysema. HEART / VESSELS: No pericardial effusion. Coronary atherosclerotic calcifications. MEDIASTINUM / ESOPHAGUS: Unremarkable. LYMPH NODES: Few mildly enlarged mediastinal and right hilar nodes such as right hilar node measuring 15 mm in maximal short axis on image 501, series 201 and prevascular node measuring 12 mm in short axis on image 38 of the same series. CHEST WALL: No significant abnormality. UPPER ABDOMEN: No acute abnormality. Marked hepatic steatosis. Prior cholecystectomy. MUSCULOSKELETAL: Chronic healed right rib fractures. No acute fracture or suspicious osseous lesion. Moderate thoracic dextroscoliosis. CONCLUSION: 1. Multifocal/viral pneumonia. 2. Mildly enlarged right hilar and mediastinal lymph nodes, likely reactive. 3. Moderate emphysema, severely steatotic liver, an additional chronic/incidental findings as above.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Patchy and confluent peripheral predominant bilateral groundglass opacities. No pneumothorax or pleural effusion. Moderate upper lobe predominant emphysema. HEART / VESSELS: No pericardial effusion. Coronary atherosclerotic calcifications. MEDIASTINUM / ESOPHAGUS: Unremarkable. LYMPH NODES: Few mildly enlarged mediastinal and right hilar nodes such as right hilar node measuring 15 mm in maximal short axis on image 501, series 201 and prevascular node measuring 12 mm in short axis on image 38 of the same series. CHEST WALL: No significant abnormality. UPPER ABDOMEN: No acute abnormality. Marked hepatic steatosis. Prior cholecystectomy. MUSCULOSKELETAL: Chronic healed right rib fractures. No acute fracture or suspicious osseous lesion. Moderate thoracic dextroscoliosis.
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FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Small to moderate sized left pleural effusion with compressive atelectasis. Otherwise no focal consolidation. The right pleural space is clear. No pneumothorax. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Similar appearing peripancreatic edema and perisplenic edema fluid. Minimal pneumobilia in the common bile duct. Gastric edema better characterized on recent abdominal CT MUSCULOSKELETAL: No significant abnormality.
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2,674 |
EXAM: CT Abdomen with contrast CLINICAL INFORMATION: 44-year-old female with history of renal cell carcinoma; follow-up. COMPARISON: CT abdomen pelvis 3/18/2021 TECHNIQUE: CT Abdomen with contrast. Patient weight: 147 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 3 ml per sec. Scan delay: Bolus Tracked. Scan field of view: 350 mm. DLP: 582.19 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Focal 1.0 x 0.7 cm arterially enhancing lesion seen near hepatic segment 4B on axial series 4, image 65. This lesion is inconspicuous on the venous phase. Peripheral, wedge-shaped area of enhancement seen within the hepatic dome measures 1.6 x 0.8 cm on axial series 4, image 24. Additional peripheral, wedge-shaped abnormality seen on the arterial phase in the posterior right hepatic lobe is likely perfusional. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Pancreas divisum noted. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Interval resection of the partially exophytic enhancing lesion involving the lower pole of the left kidney. No evidence of local recurrence along the resection margin. Right kidney is 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. Postsurgical changes associated with resection of the enhancing right lower pole renal neoplasm. No evidence of local recurrence. 2. Indeterminate arterially enhancing lesion near hepatic segment 4B. Although perhaps perfusional, a neoplasm cannot be definitively excluded. Recommend further evaluation with dedicated liver MR. Additional peripheral wedge-shaped areas of arterial enhancement are likely perfusional.
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FINDINGS: STRUCTURED REPORT: CT Abdomen LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Focal 1.0 x 0.7 cm arterially enhancing lesion seen near hepatic segment 4B on axial series 4, image 65. This lesion is inconspicuous on the venous phase. Peripheral, wedge-shaped area of enhancement seen within the hepatic dome measures 1.6 x 0.8 cm on axial series 4, image 24. Additional peripheral, wedge-shaped abnormality seen on the arterial phase in the posterior right hepatic lobe is likely perfusional. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Pancreas divisum noted. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Interval resection of the partially exophytic enhancing lesion involving the lower pole of the left kidney. No evidence of local recurrence along the resection margin. Right kidney is normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: BONES/JOINTS: There is decreased bone mineralization. There is a comminuted tibial plateau fracture with depression of the lateral tibial plateau. Nondisplaced fracture plane extends into the anterior medial tibial plateau. There is a transverse, minimally displaced and slightly impacted fracture of the fibular neck. In addition, there is a chronic appearing nondisplaced transverse fracture of the distal tibial metaphysis and a chronic appearing oblique fracture of the medial malleolus. Redemonstration of a chronic healed patellar fracture with fixation hardware in place. There are mild tricompartmental degenerative changes most pronounced in the medial tibiofemoral compartment. SOFT TISSUES: Suprapatellar lipohemarthrosis. Circumferential subcutaneous edema of the right lower extremity. Fatty atrophy of the tibialis anterior and soleus muscles. Diffuse vascular calcifications.
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2,675 |
CT Head wo contrast 1/6/2022 12:20 PM Clinical Information: AMS Comparison: Head CT 1/5/2022 Technique: Unenhanced axial brain CT with coronal and sagittal reconstructions. Scan field of view: 226 mm. DLP: 941 mGy cm. Findings: There is a stable right frontal approach ventricular shunt catheter terminating in the region of the right lateral ventricle. There has been further decompression of the right lateral ventricle which is now completely decompressed. The left lateral ventricle is essentially stable in size. The multifocal evolving parenchymal hemorrhages, the most significant residual in the left frontal lobe are otherwise unchanged with associated edema. The ventricular configuration is otherwise stable with a dilated left temporal horn. Impression: 1. Further interval decrease in right lateral ventricular size with otherwise stable right frontal approach ventricular catheter. Unchanged left temporal horn dilatation. 2. Evolving parenchymal hemorrhages with was significant residual in the left frontal lobe.
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Findings: There is a stable right frontal approach ventricular shunt catheter terminating in the region of the right lateral ventricle. There has been further decompression of the right lateral ventricle which is now completely decompressed. The left lateral ventricle is essentially stable in size. The multifocal evolving parenchymal hemorrhages, the most significant residual in the left frontal lobe are otherwise unchanged with associated edema. The ventricular configuration is otherwise stable with a dilated left temporal horn.
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FINDINGS: STRUCTURED REPORT: CT Chest PE and Abdomen Pelvis OVERALL DIAGNOSTIC QUALITY: Mildly suboptimal quality with incomplete evaluation of subsegmental pulmonary arteries. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Extensive consolidative opacities involving the right lower lobe, right middle lobe, and left lower lobe with occasional additional groundglass opacity in the upper lobes as well as peripheral nodularity in the left lower lobe. Noncalcified subpleural inferior left upper lobe nodule measuring 4 mm (series 501 image 75), previously 5 mm. Minimal opacification of left lower lobe subsegmental bronchi. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Scattered prominent mediastinal nodes, for example, a precarinal node measuring 0.9 cm (series 501 image 54), likely reactive. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Diffuse steatosis. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: No focal lesion, ductal dilation, or parenchymal atrophy. Minimal hypodensity at the uncinate process (series 601, image 99). SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Fluid is present extending to the rectum within the colon. Normal appendix. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: Mild calcified atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is absent. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Degenerative spine changes with L3-4 grade 1 anterolisthesis and trace L2-3 and L5-S1 retrolisthesis. S-shaped thoracolumbar curvature. No aggressive osseous lesion. Osteophytosis of the subarticular collapse.
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2,676 |
EXAM: CT Sinus wo contrast CLINICAL INFORMATION: Female patient 37 years with facial pain, pressure, J32.9 Chronic sinusitis, unspecified Spec Inst: Stealth protocol TECHNIQUE: 0.6 mm thick serial axial images were obtained through the paranasal sinuses without intravenous contrast. Sagittal and coronal reformatted views were also obtained. Technique: Scan field of view: 180 mm. DLP: 1266.93 mGy cm. COMPARISON: Head CT dated 1/20/2019 FINDINGS: The frontal sinuses, ethmoid air cells and sphenoid sinuses are clear. The right maxillary sinus is also clear. There is moderate mucosal thickening within the left maxillary sinus. There is periapical lucency about left maxillary molar with dehiscence along the floor of the left maxillary sinus (sagittal image 220). The walls of the paranasal sinuses are intact.. Right ostiomeatal complex is patent. There is occlusion of the left ostiomeatal complex secondary to inflammatory changes. The frontal sinuses outflow tracts are patent bilaterally. Nasal septum is essentially in the midline. No mass lesion is identified within the nasal cavity. Orbits appear unremarkable. Mastoid air cells are clear. CONCLUSION: Significant mucosal thickening involving the left maxillary sinus has developed since head CT dated 1/20/2019. There is significant lucency about the roots of left first maxillary molar representing periapical abscess resulting in dehiscence extending to the floor of the left maxillary sinus suggesting odontogenic sinusitis
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FINDINGS: The frontal sinuses, ethmoid air cells and sphenoid sinuses are clear. The right maxillary sinus is also clear. There is moderate mucosal thickening within the left maxillary sinus. There is periapical lucency about left maxillary molar with dehiscence along the floor of the left maxillary sinus (sagittal image 220). The walls of the paranasal sinuses are intact.. Right ostiomeatal complex is patent. There is occlusion of the left ostiomeatal complex secondary to inflammatory changes. The frontal sinuses outflow tracts are patent bilaterally. Nasal septum is essentially in the midline. No mass lesion is identified within the nasal cavity. Orbits appear unremarkable. Mastoid air cells are clear.
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FINDINGS: STRUCTURED REPORT: CT Chest PE and Abdomen Pelvis OVERALL DIAGNOSTIC QUALITY: Mildly suboptimal quality with incomplete evaluation of subsegmental pulmonary arteries. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Extensive consolidative opacities involving the right lower lobe, right middle lobe, and left lower lobe with occasional additional groundglass opacity in the upper lobes as well as peripheral nodularity in the left lower lobe. Noncalcified subpleural inferior left upper lobe nodule measuring 4 mm (series 501 image 75), previously 5 mm. Minimal opacification of left lower lobe subsegmental bronchi. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Scattered prominent mediastinal nodes, for example, a precarinal node measuring 0.9 cm (series 501 image 54), likely reactive. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Diffuse steatosis. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: No focal lesion, ductal dilation, or parenchymal atrophy. Minimal hypodensity at the uncinate process (series 601, image 99). SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Fluid is present extending to the rectum within the colon. Normal appendix. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: Mild calcified atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is absent. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Degenerative spine changes with L3-4 grade 1 anterolisthesis and trace L2-3 and L5-S1 retrolisthesis. S-shaped thoracolumbar curvature. No aggressive osseous lesion. Osteophytosis of the subarticular collapse.
