Datasets:
AiDoc
/
CT-MRI_metrics_validation_dataset

Dataset card Data Studio Files
xet
Community
exam_ID
int64
2k
16.7k
raw_report
stringlengths
56
10.9k
report_findings_positive
stringlengths
9
6.27k
report_findings_negative
stringlengths
9
6.27k
3,000
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 77-year-old male with lower abdominal pain. COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 280 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 70 sec. Scan field of view: 500 mm. DLP: 1851 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: No consolidation, effusion, or suspicious nodule. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Mild CAD. DIAPHRAGM: Right hemidiaphragmatic eventration containing liver. Calcified intrathoracic lymph nodes. ABDOMEN and PELVIS: LIVER: Hypoattenuating lesion along the right anterior hepatic lobe likely represents focal fat. BILIARY TRACT: Cystic duct terminates caudally. Mild intrahepatic biliary dilation. Common bile duct measures up to 1.0 cm. GALLBLADDER: Stone versus polyp measuring up to 1.0 cm in the gallbladder (series 301, image 90). PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Small left adrenal myelolipoma. KIDNEYS: Bilateral renal cysts and other subcentimeter hypoattenuating lesions that are too small characterize. Nonspecific perinephric stranding. Bilateral cortical thinning. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach is normal. Small duodenal diverticulum in the second portion. COLON / APPENDIX: Diverticulosis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered mild to moderate atherosclerosis. URINARY BLADDER: Diffuse wall thickening and perivesicular stranding. REPRODUCTIVE ORGANS: Prostate none well visualized with indwelling fiducial markers. BODY WALL: Small fat-containing inguinal hernias. MUSCULOSKELETAL: Spondylosis of the visualized spine without destructive osseous lesion. Vertebral hemangioma at L2. CONCLUSION: 1. Features consistent with cystitis. 2. Mild intrahepatic and extra hepatic biliary dilation. Recommend biochemical correlation. 3. Stone versus polyp in the gallbladder. Recommend nonemergent/outpatient ultrasound for further evaluation as clinically indicated. 4. Additional findings detailed above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: No consolidation, effusion, or suspicious nodule. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Mild CAD. DIAPHRAGM: Right hemidiaphragmatic eventration containing liver. Calcified intrathoracic lymph nodes. ABDOMEN and PELVIS: LIVER: Hypoattenuating lesion along the right anterior hepatic lobe likely represents focal fat. BILIARY TRACT: Cystic duct terminates caudally. Mild intrahepatic biliary dilation. Common bile duct measures up to 1.0 cm. GALLBLADDER: Stone versus polyp measuring up to 1.0 cm in the gallbladder (series 301, image 90). PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Small left adrenal myelolipoma. KIDNEYS: Bilateral renal cysts and other subcentimeter hypoattenuating lesions that are too small characterize. Nonspecific perinephric stranding. Bilateral cortical thinning. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach is normal. Small duodenal diverticulum in the second portion. COLON / APPENDIX: Diverticulosis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered mild to moderate atherosclerosis. URINARY BLADDER: Diffuse wall thickening and perivesicular stranding. REPRODUCTIVE ORGANS: Prostate none well visualized with indwelling fiducial markers. BODY WALL: Small fat-containing inguinal hernias. MUSCULOSKELETAL: Spondylosis of the visualized spine without destructive osseous lesion. Vertebral hemangioma at L2.
FINDINGS: LOWER NECK: No significant abnormality. Moderately suboptimal evaluation with limited evaluation primarily of the lung bases subsegmental arteries due to motion abnormality. CHEST: PULMONARY ARTERIES: No pulmonary embolus. LUNGS / AIRWAYS: Paraseptal. Lungs clear. PLEURA: No effusion or pneumothorax. HEART / PERICARDIUM: Heart is normal in size. No pericardial effusion. AORTA: Thoracic aorta is normal in course and caliber. MEDIASTINUM / ESOPHAGUS: Unremarkable. LYMPH NODES: Prominent but not pathologically enlarged hilar lymph nodes bilaterally.. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Visualized upper abdomen is unremarkable. MUSCULOSKELETAL: Degenerative changes of the thoracic spine.
3,001
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 34-year-old male with right lower quadrant pain. COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 135 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 70 sec. Scan field of view: 350 mm. DLP: 501 mGy cm. FINDINGS: Images are degraded by motion artifact which can limit diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Mildly steatotic. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: 4 mm stone is seen in the right ureterovesicular junction with minimal right hydroureter. No hydronephrosis or suspicious lesion. No other nephrolithiasis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Colon and appendix are normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Left ureteral jet of contrast is seen. REPRODUCTIVE ORGANS: Normal. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Minimally obstructing 4 mm right UVJ stone. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: Images are degraded by motion artifact which can limit diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Mildly steatotic. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: 4 mm stone is seen in the right ureterovesicular junction with minimal right hydroureter. No hydronephrosis or suspicious lesion. No other nephrolithiasis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Colon and appendix are normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Left ureteral jet of contrast is seen. REPRODUCTIVE ORGANS: Normal. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: No significant abnormality.
FINDINGS: Several images are degraded by motion. This is more evident at the cervical spine near the thoracic inlet. BRAIN PARENCHYMA: No intraparenchymal hemorrhage, mass effect or edema. Decreased cerebral cortical volume. Periventricular white matter hypoattenuation consistent with chronic microangiopathy. Gray-white matter differentiation is otherwise maintained. EXTRA-AXIAL SPACES: No epidural, subdural, or subarachnoid hemorrhage. SKULL AND SKULL BASE: No acute fracture. VENTRICULAR SYSTEM: Ex vacuo dilation. ORBITS: Remote fracture of the right lamina papyracea with herniation of extraconal fat. No signs of extraocular muscle impingement. SINUSES: Layering fluid within the sphenoid and right maxillary sinus with pronounced mucosal thickening. Right ethmoid osteoma. MASTOIDS: Clear. CRANIAL SOFT TISSUES: Unremarkable. CERVICOCRANIAL JUNCTION: The occipital condyles are normal. ATLANTODENTAL INTERVAL: Normal (
3,002
CT Head wo contrast 1/7/2022 6:55 AM Clinical Information: DLBCL patient with fall Comparison: PET/CT dated 10/19/2021. Technique: Unenhanced axial brain CT. Bone and soft tissue windows were reviewed. Sagittal and coronal images were generated from the axial data. Scan field of view: 220 mm. DLP: 577.50 mGy cm. Findings: Small extra-axial hemorrhage in the right frontoparietal region with maximal thickness of 5 mm. No significant mass effect on the underlying brain parenchyma. Encephalomalacia changes in the medial superior left hemispheric cerebellum. Age-appropriate extensive brain involution. Moderate severity periventricular white matter hypoattenuation in a pattern compatible with small vessel ischemic disease. Otherwise gray and white matter attenuation differentiation is maintained. No intracranial mass, mass effect or midline shift. No hydrocephalus. Basal cisterns are patent. Atherosclerotic calcifications of the intracranial vasculature. Bilateral pseudophakia. Chronic right maxillary sinusitis changes. Otherwise visualized paranasal sinuses, mastoid air cells and middle ear cavities are unremarkable. Extensive decreased osseous mineralization. Hyperostosis frontalis interna. No acute osseous abnormalities. Conclusion: 1. Acute right frontoparietal small extra-axial hemorrhage, likely subdural. No significant mass effect on the underlying brain. 2. Additional chronic and incidental findings as described above. The above results were discussed with Josh Lard, RN on 1/7/2022 10:03 AM, over phone by Dr. Gopi Sirineni.
Findings: Small extra-axial hemorrhage in the right frontoparietal region with maximal thickness of 5 mm. No significant mass effect on the underlying brain parenchyma. Encephalomalacia changes in the medial superior left hemispheric cerebellum. Age-appropriate extensive brain involution. Moderate severity periventricular white matter hypoattenuation in a pattern compatible with small vessel ischemic disease. Otherwise gray and white matter attenuation differentiation is maintained. No intracranial mass, mass effect or midline shift. No hydrocephalus. Basal cisterns are patent. Atherosclerotic calcifications of the intracranial vasculature. Bilateral pseudophakia. Chronic right maxillary sinusitis changes. Otherwise visualized paranasal sinuses, mastoid air cells and middle ear cavities are unremarkable. Extensive decreased osseous mineralization. Hyperostosis frontalis interna. No acute osseous abnormalities.
FINDINGS: BRAIN PARENCHYMA: No intraparenchymal hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is appropriate for patient's age. EXTRA-AXIAL SPACES: No epidural, subdural, or subarachnoid hemorrhage. SKULL AND SKULL BASE: No acute fracture. VENTRICULAR SYSTEM: Mild ex vacuo dilation. ORBITS: Bilateral pseudophakia. SINUSES: Well aerated. MASTOIDS: Clear. SOFT TISSUES: Unremarkable.
3,003
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 44-year-old male with evaluation for inflammatory bowel disease flareup. COMPARISON: CT abdomen pelvis dated 11/13/2021. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 165 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 60 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 80 sec Scan field of view: 360 mm. DLP: 503 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: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach is normal. COLON / APPENDIX: The appendix is normal. There is hyperenhancement and wall thickening of the cecum, ascending colon, and small portion of splenic flexure. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Stranding in the subcutaneous tissue of the left hip is again seen. CONCLUSION: Minimal mucosal hyperenhancement of the proximal colon could feasibly reflect a mild component of inflammatory bowel disease. No fistula or drainable fluid collection is seen. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: STRUCTURED REPORT: CT 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: Stomach is normal. COLON / APPENDIX: The appendix is normal. There is hyperenhancement and wall thickening of the cecum, ascending colon, and small portion of splenic flexure. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Stranding in the subcutaneous tissue of the left hip is again seen.
FINDINGS: BRAIN PARENCHYMA: No intraparenchymal hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is appropriate for patient's age. Partial empty sella EXTRA-AXIAL SPACES: No epidural, subdural, or subarachnoid hemorrhage. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SKULL AND SKULL BASE: No acute fracture. FACIAL BONES: No acute fracture. MANDIBLE: Intact. SINUSES: Well aerated. MASTOIDS: Clear. DENTITION: Diffuse periapical and periodontal disease with a large periapical lucency associated with the left second maxillary molar SOFT TISSUES: Large left subgaleal hematoma with subcutaneous emphysema consistent with scalp laceration and possible degloving injury.
3,004
CT Lumbar Spine from Reformat Indication: Concern for atraumatic lumbar back pain Comparison: No previous studies are available for comparison Procedure: Multiple contiguous axial images of the lumbar spine were reformatted from CT abdomen helical acquisition. Sagittal and coronal reformatted images were also obtained for evaluation of alignment. . Findings: The lumbar vertebral body heights and intervertebral disc spaces are well-maintained. Lumbar vertebral body alignment is anatomic. The paravertebral soft tissues appear normal. The remaining visualized osseous and soft tissue structures appear within normal limits. T12-L1: No significant disc bulge. No significant spinal canal or foraminal narrowing.. L1-2: No significant disc bulge. No significant spinal canal or foraminal narrowing.. L2-3: No significant disc bulge. No significant spinal canal or foraminal narrowing.. L3-4: Minimal posterior disc bulge. No significant spinal canal or foraminal narrowing.. L4-5: Mild posterior disc bulge. No significant spinal canal stenosis. No significant neural foraminal narrowing.. L5-S1: Mild posterior disc bulge with mild spinal canal stenosis. No significant neural foraminal narrowing.. Miscellaneous: Fat-containing left adnexal lesion measuring 1.9 cm, likely age dermoid cyst. Additional adjacent larger intermediate density cyst measuring approximately 4.1 cm in diameter in the left adnexa. Further evaluation with pelvic ultrasound is suggested. Impression: 1. No acute lumbar spine fracture or acute alignment abnormality. 2. Mild degenerative changes in the lumbar spine, predominantly affecting the lower lumbar spine as described above. 3. Fat-containing left adnexal lesion measuring 1.9 cm, likely age dermoid cyst. Additional adjacent larger intermediate density cyst measuring approximately 4.1 cm in diameter in the left adnexa. Further evaluation with pelvic ultrasound is suggested.
Findings: The lumbar vertebral body heights and intervertebral disc spaces are well-maintained. Lumbar vertebral body alignment is anatomic. The paravertebral soft tissues appear normal. The remaining visualized osseous and soft tissue structures appear within normal limits. T12-L1: No significant disc bulge. No significant spinal canal or foraminal narrowing.. L1-2: No significant disc bulge. No significant spinal canal or foraminal narrowing.. L2-3: No significant disc bulge. No significant spinal canal or foraminal narrowing.. L3-4: Minimal posterior disc bulge. No significant spinal canal or foraminal narrowing.. L4-5: Mild posterior disc bulge. No significant spinal canal stenosis. No significant neural foraminal narrowing.. L5-S1: Mild posterior disc bulge with mild spinal canal stenosis. No significant neural foraminal narrowing.. Miscellaneous: Fat-containing left adnexal lesion measuring 1.9 cm, likely age dermoid cyst. Additional adjacent larger intermediate density cyst measuring approximately 4.1 cm in diameter in the left adnexa. Further evaluation with pelvic ultrasound is suggested.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Bilateral dependent upper and lower lobe opacities may represent contusive changes in the setting of trauma or atelectasis. No pleural effusion or pneumothorax. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Large amount of hemorrhage surrounding the mid and lower portions of the thoracic esophagus. No pneumomediastinum. Hyperdensities within the mediastinal hemorrhage in the right of the esophagus are suspicious for active extravasation, likely venous (image 104 series 501). DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Sternomanubrial joint fracture dislocation, with approximately 5 mm displacement of the manubrium to the sternal body, with adjacent tiny osseous fragments. There is associated small retrosternal hematoma. Nondisplaced fracture of the posterior left third rib. ABDOMEN and PELVIS: Somewhat limited due to motion artifact. LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: See above for sternal manubrial fracture dislocation and rib fracture. See below for spine fractures. Comminuted right midclavicular fracture. THORACIC SPINE: VERTEBRA: Fracture of the right C7 lamina with extension into the inferior articular facet. Burst fracture of T3 with involvement of the right pedicle and transverse process with extension into the inferior articular process. Fracture fragments are within the spinal canal, with at least moderate spinal canal narrowing. T3 spinous process fracture. Anterior and right lateral translation of T3 over T4. Burst fracture of T4 with slight retropulsion. Bilateral T4 transverse process fractures. There is splaying of the T3 and T4 spinous processes. T5 and T6 compression fractures with minimal anterior wedging. Compression fracture with mild anterior wedging. DISC SPACES AND FACET JOINTS: See above PREVERTEBRAL SOFT TISSUES: Prevertebral hemorrhage associated with the compression fractures. ALIGNMENT: See above. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
3,005
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Left lower quadrant pain COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 197 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 85 sec Scan field of view: 346 mm. DLP: 681.50 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: 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 dermoid cyst measuring up to 2.0 cm with enlarged left ovary. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Left ovarian dermoid cyst with enlarged left ovary concerning for ovarian torsion. Recommend pelvic ultrasound. Findings were discussed with Dr. Edgar by Dr. Phillips via telephone at 1/7/2022 7:43 AM.