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EXAM: CT Sinus wo contrast CLINICAL INFORMATION: Male patient 71 years with large osteoma, D16.9 Benign neoplasm of bone and articular cartilage, unspecified, J32.1 Chronic frontal sinusitis Spec Inst: sinus stealth protocol TECHNIQUE: 0.6 mm thick serial axial images were obtained through the paranasal sinuses without intravenous contrast. Sagittal and coronal reformatted views were also obtained. Technique: Scan field of view: 254 mm. DLP: 1071 mGy cm. COMPARISON: 6/2/2021 FINDINGS: There is a small air-fluid level within the right frontal sinus superimposed on circumferential mucosal thickening. There is also progressive mucosal thickening within the right ethmoid air cells. There is a large osteoma within the right frontoethmoidal recess which appears stable in size measuring 16 x 13 mm, previously measured approximately 15 x 12 mm. There is also new mucosal thickening within the left frontal sinus and extending into the left frontoethmoidal recess and anterior left ethmoid air cells. There is mild mucosal thickening within the right sphenoid sinus which is stable. There is worsening mild mucosal thickening within the left sphenoid sinus. There is stable mild mucosal thickening within the left and right maxillary sinuses. No additional air-fluid levels are identified. Right frontal sinus outflow tract is occluded secondary to combination of large osteoma and mucosal thickening. The left frontal sinus outflow tract is also occluded secondary to inflammatory changes. The left ostiomeatal complex is patent. The right ostiomeatal complex is occluded secondary to inflammatory changes. There is mild rightward deviation of the anterior nasal septum and a bony spur projecting to the left. No mass lesion is identified within the nasal cavity. Walls of the paranasal sinuses are intact. There is no acute abnormality of the orbits. Mastoid air cells are clear. There is moderate generalized atrophy and mild microangiopathic changes within the periventricular white matter bilaterally. Note is made of multiple caries CONCLUSION: 01. Anterior ethmoid air cells osteoma. There is near complete occlusion of the right frontal outflow tract and new acute right frontal sinusitis. 02. Mild worsening of inflammatory changes within the left frontal sinus and also within the left sphenoid sinus 03. Caries within multiple maxillary and mandibular teeth
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FINDINGS: There is a small air-fluid level within the right frontal sinus superimposed on circumferential mucosal thickening. There is also progressive mucosal thickening within the right ethmoid air cells. There is a large osteoma within the right frontoethmoidal recess which appears stable in size measuring 16 x 13 mm, previously measured approximately 15 x 12 mm. There is also new mucosal thickening within the left frontal sinus and extending into the left frontoethmoidal recess and anterior left ethmoid air cells. There is mild mucosal thickening within the right sphenoid sinus which is stable. There is worsening mild mucosal thickening within the left sphenoid sinus. There is stable mild mucosal thickening within the left and right maxillary sinuses. No additional air-fluid levels are identified. Right frontal sinus outflow tract is occluded secondary to combination of large osteoma and mucosal thickening. The left frontal sinus outflow tract is also occluded secondary to inflammatory changes. The left ostiomeatal complex is patent. The right ostiomeatal complex is occluded secondary to inflammatory changes. There is mild rightward deviation of the anterior nasal septum and a bony spur projecting to the left. No mass lesion is identified within the nasal cavity. Walls of the paranasal sinuses are intact. There is no acute abnormality of the orbits. Mastoid air cells are clear. There is moderate generalized atrophy and mild microangiopathic changes within the periventricular white matter bilaterally. Note is made of multiple caries
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Bibasilar subsegmental atelectasis. Suspected trace right pleural effusion. DISTAL ESOPHAGUS: Esophagogastric tube is in place. HEART / VESSELS: Distal portion of a central venous catheter tip is present at the cavoatrial junction. ABDOMEN and PELVIS: LIVER: Subcentimeter focus of hypoattenuation in the medial segment left hepatic lobe is statistically a cyst. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Innumerable renal cysts of varying degrees of complexity. Indeterminate small high attenuation lesions are again seen, right kidney on image 193 and 109 series 2, and left lateral on image 162 series 2, among others. Biliary LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube is in place with the side port at the gastroesophageal junction. Diffuse severe dilation of the mid and distal small bowel with a suspected transition point in the left hemiabdomen best appreciated on image 207 series 2 and image 50 series 80316. Multiple other loops of more distal small bowel are collapsed. COLON / APPENDIX: Small amount of gas throughout the colon. Normal appendix. Rectal tube is in place. PERITONEUM / MESENTERY: Increasing ascites including ascites between loops of dilated bowel in the left hemiabdomen. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Foley catheter is in place. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Fat-containing umbilical hernia. MUSCULOSKELETAL: No destructive osseous lesions seen.
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EXAM: CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: 72-year-old man with right groin bulge thought to represent hernia. COMPARISON: 12/11/2021 TECHNIQUE: CT Abdomen and Pelvis wo IV contrast. Scan field of view: 419 mm. DLP: 542 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. The patient received oral contrast. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Minimal bilateral basilar scarring. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Focal calcification within the epicardial fat adjacent to the right atrium anteriorly is nonspecific. ABDOMEN and PELVIS: LIVER: Few scattered cysts appear unchanged, no new abnormalities for unenhanced technique. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: No abnormality for unenhanced technique. SPLEEN: Scattered granulomata appear unchanged. No new abnormalities for unenhanced technique.. ADRENALS: Normal. KIDNEYS: The native kidneys are small and atrophic. The right renal fossa allograft is surrounded by a moderate fluid collection along its anterolateral margin (see below). A second focal fluid collection is adjacent to the transplant upper pole and contains a small nidus of high attenuation, possibly clotted blood (image 109 series 3). The previously noted soft tissue foci of gas surrounding the renal transplant, the right lower quadrant surgical drain, and the transplant double-J ureteral stent have resolved/been removed in the interval. There is no hydronephrosis. Focal low-attenuation in the transplant upper pole likely represents a cyst but is incompletely evaluated without intravenous contrast. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality aside from scattered sigmoid diverticula without evidence of inflammation. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: There is a homogeneous low-attenuation peritransplant fluid collection which measures 8 x 4.5 cm in greatest transaxial dimensions (image 124 series 3) but extends approximately 17 cm along the right anterolateral abdominal wall in the craniocaudal span (image 68 series 4) before entering the inguinal canal and expanding the right aspect of the upper scrotum. On the perioperative CT from 12/11/2021, a small amount of fluid and air was seen tracking into the right hemiscrotum, within expectation for recent operation, and without expansion of the inguinal canal as is presently noted though the hernia was present on the previous scan. VESSELS: An IVC filter is in place with the superior tip located at the L2 superior endplate level. The abdominal aorta is normal in caliber and contains scattered calcified atherosclerotic plaque. URINARY BLADDER: No abnormalities for unenhanced technique the the attenuation appears slightly increased suggesting proteinaceous or hemorrhagic components. REPRODUCTIVE ORGANS: The prostate is mildly enlarged. BODY WALL: The right inguinal hernia contains fluid extending from the peritransplant extraperitoneal space and entering the upper scrotum. The length of this collection is approximately 10 cm in craniocaudal span. The fat-containing umbilical hernia is unchanged. A very small amount of fluid is seen tracking along the course of the right lower quadrant incision. There is no gas within the collection. MUSCULOSKELETAL: Bilateral hip, sacroiliac, and diffuse lumbar degenerative change. No aggressive osseous lesions. CONCLUSION: 1. The bulge in the right groin region is secondary to fluid extending from the peritransplant extraperitoneal space in the right lower abdomen into the scrotum. The abdominal portion of the collection measures approximately 17 cm in length and the portion of the collection extending into the upper scrotum measures at least 10 cm in length. There is no complexity within this collection which more likely represents a seroma or evolving hematoma than lymphocele. 2. A second fluid collection is seen around the upper pole of the right iliac fossa allograft. Focal high attenuation this collection suggests clotted blood and evolving hematoma. 3. Other incidental findings as above, stable.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. The patient received oral contrast. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Minimal bilateral basilar scarring. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Focal calcification within the epicardial fat adjacent to the right atrium anteriorly is nonspecific. ABDOMEN and PELVIS: LIVER: Few scattered cysts appear unchanged, no new abnormalities for unenhanced technique. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: No abnormality for unenhanced technique. SPLEEN: Scattered granulomata appear unchanged. No new abnormalities for unenhanced technique.. ADRENALS: Normal. KIDNEYS: The native kidneys are small and atrophic. The right renal fossa allograft is surrounded by a moderate fluid collection along its anterolateral margin (see below). A second focal fluid collection is adjacent to the transplant upper pole and contains a small nidus of high attenuation, possibly clotted blood (image 109 series 3). The previously noted soft tissue foci of gas surrounding the renal transplant, the right lower quadrant surgical drain, and the transplant double-J ureteral stent have resolved/been removed in the interval. There is no hydronephrosis. Focal low-attenuation in the transplant upper pole likely represents a cyst but is incompletely evaluated without intravenous contrast. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality aside from scattered sigmoid diverticula without evidence of inflammation. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: There is a homogeneous low-attenuation peritransplant fluid collection which measures 8 x 4.5 cm in greatest transaxial dimensions (image 124 series 3) but extends approximately 17 cm along the right anterolateral abdominal wall in the craniocaudal span (image 68 series 4) before entering the inguinal canal and expanding the right aspect of the upper scrotum. On the perioperative CT from 12/11/2021, a small amount of fluid and air was seen tracking into the right hemiscrotum, within expectation for recent operation, and without expansion of the inguinal canal as is presently noted though the hernia was present on the previous scan. VESSELS: An IVC filter is in place with the superior tip located at the L2 superior endplate level. The abdominal aorta is normal in caliber and contains scattered calcified atherosclerotic plaque. URINARY BLADDER: No abnormalities for unenhanced technique the the attenuation appears slightly increased suggesting proteinaceous or hemorrhagic components. REPRODUCTIVE ORGANS: The prostate is mildly enlarged. BODY WALL: The right inguinal hernia contains fluid extending from the peritransplant extraperitoneal space and entering the upper scrotum. The length of this collection is approximately 10 cm in craniocaudal span. The fat-containing umbilical hernia is unchanged. A very small amount of fluid is seen tracking along the course of the right lower quadrant incision. There is no gas within the collection. MUSCULOSKELETAL: Bilateral hip, sacroiliac, and diffuse lumbar degenerative change. No aggressive osseous lesions.
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FINDINGS: RIGHT: The external auditory canal is normal. The tympanic membrane is intact. The right middle ear cavity is clear. The inner ear ossicles are normal. There is no scutal or ossicular erosion. There is normal development of the cochlea, vestibule, and semicircular canals. The otic capsule is normally mineralized. The vestibular and cochlear aqueducts are not enlarged. There are no variations in vascular or facial nerve anatomy. The internal auditory canal is normal in size and configuration. The mastoid air cells are well-developed and aerated. LEFT: The external auditory canal is normal. Postsurgical changes is noted status post left-sided mastoidectomy. Residual densities noted in the resection location which can be postsurgical changes and fibrosis. The tympanic membrane is thick and retracted. Overall there is interval improvement of aeration of the left middle ear cavity however there is persistent opacification in the left middle ear cavity mainly at the epitympanum and a part of the mesotympanum with partial encasement of the ossicles. No obvious erosion of the ossicles is seen. There is minimal erosion of the left scutum. There is normal development of the cochlea, vestibule, and semicircular canals. The otic capsule is normally mineralized. The vestibular and cochlear aqueducts are not enlarged. There are no variations in vascular or facial nerve anatomy. The internal auditory canal is normal in size and configuration. There is partial opacification of the residual left-sided mastoidal air cells. There are persistent foci of retained metallic fragments and osseous fragments in the subcutaneous of the left periauricular region secondary to previous gunshot wound. There is soft tissue stranding in the left posterior auricular region with a 7 mm focus of hypodensity in favor of a small fluid collection. There is mild mucosal thickening involving the ethmoidal and maxillary sinuses. Mucosal thickening of the sphenoidal air cell is noted with partial opacification of the right sphenoidal sinus. There are multiple dental infections. The dental infection involving the right maxillary molar tooth is associated with periapical cyst and erosion toward the right maxillary sinus. The right maxillary sinusitis appears to be odontogenic in origin. There is moderate left-sided nasal septal deviation.
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2,679 |
EXAM: CT Chest wo contrast CLINICAL INFORMATION: 79-year-old female, currently undergoing chemotherapy for squamous cell carcinoma of the lung and presenting with respiratory distress. COMPARISON: None. TECHNIQUE: CT Chest wo contrast. Scan field of view: 350 mm. DLP: 337.30 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest Evaluation is degraded by motion artifact. LOWER NECK: No significant abnormality. CHEST: LUNGS / AIRWAYS / PLEURA: Patchy consolidation in the right upper lobe with associated groundglass and interlobular septal thickening, likely represents the site of known malignancy and adjacent lymphangitic spread of tumor. Nodular opacity along the right major fissure in the right middle lobe, is indeterminate, but possibly represents atelectasis. Additional areas of segmental right middle lobe atelectasis noted. A spiculated nodule in the right lower lobe measuring approximately 8 mm (series 2, image 55). Left lingular atelectasis. Small right pleural effusion. Trace left pleural effusion. No pneumothorax. HEART / VESSELS: Cardiomegaly. Small pericardial effusion. Without contrast, is difficult to separate the pericardial fluid from the mediastinal lymph nodes, and local invasion/involvement of the pericardium cannot be excluded. Atherosclerotic calcifications of the coronary arteries and thoracic aorta. Central venous port catheter tip terminates in the lower SVC. MEDIASTINUM / ESOPHAGUS: Lymphadenopathy. LYMPH NODES: Bulky mediastinal, pericardiophrenic paratracheal, and subcarinal lymph nodes. Noncontrast technique makes it difficult to separate out the hilar vasculature from possible enlarged hilar lymph nodes/hilar soft tissue. CHEST WALL: Right chest port in place. No significant abnormality. UPPER ABDOMEN: A 1.1 cm hypoattenuating lesion in the liver. MUSCULOSKELETAL: Multilevel chronic degenerative changes of the thoracic spine. Partially visualized cervical ACDF changes. CONCLUSION: 1. Irregular mixed consolidative and groundglass opacities in the right upper lobe with interlobular septal thickening, likely reflecting the known malignancy with lymphangitic spread of tumor, although evaluation is limited with lack of intravenous contrast, recommend correlation with prior imaging if available. Numerous enlarged mediastinal lymph nodes, compatible with nodal metastases. 2. Worsening radiographic findings are felt to represent worsening volume overload and atelectatic changes, especially given their rapid development, although superimposed infection is challenging to exclude without intravenous contrast. 3. Right middle lobe subsegmental atelectasis with nodular opacity along the fissure possibly represents atelectasis, however satellite nodule/mass cannot definitively be excluded. Again correlation with prior imaging would be helpful. Additional scattered areas of suspected atelectasis, as discussed 4. Spiculated nodule in the right lower lobe is suspicious for metastasis. Recommend attention on follow-up exam versus correlation with prior imaging. 5. Cardiomegaly with signs of volume overload including small pericardial effusion and right greater than left pleural effusions. 6. Indeterminate hypoattenuating liver lesion. If it would change clinical management, this could be further evaluated with outpatient contrast-enhanced MRI of abdomen 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.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest Evaluation is degraded by motion artifact. LOWER NECK: No significant abnormality. CHEST: LUNGS / AIRWAYS / PLEURA: Patchy consolidation in the right upper lobe with associated groundglass and interlobular septal thickening, likely represents the site of known malignancy and adjacent lymphangitic spread of tumor. Nodular opacity along the right major fissure in the right middle lobe, is indeterminate, but possibly represents atelectasis. Additional areas of segmental right middle lobe atelectasis noted. A spiculated nodule in the right lower lobe measuring approximately 8 mm (series 2, image 55). Left lingular atelectasis. Small right pleural effusion. Trace left pleural effusion. No pneumothorax. HEART / VESSELS: Cardiomegaly. Small pericardial effusion. Without contrast, is difficult to separate the pericardial fluid from the mediastinal lymph nodes, and local invasion/involvement of the pericardium cannot be excluded. Atherosclerotic calcifications of the coronary arteries and thoracic aorta. Central venous port catheter tip terminates in the lower SVC. MEDIASTINUM / ESOPHAGUS: Lymphadenopathy. LYMPH NODES: Bulky mediastinal, pericardiophrenic paratracheal, and subcarinal lymph nodes. Noncontrast technique makes it difficult to separate out the hilar vasculature from possible enlarged hilar lymph nodes/hilar soft tissue. CHEST WALL: Right chest port in place. No significant abnormality. UPPER ABDOMEN: A 1.1 cm hypoattenuating lesion in the liver. MUSCULOSKELETAL: Multilevel chronic degenerative changes of the thoracic spine. Partially visualized cervical ACDF changes.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. CHEST WALL: Bilateral breast implants. ABDOMEN and PELVIS: Evaluation of the upper abdomen is somewhat limited due to metal artifact from spinal hardware. LIVER: Steatosis. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal enhancement of the parenchyma with extensive stranding about the pancreatic head and uncinate process. Nonorganized peripancreatic fluid tracks caudally in the retroperitoneum to the level of the aortic bifurcation. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach is incompletely distended, but otherwise unremarkable in appearance. There is mild thickening of the duodenal wall with surrounding stranding and fluid. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: As above. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Absent uterus. Right adnexal cysts/follicles. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Posterior fusion hardware spans L3-L5.
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2,680 |
CT Chest with contrast Clinical Information: 66-year-old male Fracture, sternum ; Lung mediastinal abscess, A49.02 Methicillin resistant Staphylococcus aureus infection, unspecified site Comparison: 4/23/2021 Technique: Following injection of non-ionic contrast 2.5 mm images were obtained through the chest and upper abdomen.. Patient weight: 248 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 35 sec. Scan field of view: 460 mm. DLP: 338.60 mGy cm. Findings: Interval healing of the medial cortices of the remnant manubrium and upper sternal body. The small drains within the sternal defect with anterior chest wall have been removed. Granulation tissue/scar is seen just anterior and within the sternal defect and this has increased in size since the prior now measuring 43 x 91 mm on series 2 image 54. Retrosternal granulation tissue has decreased. Small fluid collection is seen in the anterior mediastinal fat on series 2 image 69... Enlarged subcarinal nodes are seen with the node on image 47 measuring 15 mm in short axis increased from the previous exam. No additional enlarged intrathoracic nodes are present. Small moderate hiatal hernia is seen. Calcific atherosclerosis is present in the aorta and the native coronary arteries. Post CABG findings are redemonstrated. The heart size and mediastinum are otherwise normal. The lungs are normal without suspicious nodules or masses. Tiny right fissural nodule is noted on series 2 image 50. The previously loculated right pleural effusion has resolved. No pleural effusion currently identified.. Sternal findings as above. No new focal destructive osseous lesions identified. Small cysts in the left hepatic lobe are redemonstrated. A 45 mm cyst in the medial left hepatic lobe just above the gallbladder is similar to the exam on 4/8/2021. Cyst in the upper right renal pole is partially seen. Limited images of the upper abdomen are otherwise unremarkable. Impression: 1. Interval healing of the medial cortices on both sides of the sternal defect. No findings to suggest osteomyelitis. 2. Interval increase in size of area of granulation tissue anteriorly within the sternal defect. Decreasing granulation tissue posterior to the sternal defect with a small area of complex fluid in the anterior mediastinal fat. 3. Interval resolution of loculated right pleural effusion and adjacent atelectasis. No new or acute pulmonary disease. 4. Enlarged subcarinal nodes.
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Findings: Interval healing of the medial cortices of the remnant manubrium and upper sternal body. The small drains within the sternal defect with anterior chest wall have been removed. Granulation tissue/scar is seen just anterior and within the sternal defect and this has increased in size since the prior now measuring 43 x 91 mm on series 2 image 54. Retrosternal granulation tissue has decreased. Small fluid collection is seen in the anterior mediastinal fat on series 2 image 69... Enlarged subcarinal nodes are seen with the node on image 47 measuring 15 mm in short axis increased from the previous exam. No additional enlarged intrathoracic nodes are present. Small moderate hiatal hernia is seen. Calcific atherosclerosis is present in the aorta and the native coronary arteries. Post CABG findings are redemonstrated. The heart size and mediastinum are otherwise normal. The lungs are normal without suspicious nodules or masses. Tiny right fissural nodule is noted on series 2 image 50. The previously loculated right pleural effusion has resolved. No pleural effusion currently identified.. Sternal findings as above. No new focal destructive osseous lesions identified. Small cysts in the left hepatic lobe are redemonstrated. A 45 mm cyst in the medial left hepatic lobe just above the gallbladder is similar to the exam on 4/8/2021. Cyst in the upper right renal pole is partially seen. Limited images of the upper abdomen are otherwise unremarkable.
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FINDINGS: STRUCTURED REPORT: CTA Abdomen Pelvis VASCULATURE: ABDOMINAL AORTA: Redemonstration of previously observed chronic thoracoabdominal aortic dissection. There is continued filling of the false lumen in the region of the upper abdomen, similar to the prior examination. Diameter of the abdominal aorta at the level of the celiac axis measures 5.3 x 4.6 cm (series 2 image 234), similar to the prior examination. The more distal false lumen is chronically occluded, unchanged. CELIAC AXIS: Patent and arises from the true lumen. SMA: Patent and arises from the true lumen. RIGHT RENAL: Patent. Dissection flap extends into the origin of the right renal artery, unchanged. LEFT RENAL: Occluded just distal to the origin, unchanged. IMA: Patent and arises from the true lumen. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: Moderate atherosclerotic disease. No dissection. Borderline ectatic measuring 1.7 cm (series 2, image 358). Advanced atherosclerosis of the visualized proximal superficial femoral artery with severe stenosis, similar to prior, which is patent distally. LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: Moderate atherosclerotic disease. No dissection or aneurysm. Advanced atherosclerotic disease of the visualized proximal superficial femoral artery with severe stenosis, similar to prior, which is patent distally. ------------------------------------------------------------- LOWER CHEST: Chest findings to be dictated separately; please see separate chest CT report same day. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: The left kidney is absent. Multiple small cysts are observed in the right kidney, similar to the prior examination. A hyperdense exophytic cyst in the interpolar right kidney has decreased in size compared to the prior exam, consistent with a hemorrhagic cyst. There is no hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Colonic diverticulosis without evidence of diverticulitis. Otherwise, the colon, including the appendix, is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: Filter is again observed in the infrarenal IVC. URINARY BLADDER: Decompressed, somewhat limiting evaluation. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Fluid and gas containing collection within the subcutaneous fat overlying the right gluteal musculature which measures 2.6 x 2.2 cm (series 4, image 357), new compared to prior examination with associated subcutaneous fat stranding. No additional injection granulomas are seen within the subcutaneous fat of the left flank as well. MUSCULOSKELETAL: Diffuse findings of renal osteodystrophy. Multilevel degenerative changes, similar to the prior exam.