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. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Left dermoid cyst measuring up to 2.0 cm with enlarged left ovary. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Bilateral dependent upper and lower lobe opacities may represent contusive changes in the setting of trauma or atelectasis. No pleural effusion or pneumothorax. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Large amount of hemorrhage surrounding the mid and lower portions of the thoracic esophagus. No pneumomediastinum. Hyperdensities within the mediastinal hemorrhage in the right of the esophagus are suspicious for active extravasation, likely venous (image 104 series 501). DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Sternomanubrial joint fracture dislocation, with approximately 5 mm displacement of the manubrium to the sternal body, with adjacent tiny osseous fragments. There is associated small retrosternal hematoma. Nondisplaced fracture of the posterior left third rib. ABDOMEN and PELVIS: Somewhat limited due to motion artifact. LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: See above for sternal manubrial fracture dislocation and rib fracture. See below for spine fractures. Comminuted right midclavicular fracture. THORACIC SPINE: VERTEBRA: Fracture of the right C7 lamina with extension into the inferior articular facet. Burst fracture of T3 with involvement of the right pedicle and transverse process with extension into the inferior articular process. Fracture fragments are within the spinal canal, with at least moderate spinal canal narrowing. T3 spinous process fracture. Anterior and right lateral translation of T3 over T4. Burst fracture of T4 with slight retropulsion. Bilateral T4 transverse process fractures. There is splaying of the T3 and T4 spinous processes. T5 and T6 compression fractures with minimal anterior wedging. Compression fracture with mild anterior wedging. DISC SPACES AND FACET JOINTS: See above PREVERTEBRAL SOFT TISSUES: Prevertebral hemorrhage associated with the compression fractures. ALIGNMENT: See above. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
3,006
RADIOLOGIC EXAM: CT Head wo contrast CLINICAL INFORMATION: HA, seizures. COMPARISON: 10/4/2019 TECHNIQUE: CT of the head without intravenous contrast. Scan field of view: 216 mm. DLP: 1395.90 mGy cm. FINDINGS: BRAIN PARENCHYMA: No hemorrhage, edema, or mass effect. Posterior left frontal encephalomalacia, unchanged. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: Left frontal craniotomy changes. VENTRICULAR SYSTEM: Normal. ORBITS: Right periorbital fixation. SINUSES: Right anterior maxillary wall fixation. Minimal mucosal thickening of the left maxillary sinus and ethmoid sinuses. SOFT TISSUES: Normal. CONCLUSION: No acute intracranial process. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, edema, or mass effect. Posterior left frontal encephalomalacia, unchanged. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: Left frontal craniotomy changes. VENTRICULAR SYSTEM: Normal. ORBITS: Right periorbital fixation. SINUSES: Right anterior maxillary wall fixation. Minimal mucosal thickening of the left maxillary sinus and ethmoid sinuses. SOFT TISSUES: Normal.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Bilateral dependent upper and lower lobe opacities may represent contusive changes in the setting of trauma or atelectasis. No pleural effusion or pneumothorax. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Large amount of hemorrhage surrounding the mid and lower portions of the thoracic esophagus. No pneumomediastinum. Hyperdensities within the mediastinal hemorrhage in the right of the esophagus are suspicious for active extravasation, likely venous (image 104 series 501). DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Sternomanubrial joint fracture dislocation, with approximately 5 mm displacement of the manubrium to the sternal body, with adjacent tiny osseous fragments. There is associated small retrosternal hematoma. Nondisplaced fracture of the posterior left third rib. ABDOMEN and PELVIS: Somewhat limited due to motion artifact. LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: See above for sternal manubrial fracture dislocation and rib fracture. See below for spine fractures. Comminuted right midclavicular fracture. THORACIC SPINE: VERTEBRA: Fracture of the right C7 lamina with extension into the inferior articular facet. Burst fracture of T3 with involvement of the right pedicle and transverse process with extension into the inferior articular process. Fracture fragments are within the spinal canal, with at least moderate spinal canal narrowing. T3 spinous process fracture. Anterior and right lateral translation of T3 over T4. Burst fracture of T4 with slight retropulsion. Bilateral T4 transverse process fractures. There is splaying of the T3 and T4 spinous processes. T5 and T6 compression fractures with minimal anterior wedging. Compression fracture with mild anterior wedging. DISC SPACES AND FACET JOINTS: See above PREVERTEBRAL SOFT TISSUES: Prevertebral hemorrhage associated with the compression fractures. ALIGNMENT: See above. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
3,007
EXAM: CT Wrist Right wo contrast CLINICAL INFORMATION: Trauma COMPARISON: 1/7/2022. TECHNIQUE: CT Wrist Right wo contrast Scan field of view: 148 mm. DLP: 279.60 mGy cm. FINDINGS: BONES/JOINTS: Posterior comminuted distal radial fracture with extension into the radiocarpal joint. Degenerative changes of the wrist most prominent within the CMC joint of the thumb. SOFT TISSUES: Soft tissue swelling of the wrist. CONCLUSION: 1. Distal radial comminuted fracture with intra-articular extension into the radiocarpal joint. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: BONES/JOINTS: Posterior comminuted distal radial fracture with extension into the radiocarpal joint. Degenerative changes of the wrist most prominent within the CMC joint of the thumb. SOFT TISSUES: Soft tissue swelling of the wrist.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Bilateral dependent upper and lower lobe opacities may represent contusive changes in the setting of trauma or atelectasis. No pleural effusion or pneumothorax. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Large amount of hemorrhage surrounding the mid and lower portions of the thoracic esophagus. No pneumomediastinum. Hyperdensities within the mediastinal hemorrhage in the right of the esophagus are suspicious for active extravasation, likely venous (image 104 series 501). DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Sternomanubrial joint fracture dislocation, with approximately 5 mm displacement of the manubrium to the sternal body, with adjacent tiny osseous fragments. There is associated small retrosternal hematoma. Nondisplaced fracture of the posterior left third rib. ABDOMEN and PELVIS: Somewhat limited due to motion artifact. LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: See above for sternal manubrial fracture dislocation and rib fracture. See below for spine fractures. Comminuted right midclavicular fracture. THORACIC SPINE: VERTEBRA: Fracture of the right C7 lamina with extension into the inferior articular facet. Burst fracture of T3 with involvement of the right pedicle and transverse process with extension into the inferior articular process. Fracture fragments are within the spinal canal, with at least moderate spinal canal narrowing. T3 spinous process fracture. Anterior and right lateral translation of T3 over T4. Burst fracture of T4 with slight retropulsion. Bilateral T4 transverse process fractures. There is splaying of the T3 and T4 spinous processes. T5 and T6 compression fractures with minimal anterior wedging. Compression fracture with mild anterior wedging. DISC SPACES AND FACET JOINTS: See above PREVERTEBRAL SOFT TISSUES: Prevertebral hemorrhage associated with the compression fractures. ALIGNMENT: See above. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
3,008
EXAM: CT Chest wo contrast CLINICAL INFORMATION: 69-year-old male with chronic shortness of breath COMPARISON: None. TECHNIQUE: CT Chest wo contrast. Scan field of view: 430 mm. DLP: 356.48 mGy cm. FINDINGS: Increased peribronchial thickening especially in the lower lobes left more than right with few areas of mucous plugging noted. There is no focal airspace consolidation or interstitial lung parenchymal abnormality. Calcified granuloma is present in the left upper lobe. Calcified mediastinal nodes in the AP window without any other noncalcified adenopathy. No pleural or pericardial effusion is seen and visualized bones are unremarkable. CONCLUSION: Small airway disease with multiple mucous plugging in the left lower lobe subsegmental bronchi along with evidence of prior healed granulomatous infection
FINDINGS: Increased peribronchial thickening especially in the lower lobes left more than right with few areas of mucous plugging noted. There is no focal airspace consolidation or interstitial lung parenchymal abnormality. Calcified granuloma is present in the left upper lobe. Calcified mediastinal nodes in the AP window without any other noncalcified adenopathy. No pleural or pericardial effusion is seen and visualized bones are unremarkable.
FINDINGS: BRAIN PARENCHYMA: No intraparenchymal hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is appropriate for patient's age. Partial empty sella EXTRA-AXIAL SPACES: No epidural, subdural, or subarachnoid hemorrhage. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SKULL AND SKULL BASE: No acute fracture. FACIAL BONES: No acute fracture. MANDIBLE: Intact. SINUSES: Well aerated. MASTOIDS: Clear. DENTITION: Diffuse periapical and periodontal disease with a large periapical lucency associated with the left second maxillary molar SOFT TISSUES: Large left subgaleal hematoma with subcutaneous emphysema consistent with scalp laceration and possible degloving injury.