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EXAM: CT Chest with contrast CLINICAL INFORMATION: Outside CT chest revealed abnormal esophageal/mediastinal mass. Recent upper endoscopy one normal. Follow-up study to define abnormality. COMPARISON: 2/25/2011 TECHNIQUE: CT Chest with contrast. Patient weight: 120 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 2.60 ml per sec. Scan delay: 70 sec Scan field of view: 382 mm. DLP: 345 mGy cm. FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Nodule near the right lung base measuring about 2.0 x 1.5 cm (series 3; image 154) along the major fissure. Nodule near the left lung base measuring 1.0 x 1.0 cm (series 3; image 189). A few other less than 1 cm nodules are seen bilaterally. HEART / VESSELS: Trace pericardial effusion. MEDIASTINUM / ESOPHAGUS: Mild thickening of the lower esophagus with adjacent enlarged lymph node. LYMPH NODES: Several enlarged mediastinal lymph nodes with index abnormalities as follows: A pretracheal lymph node measures about 1.7 x 3.6 cm (series 3; image 66), and anterior mediastinal/prevascular lymph node mass measures about 4.3 x 4.6 cm (image 89), and AP window lymph node measures about 2.8 x 2.0 cm (image 68). A paraesophageal mass measures about 3.2 x 2.3 cm (image 157). CHEST WALL: No significant abnormality. UPPER ABDOMEN: Please note that the concurrently obtained CT scan of the Abdomen will be dictated separately. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Enlarged mediastinal lymph nodes worrisome for malignancy. Nodules in the bilateral lower lungs are also worrisome for metastatic disease. The mediastinal lymph nodes are amenable to percutaneous CT-guided biopsy if clinically desired.
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Nodule near the right lung base measuring about 2.0 x 1.5 cm (series 3; image 154) along the major fissure. Nodule near the left lung base measuring 1.0 x 1.0 cm (series 3; image 189). A few other less than 1 cm nodules are seen bilaterally. HEART / VESSELS: Trace pericardial effusion. MEDIASTINUM / ESOPHAGUS: Mild thickening of the lower esophagus with adjacent enlarged lymph node. LYMPH NODES: Several enlarged mediastinal lymph nodes with index abnormalities as follows: A pretracheal lymph node measures about 1.7 x 3.6 cm (series 3; image 66), and anterior mediastinal/prevascular lymph node mass measures about 4.3 x 4.6 cm (image 89), and AP window lymph node measures about 2.8 x 2.0 cm (image 68). A paraesophageal mass measures about 3.2 x 2.3 cm (image 157). CHEST WALL: No significant abnormality. UPPER ABDOMEN: Please note that the concurrently obtained CT scan of the Abdomen will be dictated separately. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: Scouts: No additional findings. A - Vascular structures: Vascular: Redemonstration of thrombosed partially calcified dissection in the aneurysmally dilated descending thoracic aorta, descending into the abdomen. Mild wall thickening involving the mid distal descending thoracic aorta is unchanged. Advanced atherosclerotic calcifications and plaques involving the thoracic aorta, aortic arch sidebranches. Unchanged high-grade stenosis of the left brachiocephalic vein with tortuous an dilated main in the mid and lateral segments. Multiple collateral vessels are present in the left anterior chest wall and supraclavicular regions. Aortic measurements are as follows: Aortic root: level of the sinuses: 41 x 38 x 38 mm. Mid-ascending thoracic aorta: 38 x 34 mm. Aortic arch: 40 x 37 mm. Proximal descending thoracic aorta: 37 x 30 mm. Mid descending thoracic aorta: 43 x 29 mm. Distal descending thoracic aorta: 55 x 50 mm. Pulmonary arteries: Exam not tailored for detailed evaluation of pulmonary arteries however no large central pulmonary embolism identified. Borderline dilated main pulmonary artery measuring 32 mm in diameter. Heart and pericardium: Left atrial dilation. No pericardial effusion. Mild aortic valvular calcification. Coronary artery atherosclerotic calcification: Large amount. Postsurgical changes from prior CABG with LIMA to distal LAD, venous grafts to PDA, diagonal territories. B - Nonvascular structures: Lines and tubes: None. Lungs and pleura: Almost complete interval resolution of previously noted patchy groundglass densities and areas of consolidation in both lungs with interlobular septal thickening. Residual patchy groundglass densities persist. Areas of linear scarring/subsegmental atelectasis in both lungs, more in the lingula. No pleural effusion. No pneumothorax. Esophagus, Mediastinum and neck: Esophagus is normal. Mild retrosternal fat stranding is likely postsurgical. The thyroid gland is enlarged as before with multiple nodules bilaterally. Lymph Nodes: Unchanged few borderline enlarged mediastinal lymph nodes. One of these in the right paratracheal region measuring 30 mm in short axis. Abdomen: No upper abdominal abnormality identified. Musculoskeletal/Body Wall: No soft tissue masses. Mild diffuse anasarca. No aggressive appearing skeletal lesions. Postsurgical changes from prior median sternotomy with intact wires. Unchanged nonunion at the level of the upper most sternotomy wire. Degenerative changes in spine
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EXAM: CT Abdomen with contrast CLINICAL INFORMATION: 51-year-old female with a right lower lobe lung Mass. An multiple enlarged mediastinal lymph nodes. COMPARISON: CT 2/25/2011 TECHNIQUE: CT Abdomen with contrast. Patient weight: 120 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 2.60 ml per sec. Scan delay: 70 sec Scan field of view: 382 mm. FINDINGS: STRUCTURED REPORT: CT Abdomen ABDOMEN: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Collapsed. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Tiny benign cysts are in the right kidney. Left kidney is normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: No metastatic disease in the abdomen.
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FINDINGS: STRUCTURED REPORT: CT Abdomen ABDOMEN: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Collapsed. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Tiny benign cysts are in the right kidney. Left kidney is normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis Chest findings to be dictated separately. ABDOMEN and PELVIS: LIVER: Severe diffuse hepatic steatosis. No focal lesions. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Left ovarian physiologic cyst. No right adnexal lesions. The uterus is normal. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous lesions.
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2,683 |
EXAM: CT Lumbar Spine wo contrast CLINICAL INFORMATION: Low back pain COMPARISON: None. TECHNIQUE: CT Lumbar Spine wo contrast. Scan field of view: 176 mm. DLP: 1235.70 mGy cm. FINDINGS: VERTEBRA: No fracture. Small bone island in the left posterior ilium DISC SPACES AND FACET JOINTS: No acute injury. Minimal disc height loss and at L5-S1. No significant spinal canal stenosis. Minimal and mild facet arthropathy in the mid and lower lumbar spine, most prominent at L4-5. No osseous neural foraminal stenosis. PREVERTEBRAL SOFT TISSUES: Moderate aortoiliac atherosclerotic calcification. The soft tissues are otherwise normal. ALIGNMENT: Normal. CONCLUSION: 1. No acute osseous abnormality of the lumbar spine. 2. Mild facet arthropathy in the lower lumbar spine without significant spinal canal or neural foraminal stenosis.
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FINDINGS: VERTEBRA: No fracture. Small bone island in the left posterior ilium DISC SPACES AND FACET JOINTS: No acute injury. Minimal disc height loss and at L5-S1. No significant spinal canal stenosis. Minimal and mild facet arthropathy in the mid and lower lumbar spine, most prominent at L4-5. No osseous neural foraminal stenosis. PREVERTEBRAL SOFT TISSUES: Moderate aortoiliac atherosclerotic calcification. The soft tissues are otherwise normal. ALIGNMENT: Normal.
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FINDINGS: Scouts: No additional findings. Lines and tubes: None. Lungs and pleura: Interval development of nodular density in the right middle lobe anteriorly (series 9 image 101). Additional groundglass density focus in the right middle lobe (series 9 image 123) is also new from prior. No pleural effusion. No pneumothorax. Esophagus, Mediastinum and neck: Esophagus is normal. Mild anterior mediastinal soft tissue is unchanged, likely residual thymus. The thyroid gland is diffusely enlarged with multiple nodules, partially visualized. Lymph Nodes: Enlarged left axillary lymph node measures 16 x 14 mm (series 9 image 47), previously 15 x 13 mm. Additional small left axillary lymph nodes are unchanged. Cardiovascular: No cardiomegaly. Trace pericardial effusion. Coronary artery atherosclerotic calcification: None detected. Abdomen: Please refer to same day CT abdomen report for detailed findings below the diaphragm. Musculoskeletal/Body Wall: Enhancing left breast nodule is overall unchanged (series 9 image 103), stable from November 21 CT, mildly increased in conspicuity from October 29 CT. No aggressive appearing skeletal lesions. Deformity involving the mid sternal body is unchanged.
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EXAM: CT Chest wo contrast CLINICAL INFORMATION: 76-year-old female with provided history of abnormal x-ray. COMPARISON: Chest radiograph dated 12/20/2021 TECHNIQUE: CT Chest wo contrast. Scan field of view: 385 mm. DLP: 413 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. 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 evidence of right paramediastinal mass or lymphadenopathy. Prominent right paramediastinal region seen on the prior chest radiograph dated 12/20/2021, may be likely related to patient rotation. No lymphadenopathy in the axillary, mediastinal, or hilar regions. Small hiatal hernia. Severe calcification of the aortic valve leaflets, concerning for aortic valve stenosis. The thoracic aorta and main pulmonary artery are normal in caliber. The cardiac chambers are normal in size apart from left atrial enlargement. Scattered three-vessel 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. T12 moderate wedge deformity with approximately 50% height loss. Chest wall is unremarkable. Upper abdomen: Postsurgical changes in the upper abdomen. No acute abnormality in the upper abdominal organs. CONCLUSION: 1. No lung masses or nodules. Specifically, no right paramediastinal mass or dilated vessels. 2. Severe calcification of the aortic valve leaflets, concerning for aortic valve stenosis. 3. Severe coronary calcification. 4. T12 moderate wedge deformity with approximately 50% height loss.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. 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 evidence of right paramediastinal mass or lymphadenopathy. Prominent right paramediastinal region seen on the prior chest radiograph dated 12/20/2021, may be likely related to patient rotation. No lymphadenopathy in the axillary, mediastinal, or hilar regions. Small hiatal hernia. Severe calcification of the aortic valve leaflets, concerning for aortic valve stenosis. The thoracic aorta and main pulmonary artery are normal in caliber. The cardiac chambers are normal in size apart from left atrial enlargement. Scattered three-vessel 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. T12 moderate wedge deformity with approximately 50% height loss. Chest wall is unremarkable. Upper abdomen: Postsurgical changes in the upper abdomen. No acute abnormality in the upper abdominal organs.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Elevation of the left hemidiaphragm with adjacent atelectasis. Right lower lobe subsegmental atelectasis. 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: Simple in the interpolar region of the right kidney. Subcentimeter hypodensity is statistically a cyst but formally indeterminate LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered noninflamed diverticula. The appendix is not seen and may be surgically absent. PERITONEUM / MESENTERY: No ascites. Small area of calcification adjacent to bowel and may be a small foci of fat necrosis on image 265 series 201. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic calcifications of the abdominal aorta and branch vessels. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Endometrial cavity prominence is greater than expected for patient's age, with asymmetry in the lower uterine segment. Ovaries are normal. BODY WALL: Diastasis of the rectus muscles. Small fat-containing umbilical hernia with another inferiorly placed anterior abdominal wall fat-containing hernia with a small foci of calcification within, possibly fat necrosis. MUSCULOSKELETAL: Surgical changes from L4-L5 laminectomy and posterior fixation of L4-S1. Irregularity of the right iliac bone may be related to prior bone harvest or trauma. No destructive osseous lesions seen.