3,009
EXAM: CT Chest with contrast CLINICAL INFORMATION: 75-year-old female follow-up spine tumor COMPARISON: No prior CT for comparison TECHNIQUE: CT Chest with contrast. Patient weight: 140 lbs. IV contrast: Omnipaque 350, 60 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 35 sec Scan field of view: 334 mm. DLP: 205 mGy cm. FINDINGS: No enlarged nodes are seen in the mediastinum, hila or either axilla. A small tracheal cyst is present in the upper mediastinum in the right posterior lateral aspect of the trachea. There is no focal airspace or interstitial lung parenchymal abnormality or discrete lung nodule/mass identified. No pleural or pericardial effusion is seen and there is no focal lytic or sclerotic bone lesion. Multiple cystic lesions are identified in the liver with the largest in the left hepatic lobe. CONCLUSION: 1. No intrathoracic primary malignancy or metastatic disease. 2. Cystic lesions in the liver statistically likely simple cysts. This can be further evaluated with abdominal ultrasound as desired.
FINDINGS: No enlarged nodes are seen in the mediastinum, hila or either axilla. A small tracheal cyst is present in the upper mediastinum in the right posterior lateral aspect of the trachea. There is no focal airspace or interstitial lung parenchymal abnormality or discrete lung nodule/mass identified. No pleural or pericardial effusion is seen and there is no focal lytic or sclerotic bone lesion. Multiple cystic lesions are identified in the liver with the largest in the left hepatic lobe.
FINDINGS: BRAIN PARENCHYMA: No intraparenchymal hemorrhage, mass effect or edema. No suspicious areas of enhancement. Gray-white matter differentiation is maintained. Cerebral cortical volume is appropriate for patient's age. Mild cerebellar ectopia, incompletely evaluated. EXTRA-AXIAL SPACES: No epidural, subdural, or subarachnoid hemorrhage. SKULL AND SKULL BASE: No acute fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Well aerated. MASTOIDS: Clear. SOFT TISSUES: Unremarkable.
3,010
EXAM: CT Abdomen and Pelvis wo+w contrast CLINICAL INFORMATION: Gross hematuria COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis wo+w contrast. Patient weight: 290 lbs. IV contrast: Omnipaque 350, 180 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: 60sec/5min Scan field of view: 500 mm. DLP: 3520 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal DISTAL ESOPHAGUS: Normal. ABDOMEN and PELVIS: LIVER: Subcentimeter hypodensity is statistically a cyst. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: The left adrenal gland is nodular with a enhancing adrenal nodule measuring 1.3 cm on image 52 series 900. Two right adrenal nodules are seen, the largest measuring 1.4 cm on image 62 series 900, both consistent with adenomas. KIDNEYS: Subcentimeter hypodensities are statistically cysts. 1.7 x 1.5 cm left enhancing mass on image 118 series 900. Larger left renal cyst lower pole. No definite uroepithelial lesion seen. No definite renal calculi seen. LYMPH NODES: Shotty enlarged left external iliac and peripancreatic nodes and mildly enlarged mesenteric root nodes for example 1.2 x 1.1 cm on image 122 series 900. STOMACH / SMALL BOWEL: Probable 1.7 cm lipoma seen in the stomach on image 58 series 900. COLON / APPENDIX: Diverticulosis. PERITONEUM / MESENTERY: No ascites. Soft tissue stranding is seen in the mesenteric root.. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Very enlarged heterogeneous prostate with protrusion into the urinary bladder. BODY WALL: Small bilateral inguinal hernias. Small fat-containing umbilical hernia. MUSCULOSKELETAL: A few scattered small sclerotic foci are seen in the left pelvis with asymmetric sclerosis of the left symphysis pubis. CONCLUSION: 1. 1.7 cm enhancing left renal mass worrisome for renal cell carcinoma. 2. Bilateral adrenal nodules, two in the right consistent with adenomas but the left 1.3 cm nodule is moderately enhancing, worrisome for metastasis. Recommend multiphase CT/MRI for further evaluation. 3. Soft tissue stranding seen in the mesenteric root with a few mildly enlarged lymph nodes; differential includes mesenteric panniculitis and lymphoma. 4. Very enlarged irregular enhancing prostate with protrusion into the bladder base worrisome for prostate carcinoma. Recommend correlation with PSA. Scattered sclerotic foci as above, metastasis cannot be excluded.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal DISTAL ESOPHAGUS: Normal. ABDOMEN and PELVIS: LIVER: Subcentimeter hypodensity is statistically a cyst. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: The left adrenal gland is nodular with a enhancing adrenal nodule measuring 1.3 cm on image 52 series 900. Two right adrenal nodules are seen, the largest measuring 1.4 cm on image 62 series 900, both consistent with adenomas. KIDNEYS: Subcentimeter hypodensities are statistically cysts. 1.7 x 1.5 cm left enhancing mass on image 118 series 900. Larger left renal cyst lower pole. No definite uroepithelial lesion seen. No definite renal calculi seen. LYMPH NODES: Shotty enlarged left external iliac and peripancreatic nodes and mildly enlarged mesenteric root nodes for example 1.2 x 1.1 cm on image 122 series 900. STOMACH / SMALL BOWEL: Probable 1.7 cm lipoma seen in the stomach on image 58 series 900. COLON / APPENDIX: Diverticulosis. PERITONEUM / MESENTERY: No ascites. Soft tissue stranding is seen in the mesenteric root.. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Very enlarged heterogeneous prostate with protrusion into the urinary bladder. BODY WALL: Small bilateral inguinal hernias. Small fat-containing umbilical hernia. MUSCULOSKELETAL: A few scattered small sclerotic foci are seen in the left pelvis with asymmetric sclerosis of the left symphysis pubis.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Linear atelectatic changes at both lung bases. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Prominent in size with micronodular contour may correlate with cirrhotic changes. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Calcified granuloma. Otherwise unremarkable. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The colon is redundant PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Myomatous uterus. Heterogeneous enhancement. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. Marginal sites are seen throughout the lumbar spine. Degenerative changes of the L2-L3 disc.
3,011
EXAM: CT Chest wo contrast CLINICAL INFORMATION: 66-year-old female follow-up lung nodule COMPARISON: None. TECHNIQUE: CT Chest wo contrast. Scan field of view: 282 mm. DLP: 146.79 mGy cm. FINDINGS: Ill-defined groundglass opacities are present in both lungs left upper lobe more than right along with few scattered tiny 2 to 3 mm solid-appearing nodules bilaterally. Additional subtle subpleural reticulations are noted especially in the lower lobes without honeycombing. There is mild bronchiectasis in both lower lobes and to a lesser degree right middle and upper lobes. Mild centrilobular emphysematous changes are also present in the upper lobes. Only small subcentimeter size nodes are noted in the mediastinum. A small hiatal hernia is also evident. There is no pleural or pericardial effusion and visualized bones are unremarkable. CONCLUSION: 1. Mild upper lobe COPD and very subtle early subpleural reticulations and multi lobar mild bronchiectasis raising concern for chronic interstitial lung disease? from recurrent aspiration. 3. Indeterminate several scattered tiny 2 to 3 mm lung nodules along with areas of ill-defined groundglass parenchymal opacities most pronounced in the left upper lobe. Recommend comparison with any prior remote CT and follow-up in 3-6 months. 3. Small hiatal hernia
FINDINGS: Ill-defined groundglass opacities are present in both lungs left upper lobe more than right along with few scattered tiny 2 to 3 mm solid-appearing nodules bilaterally. Additional subtle subpleural reticulations are noted especially in the lower lobes without honeycombing. There is mild bronchiectasis in both lower lobes and to a lesser degree right middle and upper lobes. Mild centrilobular emphysematous changes are also present in the upper lobes. Only small subcentimeter size nodes are noted in the mediastinum. A small hiatal hernia is also evident. There is no pleural or pericardial effusion and visualized bones are unremarkable.
FINDINGS: BRAIN PARENCHYMA: No intraparenchymal hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral volume is normal. EXTRA-AXIAL SPACES: No epidural, subdural, or subarachnoid hemorrhage. VENTRICULAR SYSTEM: Normal. ORBITS: Minimal stranding of the inferior extraconal fat within the left orbit. Bilateral proptosis. No posterior scleral flattening or straightening of the optic nerve. OTHER: Central vascular calcifications. SKULL AND SKULL BASE: No acute fracture. FACIAL BONES: No acute fracture. MANDIBLE: Intact. SINUSES: Well aerated with mucus retention cyst in the left sphenoid sinus.. MASTOIDS: Clear. FACIAL SOFT TISSUES: Large hematoma within the soft tissues overlying the left face extending superiorly to the inferior orbital margin.