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EXAM: CT Chest wo contrast CLINICAL INFORMATION: Metastatic colorectal cancer. COMPARISON: CT chest without contrast dated 9/28/2021. TECHNIQUE: CT Chest wo contrast. Scan field of view: 390 mm. DLP: 247.63 mGy cm. 1.25 mm axial, coronal and sagittal reformats with 8mm axial MIP reformats were made and reviewed. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. Left upper lobe nodule measures 1.1 x 1.0 cm on axial image 58; series 2, previously 1.0 x 0.8 cm. A 5 mm right apical nodule on axial image 21; series 2, appears unchanged. A 5 mm peripheral right upper lobe nodule on axial image 64; series 2, also unchanged. Persistent diffuse peripheral reticulations, areas of traction bronchiectasis in the right middle lobe, lingula and bilateral lower lobes appears similar magnitude. Postradiation changes in the left lower lobe with masslike consolidation, overall unchanged. HEART / VESSELS: Postsurgical changes from prior CABG. Prosthetic aortic valve is again noted. Native coronary artery calcifications. No pericardial effusion. Ascending thoracic aorta measures up to 4.2 cm. Pulmonary artery remains dilated and measures up to 3.7 cm MEDIASTINUM / ESOPHAGUS: Esophagus appears unremarkable for the technique. LYMPH NODES: A few scattered mediastinal lymph nodes, overall unchanged, for example at prevascular lymph node measures 2.0 x 1.3 cm on axial image 65; series 2, previously 1.9 x 1.1 cm. CHEST WALL: Asymmetric left gynecomastia. UPPER ABDOMEN: No acute abnormality. MUSCULOSKELETAL: Superior endplate degenerative changes with Schmorl's node and T8. No destructive osseous lesion. Sternotomy appears well-healed and intact. CONCLUSION: 1. Mild interval enlargement in the left upper lobe nodule, now measuring up to 1.1 cm remains suspicious for metastasis. A few other noncalcified pulmonary nodules, overall unchanged. 2. Postradiation changes in the left lower lobe with adjacent masslike consolidation, overall unchanged. 3. Diffuse peripheral reticulations with areas of traction bronchiectasis related to interstitial lung disease/pulmonary fibrosis, overall unchanged. 4. Ectatic ascending thoracic aorta and dilated pulmonary arteries and other stable incidental findings as above.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. Left upper lobe nodule measures 1.1 x 1.0 cm on axial image 58; series 2, previously 1.0 x 0.8 cm. A 5 mm right apical nodule on axial image 21; series 2, appears unchanged. A 5 mm peripheral right upper lobe nodule on axial image 64; series 2, also unchanged. Persistent diffuse peripheral reticulations, areas of traction bronchiectasis in the right middle lobe, lingula and bilateral lower lobes appears similar magnitude. Postradiation changes in the left lower lobe with masslike consolidation, overall unchanged. HEART / VESSELS: Postsurgical changes from prior CABG. Prosthetic aortic valve is again noted. Native coronary artery calcifications. No pericardial effusion. Ascending thoracic aorta measures up to 4.2 cm. Pulmonary artery remains dilated and measures up to 3.7 cm MEDIASTINUM / ESOPHAGUS: Esophagus appears unremarkable for the technique. LYMPH NODES: A few scattered mediastinal lymph nodes, overall unchanged, for example at prevascular lymph node measures 2.0 x 1.3 cm on axial image 65; series 2, previously 1.9 x 1.1 cm. CHEST WALL: Asymmetric left gynecomastia. UPPER ABDOMEN: No acute abnormality. MUSCULOSKELETAL: Superior endplate degenerative changes with Schmorl's node and T8. No destructive osseous lesion. Sternotomy appears well-healed and intact.
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Findings: 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.
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2,686 |
CLINICAL HISTORY: Cerebral hemorrhage suspected, R51.9 Headache, unspecified, I69.128 Other speech and language deficits following nontraumatic intracerebral hemorrhage Spec Inst: please schedule same day as other UAB appt EXAM: CT Head wo contrast TECHNIQUE: 5 mm thick serial axial images were obtained throughout the head without intravenous contrast. Scan field of view: 211 mm. DLP: 798.53 mGy cm. COMPARISON: 12/20/2021 and also exam dated 12/5/2021 FINDINGS: There is expected evolution of encephalomalacia related to posterior right MCA infarction within the right temporal lobe and also right parietal lobe. There is no hemorrhagic conversion. There is no subdural hemorrhage, particularly at site of prior small right temporal subdural hemorrhage There are no new areas of hypoattenuation. There is no acute hemorrhage ventricles appear normal in size. There is no extra-axial collection or midline shift. Unremarkable. There is no mass effect. The calvarium is intact. The visualized paranasal sinuses and mastoid air cells are clear. The orbits are unremarkable. TECHNIQUE: 01. Expected evolution of posterior right MCA infarction. No hemorrhagic conversion. 02. Resolution of small right temporal subdural hemorrhage. No new subdural hemorrhage.
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FINDINGS: There is expected evolution of encephalomalacia related to posterior right MCA infarction within the right temporal lobe and also right parietal lobe. There is no hemorrhagic conversion. There is no subdural hemorrhage, particularly at site of prior small right temporal subdural hemorrhage There are no new areas of hypoattenuation. There is no acute hemorrhage ventricles appear normal in size. There is no extra-axial collection or midline shift. Unremarkable. There is no mass effect. The calvarium is intact. The visualized paranasal sinuses and mastoid air cells are clear. The orbits are unremarkable. TECHNIQUE: 01. Expected evolution of posterior right MCA infarction. No hemorrhagic conversion. 02. Resolution of small right temporal subdural hemorrhage. No new subdural hemorrhage.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Bilateral lung base atelectasis, left greater than right. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. No wall thickening or pericholecystic fluid. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Right renal sinus cyst. Bilateral nonobstructive renal calculi, with left staghorn configuration redemonstrated, unchanged compared to prior. No abnormal renal parenchymal enhancement. No hydronephrosis bilaterally. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis without evidence of diverticulitis. Otherwise, the colon, including the appendix, is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerotic calcification of the abdominal aorta. Infrarenal abdominal aortic ectasia measures up to 2.7 cm (series 201, image 138), unchanged. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Mild prostatomegaly. BODY WALL: Tiny fat-containing periumbilical hernia. MUSCULOSKELETAL: No aggressive osseous lesions.
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EXAM: CT Head wo contrast, CT Thoracic Spine from Reformat, CT Angio Neck, CT Chest with contrast, CT Lumbar Spine from Reformat CLINICAL INFORMATION: Fall, head injury. Intellectual disability. COMPARISON: CT head December 8, 2021. TECHNIQUE: CT Head wo contrast, CT Thoracic Spine from Reformat, CT Angio Neck, CT Chest with contrast, CT Lumbar Spine from Reformat 3-D CT MIP images were generated in post processing. Scan field of view: 227 mm. DLP: 1204 mGy cm. (accession CT220003209), Patient weight: 102 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 368 mm. DLP: 782 mGy cm. (accession CT220003215), Patient weight: 102 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. IV contrast injection rate: 3.50 ml per sec. Scan delay: bt sec. Scan field of view: 350 mm. DLP: 1022 mGy cm. (accession CT220003213) FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Moderate brain atrophy. Focal encephalomalacia in the right frontal lobe unchanged from prior. Periventricular and deep white matter hypoattenuation is stable from prior and likely represents chronic microangiopathic change. Atherosclerotic calcifications of the bilateral ICA. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Subtle posterior scalp contusive changes are suggested. Chronic ununited fracture of the left coronoid process of the left mandible. VENTRICULAR SYSTEM: Normal. ORBITS: No acute abnormality. SINUSES: Small left mastoid effusion and bilateral external auditory canal material, likely fairly large amount of cerumen. CERVICAL SPINE: Elongated ossified stylohyoid ligament bilaterally can be seen with atrial syndrome. SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. Left mastoid effusion and bilateral external auditory canal tissue, likely cerumen. The patient appears to be edentulous with mandibular atrophy as expected and there is chronic ununited left mandibular coronoid process fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Moderate brain atrophy. Focal encephalomalacia in the right frontal lobe unchanged from prior. Periventricular and deep white matter hypoattenuation is stable from prior and likely represents chronic microangiopathic change. Atherosclerotic calcifications of the bilateral ICA. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Subtle posterior scalp contusive changes are suggested. Chronic ununited fracture of the left coronoid process of the left mandible. VENTRICULAR SYSTEM: Normal. ORBITS: No acute abnormality. SINUSES: Small left mastoid effusion and bilateral external auditory canal material, likely fairly large amount of cerumen. CERVICAL SPINE: Elongated ossified stylohyoid ligament bilaterally can be seen with atrial syndrome. SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. Left mastoid effusion and bilateral external auditory canal tissue, likely cerumen. The patient appears to be edentulous with mandibular atrophy as expected and there is chronic ununited left mandibular coronoid process fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: Scouts: No additional findings. Lines and tubes: None. Lungs and pleura: No suspicious pulmonary nodules. Small 2 to 3 mm juxtapleural nodularity in the left upper lobe laterally (series 2 image 30) is unchanged, nonspecific. No pulmonary consolidation. Interval resolution of previously noted areas of subsegmental atelectasis in both lower lobes. Mild groundglass density in the right lower lobe posteriorly may be due to partial dependent atelectasis. Subsegmental atelectasis/scarring in the right middle lobe is also improved on comparison. Biapical lung scarring. No pleural effusion. No pneumothorax. Esophagus, Mediastinum and neck: Esophagus is normal. Mild anterior mediastinal soft tissue may be reactive thymus The thyroid gland is nonvisualized. Lymph Nodes: None enlarged. Cardiovascular: No cardiomegaly or pericardial effusion. Mild mitral annular calcification. Coronary artery atherosclerotic calcification: None detected. Abdomen: Visualized abdomen shows cirrhotic hepatic morphology, incompletely evaluated hepatic hypodensities. Musculoskeletal/Body Wall: No soft tissue masses. No aggressive appearing skeletal lesions. Mild degenerative changes in spine.
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2,688 |
RADIOLOGIC EXAM: CT Cervical Spine wo contrast CLINICAL INFORMATION: Fall. COMPARISON: None. TECHNIQUE: CT Cervical Spine wo contrastScan field of view: 200 mm. DLP: 934 mGy cm. Following CT of the neck, reformatted images were produced to optimize visualization of the osseous structures of the cervical spine. STRUCTURED REPORT: CT Cervical Spine Trauma 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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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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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Patchy small hypodensities scattered throughout the liver appears similar to prior. A dominant posterior segment lesion appears smaller, approximately 2.7 x 1.4 cm on image 170 series 12, previously 3.3 x 2.2 cm. Stable calcified lesion in the right hepatic dome. BILIARY TRACT: Mild intra and no extrahepatic biliary ductal dilatation. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Splenic hypodense lesion is grossly unchanged from prior. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. Portal venous nodal group measures 1.0 x 1.3 cm on image 180 series 12, previously 2.0 x 1.9 cm on image 89 series 308. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Fibroid uterus. Adnexa are unremarkable. BODY WALL: Small fat-containing umbilical hernia MUSCULOSKELETAL: No destructive osseous lesions seen.