3,012
EXAM: CT Ankle Left wo contrast CLINICAL INFORMATION: Left ankle pain. History of MRI showing left talar head and calcaneal anterior process fractures. COMPARISON: Bilateral foot radiograph 12/21/2021. TECHNIQUE: CT Ankle Left wo contrast Scan field of view: 206 mm. DLP: 247.20 mGy cm. STRUCTURED REPORT: CT Bone vDec2021 FINDINGS: BONES/JOINTS: No acute fracture or malalignment. SOFT TISSUES: No large hematoma or fluid collection. CONCLUSION: No acute 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.
FINDINGS: BONES/JOINTS: No acute fracture or malalignment. SOFT TISSUES: No large hematoma or fluid collection.
FINDINGS: BRAIN PARENCHYMA: No intraparenchymal hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral volume is normal. EXTRA-AXIAL SPACES: No epidural, subdural, or subarachnoid hemorrhage. VENTRICULAR SYSTEM: Normal. ORBITS: Minimal stranding of the inferior extraconal fat within the left orbit. Bilateral proptosis. No posterior scleral flattening or straightening of the optic nerve. OTHER: Central vascular calcifications. SKULL AND SKULL BASE: No acute fracture. FACIAL BONES: No acute fracture. MANDIBLE: Intact. SINUSES: Well aerated with mucus retention cyst in the left sphenoid sinus.. MASTOIDS: Clear. FACIAL SOFT TISSUES: Large hematoma within the soft tissues overlying the left face extending superiorly to the inferior orbital margin.
3,013
RADIOLOGIC EXAM: CT Head wo contrast CLINICAL INFORMATION: Trauma. COMPARISON: CT head dated 2/11/2021. TECHNIQUE: CT Head wo contrastScan field of view: 230 mm. DLP: 1404.20 mGy cm. STRUCTURED REPORT: CT Head Trauma FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Mild age-appropriate brain involution. Moderate severity periventricular white matter hypoattenuation, suggesting chronic small vessel ischemic disease. Intracranial vascular atherosclerosis. EXTRA-AXIAL SPACES: Stable linear branching calcifications along the lateral aspect of the right lobe may be cortical venous calcifications. SKULL AND SKULL BASE: No fracture. Right mastoid effusion. VENTRICULAR SYSTEM: Normal. ORBITS: Bilateral pseudophakia. SINUSES: Normal. CONCLUSION: 1. No acute intracranial process. 2. Small right mastoid effusion. 3. Other chronic and incidental findings as described above.
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Mild age-appropriate brain involution. Moderate severity periventricular white matter hypoattenuation, suggesting chronic small vessel ischemic disease. Intracranial vascular atherosclerosis. EXTRA-AXIAL SPACES: Stable linear branching calcifications along the lateral aspect of the right lobe may be cortical venous calcifications. SKULL AND SKULL BASE: No fracture. Right mastoid effusion. VENTRICULAR SYSTEM: Normal. ORBITS: Bilateral pseudophakia. SINUSES: Normal.
FINDINGS: BRAIN PARENCHYMA: Moderate parenchymal atrophy. Periventricular and subcortical white matter lucencies. Loss of gray-white differentiation at the medial, inferior right cerebellar hemisphere. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. No aggressive osseous lesion. VENTRICULAR SYSTEM: Ex vacuo dilatation. ORBITS: Left pseudophakia SINUSES: Normal. OTHER: Decreased size of right scalp hematoma. Nasoenteric tube. Central vascular calcifications.
3,014
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Fall COMPARISON: 12/11/21 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 100 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 75 sec Scan field of view: 332 mm. DLP: 328.80 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: No acute abnormality or significant change. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Stable cardiomegaly. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Stable left adrenal nodule. Right adrenal gland is normal. KIDNEYS: Unchanged renal cysts and additional stable subcentimeter hypoattenuating lesions are too small to characterize but likely also cysts. Otherwise normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No bowel obstruction. Uncomplicated lower ventral abdominal wall hernia containing short segment of not dilated small bowel. Small sliding hiatal hernia. COLON / APPENDIX: No acute abnormality. Noninflamed colonic diverticula. PERITONEUM / MESENTERY: No free fluid or free air. RETROPERITONEUM: Normal. VESSELS: Aortoiliac atherosclerotic disease with stable ectasia of the infrarenal abdominal aortic. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No acute abnormality. Prior hysterectomy. BODY WALL: Uncomplicated ventral abdominal hernia containing segment of small bowel. MUSCULOSKELETAL: No acute fracture or destructive osseous lesion. CONCLUSION: 1. No acute abdominal or pelvic abnormality. 2. Noninflamed colonic diverticula, small uncomplicated ventral abdominal wall hernia containing short segment of small bowel, and additional chronic/incidental findings as above.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: No acute abnormality or significant change. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Stable cardiomegaly. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Stable left adrenal nodule. Right adrenal gland is normal. KIDNEYS: Unchanged renal cysts and additional stable subcentimeter hypoattenuating lesions are too small to characterize but likely also cysts. Otherwise normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No bowel obstruction. Uncomplicated lower ventral abdominal wall hernia containing short segment of not dilated small bowel. Small sliding hiatal hernia. COLON / APPENDIX: No acute abnormality. Noninflamed colonic diverticula. PERITONEUM / MESENTERY: No free fluid or free air. RETROPERITONEUM: Normal. VESSELS: Aortoiliac atherosclerotic disease with stable ectasia of the infrarenal abdominal aortic. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No acute abnormality. Prior hysterectomy. BODY WALL: Uncomplicated ventral abdominal hernia containing segment of small bowel. MUSCULOSKELETAL: No acute fracture or destructive osseous lesion.
FINDINGS: CT of the head without contrast: See separately dictated report for noncontrast CT findings. CT angiogram of the brain: RIGHT INTRACRANIAL CAROTID: Calcific and noncalcific atherosclerosis within the cavernous and clinoid segments with mild luminal narrowing. There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT INTRACRANIAL CAROTID: Calcific and noncalcific atherosclerosis within the cavernous and clinoid segments with mild luminal narrowing. There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Fetal origin of the bilateral PCAs. Slight narrowing of the right posterior communicating artery. Otherwise there is no evidence of significant stenosis, occlusion, or aneurysmal dilation. VERTEBROBASILAR ARTERIES: Complete occlusion of the right V4 segment. Significant narrowing of the left V4 segment and the proximal basilar artery with near occlusion. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: Calcific and noncalcific atherosclerosis within the bulb without significant stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: Moderate sized atheromatous plaque at the bifurcation extending into the ICA with approximately 30% luminal narrowing. There is no evidence of flow-limiting stenosis, occlusion, or aneurysmal dilation. RIGHT VERTEBRAL ARTERY: Significantly diminutive compared to the left with occlusion of the V2 segment within the transverse foramen of C3. Minimal reconstitution of flow within the proximal V3 segment with recurrent occlusion in the distal V3 and V4 segments. LEFT VERTEBRAL ARTERY: Multifocal narrowing within the V4 segment extending into the basilar artery.
3,015
RADIOLOGIC EXAM: CT Lumbar Spine from Reformat CLINICAL INFORMATION: Trauma. COMPARISON: CT abdomen 12/11/2021. TECHNIQUE: CT Lumbar Spine from Reformat Following CT of the abdomen, reformatted images were produced to optimize visualization of the osseous structures of the lumbar spine. STRUCTURED REPORT: CT Lumbar Spine Trauma FINDINGS: VERTEBRA: No acute fractures. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel discogenic and facet related degenerative changes of the lumbar spine. Prominent disc osteophyte complexes at L1-L2, L2-L3, L4-L5 and L5-S1. Moderate spinal canal stenosis at L4-L5 mild spinal canal stenosis at L1-L2. Bilateral severe neural foraminal stenosis at T12-L1, right L1-L2, right L2-L3, bilateral L3-L4, bilateral L5-S1 and left L4-L5 with mild neural foraminal stenosis at left L2-L3 and L1-L2. PREVERTEBRAL SOFT TISSUES: Infrarenal abdominal aortic ectasia measuring approximately 2.7 cm in maximum diameter. Extensive abdominal pelvic vascular calcifications. Colonic diverticulosis. No other significant abnormality of the abdominal and pelvic soft tissues. Paravertebral musculature demonstrates mild atrophy. ALIGNMENT: Grade 1 anterolisthesis of L4 on L5. Scoliosis of the lumbar spine with apex to the left. CONCLUSION: 1. No acute fracture or malalignment of the lumbar spine. Other multilevel chronic degenerative changes as described above. Overall similar appearance to prior CT study performed on 12/11/2021.
FINDINGS: VERTEBRA: No acute fractures. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel discogenic and facet related degenerative changes of the lumbar spine. Prominent disc osteophyte complexes at L1-L2, L2-L3, L4-L5 and L5-S1. Moderate spinal canal stenosis at L4-L5 mild spinal canal stenosis at L1-L2. Bilateral severe neural foraminal stenosis at T12-L1, right L1-L2, right L2-L3, bilateral L3-L4, bilateral L5-S1 and left L4-L5 with mild neural foraminal stenosis at left L2-L3 and L1-L2. PREVERTEBRAL SOFT TISSUES: Infrarenal abdominal aortic ectasia measuring approximately 2.7 cm in maximum diameter. Extensive abdominal pelvic vascular calcifications. Colonic diverticulosis. No other significant abnormality of the abdominal and pelvic soft tissues. Paravertebral musculature demonstrates mild atrophy. ALIGNMENT: Grade 1 anterolisthesis of L4 on L5. Scoliosis of the lumbar spine with apex to the left.
FINDINGS: CT of the head without contrast: See separately dictated report for noncontrast CT findings. CT angiogram of the brain: RIGHT INTRACRANIAL CAROTID: Calcific and noncalcific atherosclerosis within the cavernous and clinoid segments with mild luminal narrowing. There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT INTRACRANIAL CAROTID: Calcific and noncalcific atherosclerosis within the cavernous and clinoid segments with mild luminal narrowing. There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Fetal origin of the bilateral PCAs. Slight narrowing of the right posterior communicating artery. Otherwise there is no evidence of significant stenosis, occlusion, or aneurysmal dilation. VERTEBROBASILAR ARTERIES: Complete occlusion of the right V4 segment. Significant narrowing of the left V4 segment and the proximal basilar artery with near occlusion. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: Calcific and noncalcific atherosclerosis within the bulb without significant stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: Moderate sized atheromatous plaque at the bifurcation extending into the ICA with approximately 30% luminal narrowing. There is no evidence of flow-limiting stenosis, occlusion, or aneurysmal dilation. RIGHT VERTEBRAL ARTERY: Significantly diminutive compared to the left with occlusion of the V2 segment within the transverse foramen of C3. Minimal reconstitution of flow within the proximal V3 segment with recurrent occlusion in the distal V3 and V4 segments. LEFT VERTEBRAL ARTERY: Multifocal narrowing within the V4 segment extending into the basilar artery.
3,016
RADIOLOGIC EXAM: CT Cervical Spine wo contrast CLINICAL INFORMATION: Fall COMPARISON: 1/10/15 TECHNIQUE: CT Cervical Spine wo contrast 3-D CT MIP and Volume rendered angiographic images were generated in post processing. Scan field of view: 217 mm. DLP: 376 mGy cm. 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 (
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 (
"Prognostic" color maps were also generated depicting areas of ischemia (voxel values for MTT > 1.4 times mirror image voxels on the contralateral "normal side") in the color green and areas predictive of infarction (CBV values 6.0 seconds: 15 mL. Mismatch volume: 4 mL. Color parametric and prognostic maps demonstrate infarct and small volume penumbra involving the distribution of the right PICA. ---------------
3,017
EXAM: CT Enterography CLINICAL INFORMATION: Known mild distal small bowel stricture and abscess with unsubstantiated history of Crohn's. Bowel obstruction suspected. COMPARISON: 10/19/2017. TECHNIQUE: CT imaging of the abdomen and pelvis was performed with IV contrast per CT enterography protocol. CT Enterography Patient weight: 122 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: 338 mm. DLP: 415 mGy cm. STRUCTURED REPORT: CT Enterography FINDINGS: LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. ABDOMEN AND PELVIS: STOMACH: No abnormality. SMALL BOWEL: Distal ileum is thick-walled with distal ileal narrowing without gross terminal ileal wall thickening. Severe small bowel dilatation upstream, with another loop of bowel tethered and narrowed in the region of the more distal small bowel thickening on image 211 series 2. PERITONEUM / MESENTERY: No fistula or abscess. Small ascites. COLORECTAL: No abnormal bowel wall thickening or enhancement. APPENDIX: Not definitely seen. PERIANAL TISSUES: No fistula or abscess. LIVER: Scattered hepatic cysts. Small subcentimeter hypodensities are statistically cysts. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: 1.2 cm hypodensity in the right kidney is indeterminate on this study but was a simple cyst on recent MRI.. 1.1 cm left renal cyst at the upper pole is indeterminate. Simple left renal cysts. The most caudal left renal cyst has small amount of peripheral calcification and is slightly over threshold for simple cyst but did not enhance on the prior CT of 10/17 with and without contrast. LYMPH NODES: Mildly enlarged mesenteric root adenopathy and an enlarged node adjacent to the area of bowel wall thickening and narrowing measuring 1.7 cm on image 198 series 2 RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic disease. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostate is moderately enlarged with calcification. BODY WALL: Small left inguinal fat-containing hernia. MUSCULOSKELETAL: Marked osteopenia. CONCLUSION: 1. 1.2 cm hypodensity in the right kidney is indeterminate and enlarged from prior. Recommend ultrasound to exclude solid renal lesion. 2. High-grade small bowel obstruction, with severe dilatation of mid and distal small bowel. The distal ileum is markedly thick-walled and with a focal area of narrowing in the right lower quadrant with adjacent adenopathy. An additional upstream small bowel narrowing is seen with tethering to the more distal small bowel narrowing. Mild mesenteric soft tissue stranding and adenopathy. Findings are consistent but not diagnostic of Crohn's disease, carcinoid tumor is in the differential due to the enhancing nodule in the area of tethering. No definite focal abscess seen on today's study; no definite fistula seen. 3. Incidental findings as detailed above.
FINDINGS: LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. ABDOMEN AND PELVIS: STOMACH: No abnormality. SMALL BOWEL: Distal ileum is thick-walled with distal ileal narrowing without gross terminal ileal wall thickening. Severe small bowel dilatation upstream, with another loop of bowel tethered and narrowed in the region of the more distal small bowel thickening on image 211 series 2. PERITONEUM / MESENTERY: No fistula or abscess. Small ascites. COLORECTAL: No abnormal bowel wall thickening or enhancement. APPENDIX: Not definitely seen. PERIANAL TISSUES: No fistula or abscess. LIVER: Scattered hepatic cysts. Small subcentimeter hypodensities are statistically cysts. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: 1.2 cm hypodensity in the right kidney is indeterminate on this study but was a simple cyst on recent MRI.. 1.1 cm left renal cyst at the upper pole is indeterminate. Simple left renal cysts. The most caudal left renal cyst has small amount of peripheral calcification and is slightly over threshold for simple cyst but did not enhance on the prior CT of 10/17 with and without contrast. LYMPH NODES: Mildly enlarged mesenteric root adenopathy and an enlarged node adjacent to the area of bowel wall thickening and narrowing measuring 1.7 cm on image 198 series 2 RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic disease. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostate is moderately enlarged with calcification. BODY WALL: Small left inguinal fat-containing hernia. MUSCULOSKELETAL: Marked osteopenia.
FINDINGS: BRAIN PARENCHYMA: No intraparenchymal hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is appropriate for patient's age. EXTRA-AXIAL SPACES: No epidural, subdural, or subarachnoid hemorrhage. SKULL AND SKULL BASE: No acute fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Left maxillary sinus mucus retention cyst. MASTOIDS: Clear. SOFT TISSUES: Unremarkable.