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2,689 |
EXAM: CT Head wo contrast, CT Thoracic Spine from Reformat, CT Angio Neck, CT Chest with contrast, CT Lumbar Spine from Reformat CLINICAL INFORMATION: Fall, head injury. Intellectual disability. COMPARISON: CT head December 8, 2021. TECHNIQUE: CT Head wo contrast, CT Thoracic Spine from Reformat, CT Angio Neck, CT Chest with contrast, CT Lumbar Spine from Reformat 3-D CT MIP images were generated in post processing. Scan field of view: 227 mm. DLP: 1204 mGy cm. (accession CT220003209), Patient weight: 102 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 368 mm. DLP: 782 mGy cm. (accession CT220003215), Patient weight: 102 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. IV contrast injection rate: 3.50 ml per sec. Scan delay: bt sec. Scan field of view: 350 mm. DLP: 1022 mGy cm. (accession CT220003213) FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Moderate brain atrophy. Focal encephalomalacia in the right frontal lobe unchanged from prior. Periventricular and deep white matter hypoattenuation is stable from prior and likely represents chronic microangiopathic change. Atherosclerotic calcifications of the bilateral ICA. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Subtle posterior scalp contusive changes are suggested. Chronic ununited fracture of the left coronoid process of the left mandible. VENTRICULAR SYSTEM: Normal. ORBITS: No acute abnormality. SINUSES: Small left mastoid effusion and bilateral external auditory canal material, likely fairly large amount of cerumen. CERVICAL SPINE: Elongated ossified stylohyoid ligament bilaterally can be seen with atrial syndrome. SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. Left mastoid effusion and bilateral external auditory canal tissue, likely cerumen. The patient appears to be edentulous with mandibular atrophy as expected and there is chronic ununited left mandibular coronoid process fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Moderate brain atrophy. Focal encephalomalacia in the right frontal lobe unchanged from prior. Periventricular and deep white matter hypoattenuation is stable from prior and likely represents chronic microangiopathic change. Atherosclerotic calcifications of the bilateral ICA. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Subtle posterior scalp contusive changes are suggested. Chronic ununited fracture of the left coronoid process of the left mandible. VENTRICULAR SYSTEM: Normal. ORBITS: No acute abnormality. SINUSES: Small left mastoid effusion and bilateral external auditory canal material, likely fairly large amount of cerumen. CERVICAL SPINE: Elongated ossified stylohyoid ligament bilaterally can be seen with atrial syndrome. SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. Left mastoid effusion and bilateral external auditory canal tissue, likely cerumen. The patient appears to be edentulous with mandibular atrophy as expected and there is chronic ununited left mandibular coronoid process fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: Scouts: No additional findings. Lines and tubes: Right IJ port catheter tip is at the cavoatrial junction. Lungs and pleura: Redemonstration of areas of linear and subsegmental atelectasis and scarring with associated bronchiectasis in the right upper and middle lobes anteriorly. Mild biapical lung scarring. Almost complete interval resolution of previously noted subsegmental consolidation/atelectasis in the left lower lobe medially, and nodularity in the superior segment of the right lower lobe. No suspicious pulmonary nodules. No pleural effusion. No pneumothorax. Esophagus, Mediastinum and neck: Esophagus is normal. No abnormality in the mediastinum. The thyroid gland is normal. Lymph Nodes: None enlarged. Small left internal mammary lymph node is unchanged. Small calcified mediastinal and bilateral hilar lymph nodes are unchanged Cardiovascular: No cardiomegaly or pericardial effusion. Coronary artery atherosclerotic calcification: None detected. Abdomen: No upper abdominal abnormality identified. Musculoskeletal/Body Wall: Postsurgical changes in the anterior chest wall with bilateral breast implants in place. Surgical staples are also present in both axillae. T6 vertebral body adjacent lesion is unchanged.
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2,690 |
EXAM: CT Head wo contrast, CT Thoracic Spine from Reformat, CT Angio Neck, CT Chest with contrast, CT Lumbar Spine from Reformat CLINICAL INFORMATION: Fall, head injury. Intellectual disability. COMPARISON: CT head December 8, 2021. TECHNIQUE: CT Head wo contrast, CT Thoracic Spine from Reformat, CT Angio Neck, CT Chest with contrast, CT Lumbar Spine from Reformat 3-D CT MIP images were generated in post processing. Scan field of view: 227 mm. DLP: 1204 mGy cm. (accession CT220003209), Patient weight: 102 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 368 mm. DLP: 782 mGy cm. (accession CT220003215), Patient weight: 102 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. IV contrast injection rate: 3.50 ml per sec. Scan delay: bt sec. Scan field of view: 350 mm. DLP: 1022 mGy cm. (accession CT220003213) FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Moderate brain atrophy. Focal encephalomalacia in the right frontal lobe unchanged from prior. Periventricular and deep white matter hypoattenuation is stable from prior and likely represents chronic microangiopathic change. Atherosclerotic calcifications of the bilateral ICA. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Subtle posterior scalp contusive changes are suggested. Chronic ununited fracture of the left coronoid process of the left mandible. VENTRICULAR SYSTEM: Normal. ORBITS: No acute abnormality. SINUSES: Small left mastoid effusion and bilateral external auditory canal material, likely fairly large amount of cerumen. CERVICAL SPINE: Elongated ossified stylohyoid ligament bilaterally can be seen with atrial syndrome. SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. Left mastoid effusion and bilateral external auditory canal tissue, likely cerumen. The patient appears to be edentulous with mandibular atrophy as expected and there is chronic ununited left mandibular coronoid process fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Moderate brain atrophy. Focal encephalomalacia in the right frontal lobe unchanged from prior. Periventricular and deep white matter hypoattenuation is stable from prior and likely represents chronic microangiopathic change. Atherosclerotic calcifications of the bilateral ICA. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Subtle posterior scalp contusive changes are suggested. Chronic ununited fracture of the left coronoid process of the left mandible. VENTRICULAR SYSTEM: Normal. ORBITS: No acute abnormality. SINUSES: Small left mastoid effusion and bilateral external auditory canal material, likely fairly large amount of cerumen. CERVICAL SPINE: Elongated ossified stylohyoid ligament bilaterally can be seen with atrial syndrome. SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. Left mastoid effusion and bilateral external auditory canal tissue, likely cerumen. The patient appears to be edentulous with mandibular atrophy as expected and there is chronic ununited left mandibular coronoid process fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: BRAIN PARENCHYMA: No intraparenchymal hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Redemonstration of age-appropriate mild frontoparietal volume loss. Mild periventricular frontal white matter hypoattenuation again seen, related to mild chronic microvascular ischemic disease. EXTRA-AXIAL SPACES: No epidural, subdural, or subarachnoid hemorrhage. SKULL AND SKULL BASE: No acute fracture. Persistent atherosclerotic calcifications of the bilateral carotid siphons. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. Unchanged bilateral lens replacements. SINUSES: Mastoid air cells and paranasal sinuses are well aerated.
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2,691 |
EXAM: CT Head wo contrast, CT Thoracic Spine from Reformat, CT Angio Neck, CT Chest with contrast, CT Lumbar Spine from Reformat CLINICAL INFORMATION: Fall, head injury. Intellectual disability. COMPARISON: CT head December 8, 2021. TECHNIQUE: CT Head wo contrast, CT Thoracic Spine from Reformat, CT Angio Neck, CT Chest with contrast, CT Lumbar Spine from Reformat 3-D CT MIP images were generated in post processing. Scan field of view: 227 mm. DLP: 1204 mGy cm. (accession CT220003209), Patient weight: 102 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 368 mm. DLP: 782 mGy cm. (accession CT220003215), Patient weight: 102 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. IV contrast injection rate: 3.50 ml per sec. Scan delay: bt sec. Scan field of view: 350 mm. DLP: 1022 mGy cm. (accession CT220003213) FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Moderate brain atrophy. Focal encephalomalacia in the right frontal lobe unchanged from prior. Periventricular and deep white matter hypoattenuation is stable from prior and likely represents chronic microangiopathic change. Atherosclerotic calcifications of the bilateral ICA. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Subtle posterior scalp contusive changes are suggested. Chronic ununited fracture of the left coronoid process of the left mandible. VENTRICULAR SYSTEM: Normal. ORBITS: No acute abnormality. SINUSES: Small left mastoid effusion and bilateral external auditory canal material, likely fairly large amount of cerumen. CERVICAL SPINE: Elongated ossified stylohyoid ligament bilaterally can be seen with atrial syndrome. SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. Left mastoid effusion and bilateral external auditory canal tissue, likely cerumen. The patient appears to be edentulous with mandibular atrophy as expected and there is chronic ununited left mandibular coronoid process fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Moderate brain atrophy. Focal encephalomalacia in the right frontal lobe unchanged from prior. Periventricular and deep white matter hypoattenuation is stable from prior and likely represents chronic microangiopathic change. Atherosclerotic calcifications of the bilateral ICA. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Subtle posterior scalp contusive changes are suggested. Chronic ununited fracture of the left coronoid process of the left mandible. VENTRICULAR SYSTEM: Normal. ORBITS: No acute abnormality. SINUSES: Small left mastoid effusion and bilateral external auditory canal material, likely fairly large amount of cerumen. CERVICAL SPINE: Elongated ossified stylohyoid ligament bilaterally can be seen with atrial syndrome. SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. Left mastoid effusion and bilateral external auditory canal tissue, likely cerumen. The patient appears to be edentulous with mandibular atrophy as expected and there is chronic ununited left mandibular coronoid process fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: Scouts: No additional findings. Lines and tubes: Right IJ catheter terminates at the cavoatrial junction. Lungs and pleura: Redemonstration of areas of scarring, atelectasis with associated bronchiectasis bilaterally with significant interval decrease in previously noted associated groundglass density and interlobular septal thickening. Patchy areas of residual groundglass densities remaining (series 3 image 46, 64 for example). Subsegmental atelectasis/consolidation in the left lower lobe posteriorly. No pleural effusion. No pneumothorax. Esophagus, Mediastinum and neck: Esophagus is normal. No abnormality in the mediastinum. The thyroid gland is normal. Lymph Nodes: Unchanged borderline enlarged subcarinal lymph nodes. Cardiovascular: No cardiomegaly or pericardial effusion. Mild lipomatous hypertrophy of interatrial septum. Mild hypodense appearance of the blood pool relative to myocardium suggest overnight anemia. Atherosclerotic calcifications involving the Coronary artery atherosclerotic calcification: Small amount. Abdomen: Partially visualized atrophied left kidney. Few cortical right renal hypodensities are better seen on prior contrast CT from December 2021. Mild right perinephric fat stranding as before. Heterogeneous hypodensity with areas of calcification in the right lobe posteriorly, incompletely evaluated. Mild intrahepatic biliary dilation in the left lobe as before. Musculoskeletal/Body Wall: No soft tissue masses. Bilateral gynecomastia. No aggressive appearing skeletal lesions. Degenerative changes in spine.