3,018
EXAM: CT Bone Pelvis w soft tissue no charge CLINICAL INFORMATION: Pelvic trauma COMPARISON: None. TECHNIQUE: CT Bone Pelvis w soft tissue no charge Scan field of view: 344 mm. Findings: There is a comminuted, moderately displaced fracture through the right iliac wing. There is no extension into the right sacroiliac joint. There is disruption of the right iliac crest laterally. No additional fracture is seen in the pelvic ring. Small soft tissue calcifications along the anterior aspect of the right greater trochanter appears chronic and likely reflects hydroxyapatite crystal deposition in the gluteus minimus tendon. Impression: Comminuted right iliac wing fracture
Findings: There is a comminuted, moderately displaced fracture through the right iliac wing. There is no extension into the right sacroiliac joint. There is disruption of the right iliac crest laterally. No additional fracture is seen in the pelvic ring. Small soft tissue calcifications along the anterior aspect of the right greater trochanter appears chronic and likely reflects hydroxyapatite crystal deposition in the gluteus minimus tendon.
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, intracranial mass, large territory infarct, or edema. Gray-white matter differentiation maintained. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: Suspected left nasal fracture with minimal displacement. No other fracture. No aggressive osseous lesion. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Right maxillary sinus mucus retention cyst.
3,019
CT Angio Head wo+w contrast, CT Angio Neck 1/7/2022 7:48 AM Indication: StrokeTIA, assess extracranial arteries, R20.2 Paresthesia of skin Spec Inst: Numbness to entire right arm and leg 2 days ago, current smoker. Comparison: No prior similar studies are presented for comparison at this time. Technique: Axial noncontrast images from the level of the skull base to the vertex. After the administration of IV contrast bolus, helical axial images were obtained from the clavicles to the vertex and reformatted in multiple planes. Delayed contrast enhanced axial images were then performed from the base of the skull to the vertex. 3-D CT angiographic images were generated from the axial data set. "Sliding MIP" images were also generated in the sagittal, axial, and coronal planes. Patient weight: 300 lbs. IV contrast: Omnipaque 350, 125 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 4 ml per sec. Scan delay: BT sec. Scan field of view: 255 mm. DLP: 5540.50 mGy cm. (accession CT220003604), Patient weight: 300 lbs. IV contrast: Omnipaque 350, 125 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracking Scan field of view: 255 mm. (accession CT220003603) Findings: Conventional CT of the brain: There is no evidence of acute intracranial hemorrhage. There is no evidence of midline shift, mass effect, or other space-occupying lesion. The ventricular system is normal without hydrocephalus. Delayed postcontrast imaging demonstrates no pathologic enhancement. CT angiogram of the brain: Scattered atherosclerosis of the intracranial vasculature. The visualized portions of the ICAs and vertebrobasilar system appear within normal limits. The visualized portions of the ACAs, MCAs, and PCAs appear within normal limits. Neural venous sinuses and cortical veins appear patent. CT angiogram of the neck: Severe streak artifact from bilateral shoulders and extensive quantum mottle involving the mediastinum and lower cervical region limits evaluation of aortic arch and proximal arch vessels. Within this limitation, there is common origin of right brachiocephalic and left common carotid artery and otherwise normal-appearing aortic arch and proximal arch vessels. Minimal atherosclerotic changes at bilateral carotid bulbs. Poor visualization of bilateral proximal vertebral arteries. The visualized distal vertebral arteries in the neck are unremarkable. Otherwise, the visualized portions of the common, as well as cervical portions of the internal, and external carotid arteries appear within normal limits. Miscellaneous: Above-described severe artifacts limit evaluation of the upper mediastinum and lower neck soft tissues. No significant abnormality within this limitation. No acute abnormalities in the cervical spine with mild degenerative changes. IMPRESSION: No acute intracranial process appreciated. No evidence of cervical or intracranial arterial abnormality at this time.
Findings: Conventional CT of the brain: There is no evidence of acute intracranial hemorrhage. There is no evidence of midline shift, mass effect, or other space-occupying lesion. The ventricular system is normal without hydrocephalus. Delayed postcontrast imaging demonstrates no pathologic enhancement. CT angiogram of the brain: Scattered atherosclerosis of the intracranial vasculature. The visualized portions of the ICAs and vertebrobasilar system appear within normal limits. The visualized portions of the ACAs, MCAs, and PCAs appear within normal limits. Neural venous sinuses and cortical veins appear patent. CT angiogram of the neck: Severe streak artifact from bilateral shoulders and extensive quantum mottle involving the mediastinum and lower cervical region limits evaluation of aortic arch and proximal arch vessels. Within this limitation, there is common origin of right brachiocephalic and left common carotid artery and otherwise normal-appearing aortic arch and proximal arch vessels. Minimal atherosclerotic changes at bilateral carotid bulbs. Poor visualization of bilateral proximal vertebral arteries. The visualized distal vertebral arteries in the neck are unremarkable. Otherwise, the visualized portions of the common, as well as cervical portions of the internal, and external carotid arteries appear within normal limits. Miscellaneous: Above-described severe artifacts limit evaluation of the upper mediastinum and lower neck soft tissues. No significant abnormality within this limitation. No acute abnormalities in the cervical spine with mild degenerative changes.
FINDINGS: 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 fracture. No aggressive osseous lesion. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Mucosal thickening involving the maxillary sinuses and ethmoid air cells with multiple maxillary sinus mucus retention cysts. OTHER: Endotracheal tube and oroenteric tube.
3,020
CT Angio Head wo+w contrast, CT Angio Neck 1/7/2022 7:48 AM Indication: StrokeTIA, assess extracranial arteries, R20.2 Paresthesia of skin Spec Inst: Numbness to entire right arm and leg 2 days ago, current smoker. Comparison: No prior similar studies are presented for comparison at this time. Technique: Axial noncontrast images from the level of the skull base to the vertex. After the administration of IV contrast bolus, helical axial images were obtained from the clavicles to the vertex and reformatted in multiple planes. Delayed contrast enhanced axial images were then performed from the base of the skull to the vertex. 3-D CT angiographic images were generated from the axial data set. "Sliding MIP" images were also generated in the sagittal, axial, and coronal planes. Patient weight: 300 lbs. IV contrast: Omnipaque 350, 125 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 4 ml per sec. Scan delay: BT sec. Scan field of view: 255 mm. DLP: 5540.50 mGy cm. (accession CT220003604), Patient weight: 300 lbs. IV contrast: Omnipaque 350, 125 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracking Scan field of view: 255 mm. (accession CT220003603) Findings: Conventional CT of the brain: There is no evidence of acute intracranial hemorrhage. There is no evidence of midline shift, mass effect, or other space-occupying lesion. The ventricular system is normal without hydrocephalus. Delayed postcontrast imaging demonstrates no pathologic enhancement. CT angiogram of the brain: Scattered atherosclerosis of the intracranial vasculature. The visualized portions of the ICAs and vertebrobasilar system appear within normal limits. The visualized portions of the ACAs, MCAs, and PCAs appear within normal limits. Neural venous sinuses and cortical veins appear patent. CT angiogram of the neck: Severe streak artifact from bilateral shoulders and extensive quantum mottle involving the mediastinum and lower cervical region limits evaluation of aortic arch and proximal arch vessels. Within this limitation, there is common origin of right brachiocephalic and left common carotid artery and otherwise normal-appearing aortic arch and proximal arch vessels. Minimal atherosclerotic changes at bilateral carotid bulbs. Poor visualization of bilateral proximal vertebral arteries. The visualized distal vertebral arteries in the neck are unremarkable. Otherwise, the visualized portions of the common, as well as cervical portions of the internal, and external carotid arteries appear within normal limits. Miscellaneous: Above-described severe artifacts limit evaluation of the upper mediastinum and lower neck soft tissues. No significant abnormality within this limitation. No acute abnormalities in the cervical spine with mild degenerative changes. IMPRESSION: No acute intracranial process appreciated. No evidence of cervical or intracranial arterial abnormality at this time.