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2,692 |
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Intellectual disability, fall with head injury COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 102 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 368 mm. DLP: 782 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately reported chest CT. Also, thoracic spine and lumbar CT spine are reported separately. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: No abnormality. GALLBLADDER: Cholelithiasis. PANCREAS: Normal. SPLEEN: Scattered calcified granulomas. Otherwise, unremarkable. ADRENALS: Normal. KIDNEYS: There are indeterminate hypoattenuating renal lesions bilaterally. Evaluation is degraded in the setting of the arms over the abdomen. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: There is a hiatal hernia. See separately dictated chest CT report regarding the esophagus. The small bowel is nondilated. COLON / APPENDIX: Diverticulosis without acute diverticulitis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Normal branching pattern. Mild atherosclerosis involving the descending aorta and branching vessels. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Borderline prostatomegaly with dystrophic calcifications. There is a well-circumscribed lesion within the left groin that measures approximately 2.9 x 2.6 cm (series 303 image 458). This lesion measures approximately 40 HU and may represent a high riding testicle or possibly a spermatic cord hydrocele filled with complex fluid. The right testicle is not definitively visualized. There may be a testicle in the left hemiscrotum. Left hydrocele is not excluded. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute osseous abnormality evident. Ankylosis of the SI joints, multilevel degenerative changes in the lumbar spine and subtle changes of osteonecrosis in the superomedial femoral heads on the left and the right. CONCLUSION: 1. No acute traumatic abnormality evident in the abdomen or pelvis 2. See separately dictated chest CT. 3. Indeterminate bilateral renal hypoattenuating lesions, difficult to characterize as there is artifact related to the patient's arm over the abdomen. Consider nonemergent outpatient ultrasound or multiphase MR/CT for follow-up when appropriate. 4. Lesion in the left inguinal canal may represent possibly a high riding testicle or lesion of another etiology such as a complex funiculocele. The right testicle is not definitively visualized. Left hydrocele versus testicle present. Recommend further characterization with nonemergent scrotal sonogram when appropriate. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately reported chest CT. Also, thoracic spine and lumbar CT spine are reported separately. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: No abnormality. GALLBLADDER: Cholelithiasis. PANCREAS: Normal. SPLEEN: Scattered calcified granulomas. Otherwise, unremarkable. ADRENALS: Normal. KIDNEYS: There are indeterminate hypoattenuating renal lesions bilaterally. Evaluation is degraded in the setting of the arms over the abdomen. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: There is a hiatal hernia. See separately dictated chest CT report regarding the esophagus. The small bowel is nondilated. COLON / APPENDIX: Diverticulosis without acute diverticulitis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Normal branching pattern. Mild atherosclerosis involving the descending aorta and branching vessels. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Borderline prostatomegaly with dystrophic calcifications. There is a well-circumscribed lesion within the left groin that measures approximately 2.9 x 2.6 cm (series 303 image 458). This lesion measures approximately 40 HU and may represent a high riding testicle or possibly a spermatic cord hydrocele filled with complex fluid. The right testicle is not definitively visualized. There may be a testicle in the left hemiscrotum. Left hydrocele is not excluded. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute osseous abnormality evident. Ankylosis of the SI joints, multilevel degenerative changes in the lumbar spine and subtle changes of osteonecrosis in the superomedial femoral heads on the left and the right.
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Findings: RADIOLOGIC EXAM: CT Venogram Head CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Venogram HeadPatient weight: 225 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 200 mm. DLP: 6220.80 mGy cm. STRUCTURED REPORT: CT Head FINDINGS: BRAIN PARENCHYMA: There is no acute intracranial hemorrhage or acute infarct. No brain edema or mass effect. No abnormal enhancement. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. Dural venous sinuses and major cortical veins are well-opacified without filling defect. Small arachnoid granulation in the right transverse sinus.
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2,693 |
EXAM: CT Head wo contrast, CT Thoracic Spine from Reformat, CT Angio Neck, CT Chest with contrast, CT Lumbar Spine from Reformat CLINICAL INFORMATION: Fall, head injury. Intellectual disability. COMPARISON: CT head December 8, 2021. TECHNIQUE: CT Head wo contrast, CT Thoracic Spine from Reformat, CT Angio Neck, CT Chest with contrast, CT Lumbar Spine from Reformat 3-D CT MIP images were generated in post processing. Scan field of view: 227 mm. DLP: 1204 mGy cm. (accession CT220003209), Patient weight: 102 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 368 mm. DLP: 782 mGy cm. (accession CT220003215), Patient weight: 102 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. IV contrast injection rate: 3.50 ml per sec. Scan delay: bt sec. Scan field of view: 350 mm. DLP: 1022 mGy cm. (accession CT220003213) FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Moderate brain atrophy. Focal encephalomalacia in the right frontal lobe unchanged from prior. Periventricular and deep white matter hypoattenuation is stable from prior and likely represents chronic microangiopathic change. Atherosclerotic calcifications of the bilateral ICA. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Subtle posterior scalp contusive changes are suggested. Chronic ununited fracture of the left coronoid process of the left mandible. VENTRICULAR SYSTEM: Normal. ORBITS: No acute abnormality. SINUSES: Small left mastoid effusion and bilateral external auditory canal material, likely fairly large amount of cerumen. CERVICAL SPINE: Elongated ossified stylohyoid ligament bilaterally can be seen with atrial syndrome. SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. Left mastoid effusion and bilateral external auditory canal tissue, likely cerumen. The patient appears to be edentulous with mandibular atrophy as expected and there is chronic ununited left mandibular coronoid process fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Moderate brain atrophy. Focal encephalomalacia in the right frontal lobe unchanged from prior. Periventricular and deep white matter hypoattenuation is stable from prior and likely represents chronic microangiopathic change. Atherosclerotic calcifications of the bilateral ICA. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Subtle posterior scalp contusive changes are suggested. Chronic ununited fracture of the left coronoid process of the left mandible. VENTRICULAR SYSTEM: Normal. ORBITS: No acute abnormality. SINUSES: Small left mastoid effusion and bilateral external auditory canal material, likely fairly large amount of cerumen. CERVICAL SPINE: Elongated ossified stylohyoid ligament bilaterally can be seen with atrial syndrome. SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. Left mastoid effusion and bilateral external auditory canal tissue, likely cerumen. The patient appears to be edentulous with mandibular atrophy as expected and there is chronic ununited left mandibular coronoid process fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: No pleural effusion, or pneumothorax. No suspicious pulmonary nodule. Bilateral dependent and linear subsegmental atelectasis is overall unchanged. HEART / VESSELS: Heart size is normal. No pericardial effusion. Stable moderate to severe atherosclerotic disease of the thoracic aorta. MEDIASTINUM / ESOPHAGUS: Prominent mediastinal lymph nodes, overall stable. See below. LYMPH NODES: Prominent mediastinal and bilateral hilar lymph nodes are overall stable compared to prior examination. The largest lymph node is in the left paratracheal distribution measuring 1.8 x 0.9 cm on series 11 image 59 on series 11 image 59, previously 2.0 x 1.0 cm. CHEST WALL: Surgical clips are present in the right axilla. UPPER ABDOMEN: Please see same day CT abdomen for abdomen findings. MUSCULOSKELETAL: New anterior wedge deformity involving the T5 vertebral body with approximately 50% height loss and approximately 4 mm of retropulsion of fracture fragments into the spinal canal. There is also a new compression deformity at L1 resulting in 75% height loss. There is a new fracture of the manubrium. Subacute-chronic fractures of the right third, fourth and left posterior third, fourth ribs, also new from prior examination.
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2,694 |
EXAM: CT Abdomen and Pelvis wo+w contrast CLINICAL INFORMATION: Renal colic versus ruptured diverticulitis COMPARISON: 2/19/2014 TECHNIQUE: CT Abdomen and Pelvis wo+w contrast. Patient weight: 150 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 78 sec. Scan field of view: 350 mm. DLP: 1214.80 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: There is a moderate hiatal hernia, likely mixed type. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: There is mild intra and extrahepatic biliary duct dilatation which tapers to the ampulla. This is probably related to prior cholecystectomy. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Punctate nonobstructing stone is seen in the upper pole the right kidney. There is mild right hydroureter with periureteral stranding and enhancement. The right kidney is otherwise unremarkable. There is a small subcentimeter hypodensity seen within the left kidney which is technically indeterminate but statistically likely a cyst. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered noninflamed colonic diverticula are seen. Hyperdensities seen within the transverse colon are likely ingested medication. Thickening of the sigmoid colon is thought to likely be due to lack distention. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild aortoiliac atherosclerosis without aneurysmal dilatation. URINARY BLADDER: There is a punctate dependent stone measuring 2-3 mm in the right urinary bladder separate from the UVJ, possibly a recently passed ureteral calculus.. REPRODUCTIVE ORGANS: Hysterectomy changes are noted. No adnexal mass. BODY WALL: Small fat-containing umbilical hernia. Rectus diastases. MUSCULOSKELETAL: Moderate degenerative changes are seen within the spine. No focal destructive osseous lesion is identified. CONCLUSION: 1. Findings are most suggestive of recently passed right ureteral calculus. Mild right hydroureter with periureteral enhancement and stranding, probably related to recent obstruction, although superimposed ascending infection is not excluded. No obstructing ureteral calculus is currently identified. 2. Additional punctate nonobstructing right nephrolithiasis. 3. Additional findings above.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: There is a moderate hiatal hernia, likely mixed type. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: There is mild intra and extrahepatic biliary duct dilatation which tapers to the ampulla. This is probably related to prior cholecystectomy. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Punctate nonobstructing stone is seen in the upper pole the right kidney. There is mild right hydroureter with periureteral stranding and enhancement. The right kidney is otherwise unremarkable. There is a small subcentimeter hypodensity seen within the left kidney which is technically indeterminate but statistically likely a cyst. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered noninflamed colonic diverticula are seen. Hyperdensities seen within the transverse colon are likely ingested medication. Thickening of the sigmoid colon is thought to likely be due to lack distention. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild aortoiliac atherosclerosis without aneurysmal dilatation. URINARY BLADDER: There is a punctate dependent stone measuring 2-3 mm in the right urinary bladder separate from the UVJ, possibly a recently passed ureteral calculus.. REPRODUCTIVE ORGANS: Hysterectomy changes are noted. No adnexal mass. BODY WALL: Small fat-containing umbilical hernia. Rectus diastases. MUSCULOSKELETAL: Moderate degenerative changes are seen within the spine. No focal destructive osseous lesion is identified.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately dictated CT chest. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Stable intrahepatic and extra hepatic biliary ductal dilation, likely related to postcholecystectomy state. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered noninflamed colonic diverticula. Normal appendix. PERITONEUM / MESENTERY: No ascites. RETROPERITONEUM: Normal. VESSELS: Advanced calcified atherosclerotic plaque of the abdominal aorta and branch vessels. Ectasia of the left common iliac artery. URINARY BLADDER: Collapsed. REPRODUCTIVE ORGANS: Uterus is absent. Adnexa are unremarkable BODY WALL: Fat-containing supraumbilical hernia. MUSCULOSKELETAL: Osteopenia. There are 11 rib-bearing vertebra and 6 lumbar type vertebra. New compression deformity of the superiormost (L1) with near vertebra plana.
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2,695 |
CT Head wo contrast 1/7/2022 4:00 AM Clinical Information: Status post CSF leak repair Spec Inst: Stealth protocol Comparison: Head CTV 1/3/2022 Technique: Unenhanced axial brain CT with coronal and sagittal reconstructions. Scan field of view: 235 mm. DLP: 1885.20 mGy cm. Findings: Postsurgical changes from left temporal craniotomy, partial mastoidectomy with tegmen cephalocele repair are noted. There is opacification of the residual mastoid air cells and middle ear cavity. Overlying scalp fluid, hemorrhage and gas is noted. There is left frontal pneumocephalus. There is an extra-axial collection along the floor and lateral aspect of the left middle cranial fossa at the margins of the craniotomy. Otherwise, there is no parenchymal hemorrhage, edema or mass effect. There is no significant midline shift. The visualized paranasal sinuses are clear. Impression: Interval postsurgical changes from left tegmen cephalocele repair. Small extra-axial collection along the craniotomy margins and small volume left frontal pneumocephalus.
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Findings: Postsurgical changes from left temporal craniotomy, partial mastoidectomy with tegmen cephalocele repair are noted. There is opacification of the residual mastoid air cells and middle ear cavity. Overlying scalp fluid, hemorrhage and gas is noted. There is left frontal pneumocephalus. There is an extra-axial collection along the floor and lateral aspect of the left middle cranial fossa at the margins of the craniotomy. Otherwise, there is no parenchymal hemorrhage, edema or mass effect. There is no significant midline shift. The visualized paranasal sinuses are clear.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis CT chest findings are reported separately. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Expected postcholecystectomy prominence of the common bile duct. GALLBLADDER: Surgically absent. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Posterior parenchymal calcification in the posterior right kidney. Stable subcentimeter complex left renal cyst on axial series 3, image 204. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Normal caliber abdominal aorta. Moderate atherosclerotic disease is present. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is surgically absent. BODY WALL: Approximately 5.7 cm fat-containing left spigelian hernia noted on axial series 3, image 329. MUSCULOSKELETAL: No significant abnormality.
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2,696 |
EXAM: CT Chest wo contrast CLINICAL INFORMATION: Follow-up, history of cavitary pneumonia. COMPARISON: 10/28/2021 TECHNIQUE: CT Chest wo contrast. Scan field of view: 320 mm. DLP: 254.91 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Scattered areas of peripheral septal thickening, scarring, bronchiectasis all appear unchanged. Significant interval improvement in the right apical cavitary lesions. A pneumatocele at the right lung base along the right major fissure is unchanged. Interval increase in the hazy groundglass opacities in the right lower lobe. HEART / VESSELS: Borderline heart size. Small pericardial effusion. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Significant interval improvement/near complete resolution of the previously seen right apical cavitary lesions. The lesions are replaced by scarring/consolidation. 2. Interval increase in the groundglass opacities in the left lower lobe. Scattered areas of scarring and traction bronchiectasis are not significantly changed.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Scattered areas of peripheral septal thickening, scarring, bronchiectasis all appear unchanged. Significant interval improvement in the right apical cavitary lesions. A pneumatocele at the right lung base along the right major fissure is unchanged. Interval increase in the hazy groundglass opacities in the right lower lobe. HEART / VESSELS: Borderline heart size. Small pericardial effusion. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No significant abnormality.
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Findings: Lines and Tubes: None. Body Wall and Abdomen: No destructive osseous lesions. CT of the abdomen and pelvis will be reported separately. Lymph Nodes, Mediastinum and Neck: Shotty axillary lymph nodes bilaterally are similar. Left hilar lymph node image 80 series 3 is unchanged. Lungs and Pleura: No pleural effusion. Linear scarring or subsegmental atelectasis in the upper left lung is similar. Cardiovascular: Normal heart size. No central PTE or pericardial effusion.
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2,697 |
EXAM: CT Chest wo contrast CLINICAL INFORMATION: 35-year-old female with provided history of cough, fever and pneumonia. COMPARISON: None. TECHNIQUE: CT Chest wo contrast. Scan field of view: 342 mm. DLP: 253.40 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. 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: Left renal midpole nonobstructive stone. CONCLUSION: No acute disease in the chest.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. 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: Left renal midpole nonobstructive stone.
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Findings: CTA neck: The top of the aortic arch and brachiocephalic arteries are unremarkable. There are calcified nonstenotic plaques at the carotid bifurcations. The cervical ICAs are essentially negative. Both vertebral arteries are sizable with normal appearance and antegrade flow. Cervical spine has minor degenerative changes but otherwise unremarkable appearance. CTA Head: There are dense calcifications in the cavernous ICAs but no flow-limiting stenosis is seen. The supraclinoid ICAs and the proximal ACAs, MCA's and PCAs are unremarkable. There is dolichoectasia of the basilar artery but otherwise normal appearance. The basilar branches have expected appearance. No aneurysm, AVM or intrinsic vascular lesion is seen. No intrinsic vascular lesion is seen. ---------------
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2,698 |
EXAM: CT Abdomen with contrast CLINICAL INFORMATION: 75-year-old female with newly diagnosed neuroendocrine tumor. COMPARISON: CT outside 9/27/2021 TECHNIQUE: CT Abdomen with contrast. Patient weight: 150 lbs. IV contrast: Omnipaque 350, 143 ml, per protocol. Water: 12 oz. Saline flush: 10 ml. IV contrast injection rate: 4 ml per sec. Scan delay: Bolus Tracked. Scan field of view: 400 mm. FINDINGS: STRUCTURED REPORT: CT Abdomen LOWER CHEST: Please see separately dictated same-day CT chest. ABDOMEN: LIVER: Normal. BILIARY TRACT: Similar appearance of the intra and extrahepatic biliary duct dilation. There is gradual tapering of the common bile duct ampulla. The common bile duct measures up to 1.5 cm in diameter (series 900 image 98), unchanged from prior. GALLBLADDER: No abnormality. PANCREAS: Enhancing lesion measuring approximately 0.7 cm seen within the pancreatic body seen on axial series 7, image 213. Redemonstration of a hypoattenuating lesion in the superior aspect of the pancreatic body measuring up to 6 mm (series 900 image 83), previously 8 mm. The pancreatic duct is not dilated. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Unchanged bilateral renal cortical scarring. Subcentimeter hypodensity within the right inferior pole, likely representing cysts. No hydronephrosis bilaterally. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: The stomach is distended. Unchanged duodenal diverticulum. COLON: Diverticulosis without evidence of diverticulitis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate scattered atherosclerotic calcifications of the abdominal aorta which is normal in caliber. BODY WALL: No significant abnormality. Prominent hyperdensity within the right posterior soft tissues is likely transversing vessel. MUSCULOSKELETAL: Multilevel discogenic degenerative changes throughout the thoracolumbar spine. No aggressive osseous lesions. CONCLUSION: 1. Subtle enhancing lesion in the pancreatic body as described above, perhaps corresponding with the biopsy-proven pancreatic neuroendocrine tumor. No evidence of metastatic disease elsewhere in the abdomen or pelvis. 2. Stable hypoattenuating lesion in the superior aspect of the pancreatic body measuring up to 6 mm without arterial hyperenhancement, most suggestive of a sidebranch IPMN. 3. Stable intra and extrahepatic biliary duct dilation. 4. Additional chronic and incidental findings as described above. 5. Please see separately dictated same-day CT chest. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT Abdomen LOWER CHEST: Please see separately dictated same-day CT chest. ABDOMEN: LIVER: Normal. BILIARY TRACT: Similar appearance of the intra and extrahepatic biliary duct dilation. There is gradual tapering of the common bile duct ampulla. The common bile duct measures up to 1.5 cm in diameter (series 900 image 98), unchanged from prior. GALLBLADDER: No abnormality. PANCREAS: Enhancing lesion measuring approximately 0.7 cm seen within the pancreatic body seen on axial series 7, image 213. Redemonstration of a hypoattenuating lesion in the superior aspect of the pancreatic body measuring up to 6 mm (series 900 image 83), previously 8 mm. The pancreatic duct is not dilated. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Unchanged bilateral renal cortical scarring. Subcentimeter hypodensity within the right inferior pole, likely representing cysts. No hydronephrosis bilaterally. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: The stomach is distended. Unchanged duodenal diverticulum. COLON: Diverticulosis without evidence of diverticulitis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate scattered atherosclerotic calcifications of the abdominal aorta which is normal in caliber. BODY WALL: No significant abnormality. Prominent hyperdensity within the right posterior soft tissues is likely transversing vessel. MUSCULOSKELETAL: Multilevel discogenic degenerative changes throughout the thoracolumbar spine. No aggressive osseous lesions.
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Findings: CTA neck: The top of the aortic arch and brachiocephalic arteries are unremarkable. There are calcified nonstenotic plaques at the carotid bifurcations. The cervical ICAs are essentially negative. Both vertebral arteries are sizable with normal appearance and antegrade flow. Cervical spine has minor degenerative changes but otherwise unremarkable appearance. CTA Head: There are dense calcifications in the cavernous ICAs but no flow-limiting stenosis is seen. The supraclinoid ICAs and the proximal ACAs, MCA's and PCAs are unremarkable. There is dolichoectasia of the basilar artery but otherwise normal appearance. The basilar branches have expected appearance. No aneurysm, AVM or intrinsic vascular lesion is seen. No intrinsic vascular lesion is seen. ---------------
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2,699 |
EXAM: CT Chest with contrast CLINICAL INFORMATION: Newly diagnosed neuroendocrine tumor. COMPARISON: Multiple prior abdomen CTs, most recently same day and 9/27/2021. TECHNIQUE: CT Chest with contrast. Patient weight: 150 lbs. IV contrast: Omnipaque 350, 143 ml, per protocol. Water: 12 oz. Saline flush: 10 ml. IV contrast injection rate: 4 ml per sec. Scan delay: Bolus Tracked. Scan field of view: 400 mm. DLP: 568 mGy cm. FINDINGS: STRUCTURED REPORT: CT Chest and bronchiectasis is LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Noncalcified 4 mm nodule in the right middle lobe (image 21, series #), unchanged from the CT abdomen and pelvis dated 7/23/2018. A tiny left apical nodule is seen on series 7 image 47 with no previous imaging of this area for comparison. No pleural effusion or pneumothorax. Diverticulum is present in the superior mediastinum and unclear if that arises from the trachea or the esophagus.. Central airways are patent. HEART / VESSELS: Normal heart size. No pericardial effusion. Moderate multivessel coronary artery atherosclerosis. MEDIASTINUM / ESOPHAGUS: Trace fluid in the distal esophagus, likely secondary to reflux. Small hiatal hernia. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Please see separately reported same day CT abdomen and pelvis. MUSCULOSKELETAL: No aggressive osseous lesions. Chronic anterior compression deformity of T12 with less than 25% vertebral body height loss. Mild multilevel discogenic degenerative changes of the thoracic spine. CONCLUSION: 1. Noncalcified 4 mm right middle lobe nodule, unchanged since 7/23/2018. Additional tiny left apical nodule with no prior imaging at that level for comparison. Probably benign but attention on follow-up will be needed. No additional nodules and no adenopathy.. 2. Other incidental findings as above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT Chest and bronchiectasis is LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Noncalcified 4 mm nodule in the right middle lobe (image 21, series #), unchanged from the CT abdomen and pelvis dated 7/23/2018. A tiny left apical nodule is seen on series 7 image 47 with no previous imaging of this area for comparison. No pleural effusion or pneumothorax. Diverticulum is present in the superior mediastinum and unclear if that arises from the trachea or the esophagus.. Central airways are patent. HEART / VESSELS: Normal heart size. No pericardial effusion. Moderate multivessel coronary artery atherosclerosis. MEDIASTINUM / ESOPHAGUS: Trace fluid in the distal esophagus, likely secondary to reflux. Small hiatal hernia. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Please see separately reported same day CT abdomen and pelvis. MUSCULOSKELETAL: No aggressive osseous lesions. Chronic anterior compression deformity of T12 with less than 25% vertebral body height loss. Mild multilevel discogenic degenerative changes of the thoracic spine.
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FINDINGS: White matter hypodensity suggestive for advanced microvascular angiopathy. Intracranial atherosclerosis is seen. An old lacunar infarction of the left caudate head is seen. The brain parenchyma appears normal without evidence for acute territorial infarct, mass lesion, mass effect, or recent hemorrhage. The ventricles are normal in size. There is no abnormal extra axial collection. The calvarium is intact. Small retention cyst of left ethmoidal sinus is noted.. The orbits are normal.
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