Findings: Conventional CT of the brain: There is no evidence of acute intracranial hemorrhage. There is no evidence of midline shift, mass effect, or other space-occupying lesion. The ventricular system is normal without hydrocephalus. Delayed postcontrast imaging demonstrates no pathologic enhancement. CT angiogram of the brain: Scattered atherosclerosis of the intracranial vasculature. The visualized portions of the ICAs and vertebrobasilar system appear within normal limits. The visualized portions of the ACAs, MCAs, and PCAs appear within normal limits. Neural venous sinuses and cortical veins appear patent. CT angiogram of the neck: Severe streak artifact from bilateral shoulders and extensive quantum mottle involving the mediastinum and lower cervical region limits evaluation of aortic arch and proximal arch vessels. Within this limitation, there is common origin of right brachiocephalic and left common carotid artery and otherwise normal-appearing aortic arch and proximal arch vessels. Minimal atherosclerotic changes at bilateral carotid bulbs. Poor visualization of bilateral proximal vertebral arteries. The visualized distal vertebral arteries in the neck are unremarkable. Otherwise, the visualized portions of the common, as well as cervical portions of the internal, and external carotid arteries appear within normal limits. Miscellaneous: Above-described severe artifacts limit evaluation of the upper mediastinum and lower neck soft tissues. No significant abnormality within this limitation. No acute abnormalities in the cervical spine with mild degenerative changes.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Endotracheal and enteric tubes. Examination is limited to due to artifact from bilateral arm down positioning. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube terminates approximately 2 cm above the carina. Layering secretions noted in the trachea, left, and right mainstem bronchi, right interlobar bronchus, and left lower lobe bronchus. Bilateral dependent consolidative opacities in the lower lobes. No pleural effusion or pneumothorax. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Esophagogastric tube courses throughout the esophagus. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Left renal hypodensities probably represent simple cysts, although evaluation is limited due to beam hardening artifact from patient's arms. No focal laceration. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube terminates in the proximal stomach, with sidehole just distal to the gastroesophageal junction.. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Decompressed around a Foley catheter, limiting wall evaluation. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute fracture. THORACIC SPINE: VERTEBRA: Anterior wedging of T10 vertebral body appears most likely chronic or developmental. No other fracture. DISC SPACES AND FACET JOINTS: Multilevel mild discogenic degenerative changes PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
3,021
EXAM: CT Abdomen wo+w contrast CLINICAL INFORMATION: 54-year-old male with HCC surveillance status post liver transplant. COMPARISON: CT abdomen 3/26/2021 TECHNIQUE: CT Abdomen wo+w contrast. Patient weight: 236 lbs. IV contrast: Omnipaque 350, 180 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: Bolus Tracked. Scan field of view: 500 mm. FINDINGS: STRUCTURED REPORT: CT Abdomen LOWER CHEST: Please see separately dictated same-day CT chest. ABDOMEN: LIVER: Postsurgical changes from a liver transplant. There are no suspicious lesions. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: There is a cystic lesion within the tail of the pancreas measuring 1.3 x 1.3 cm (series 900 image 97), previously 1.3 cm on 3/26/2021. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Subcentimeter hypodensities are statistically cysts but formally indeterminate. But formally indeterminate. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: Diverticulosis without evidence of diverticulitis. The appendix is not well visualized. PERITONEUM / MESENTERY: Small area of fat necrosis on image 334 series 13. No ascites. RETROPERITONEUM: Normal. VESSELS: Redemonstration of large splenic and retroperitoneal varices. BODY WALL: There is a focal defect of the right lateral abdominal wall measuring approximately 3.0 cm (series 900 image 182) containing herniated fat, new from prior. Postsurgical changes from a prior anterior abdominal wall incision. MUSCULOSKELETAL: No destructive osseous lesions seen CONCLUSION: 1. Postsurgical changes from a prior liver transplant without evidence of residual or recurrent HCC. 2. Unchanged large splenic and retroperitoneal varices. 3. Stable appearance of the pancreatic tail cystic lesion. 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.
FINDINGS: STRUCTURED REPORT: CT Abdomen LOWER CHEST: Please see separately dictated same-day CT chest. ABDOMEN: LIVER: Postsurgical changes from a liver transplant. There are no suspicious lesions. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: There is a cystic lesion within the tail of the pancreas measuring 1.3 x 1.3 cm (series 900 image 97), previously 1.3 cm on 3/26/2021. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Subcentimeter hypodensities are statistically cysts but formally indeterminate. But formally indeterminate. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: Diverticulosis without evidence of diverticulitis. The appendix is not well visualized. PERITONEUM / MESENTERY: Small area of fat necrosis on image 334 series 13. No ascites. RETROPERITONEUM: Normal. VESSELS: Redemonstration of large splenic and retroperitoneal varices. BODY WALL: There is a focal defect of the right lateral abdominal wall measuring approximately 3.0 cm (series 900 image 182) containing herniated fat, new from prior. Postsurgical changes from a prior anterior abdominal wall incision. MUSCULOSKELETAL: No destructive osseous lesions seen
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Endotracheal and enteric tubes. Examination is limited to due to artifact from bilateral arm down positioning. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube terminates approximately 2 cm above the carina. Layering secretions noted in the trachea, left, and right mainstem bronchi, right interlobar bronchus, and left lower lobe bronchus. Bilateral dependent consolidative opacities in the lower lobes. No pleural effusion or pneumothorax. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Esophagogastric tube courses throughout the esophagus. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Left renal hypodensities probably represent simple cysts, although evaluation is limited due to beam hardening artifact from patient's arms. No focal laceration. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube terminates in the proximal stomach, with sidehole just distal to the gastroesophageal junction.. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Decompressed around a Foley catheter, limiting wall evaluation. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute fracture. THORACIC SPINE: VERTEBRA: Anterior wedging of T10 vertebral body appears most likely chronic or developmental. No other fracture. DISC SPACES AND FACET JOINTS: Multilevel mild discogenic degenerative changes PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
3,022
CT Chest with contrast Clinical Information: HCC surveillance sp liver transplant; HO HCC, Z94.4 Liver transplant status, D89.9 Disorder involving the immune mechanism, unspecified Spec Inst: HCC surveillance; please evaluate for recurrent HCC Comparison: 3/26/2021 Technique: Following injection of non-ionic contrast 1 mm images were obtained through the chest. Abdominal findings will be reported separately. Patient weight: 236 lbs. IV contrast: Omnipaque 350, 180 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: 10 sec. Scan field of view: 500 mm. DLP: 2747 mGy cm. Findings: No enlarged intrathoracic nodes are present. Small hiatal hernia. Mild coronary artery calcification is seen. The heart size and mediastinum are otherwise normal. Small RML nodule along the right minor fissure on series 14 image 312 remains unchanged. The 3 mm RLL nodule on image 35 is also unchanged. New focal consolidation with some peripheral tree-in-bud opacity is seen medially in the left lung base. Increased bilateral bronchial wall thickening is present. Slight atelectasis in the RLL is redemonstrated. The lungs are otherwise normal with no new nodules or masses.. No pleural effusion. No focal destructive osseous lesions identified. CT abdomen and pelvis will be dictated separately. Impression: 1. Two tiny nodules which are unchanged back to 2018 consistent with benign nodules. No intrathoracic metastases. 2. New area of parenchymal consolidation and peripheral tree-in-bud opacities in the medial left lower lobe consistent with infection. 3. Increased bilateral bronchial wall thickening representing airway infection or inflammation.
Findings: No enlarged intrathoracic nodes are present. Small hiatal hernia. Mild coronary artery calcification is seen. The heart size and mediastinum are otherwise normal. Small RML nodule along the right minor fissure on series 14 image 312 remains unchanged. The 3 mm RLL nodule on image 35 is also unchanged. New focal consolidation with some peripheral tree-in-bud opacity is seen medially in the left lung base. Increased bilateral bronchial wall thickening is present. Slight atelectasis in the RLL is redemonstrated. The lungs are otherwise normal with no new nodules or masses.. No pleural effusion. No focal destructive osseous lesions identified. CT abdomen and pelvis will be dictated separately.
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 (
3,023
CLINICAL HISTORY PROVIDED: Subdural hematoma, S06.5X9A Traumatic subdural hemorrhage with loss of consciousness of unspecified duration, initial encounter TECHNIQUE: Axial 5 mm thick CT images of the brain were performed without intravenous contrast. Scan field of view: 226 mm. DLP: 798.53 mGy cm. COMPARISON: CT head 10/15/2021. FINDINGS: Interval decrease of the left frontoparietal convexity subdural hemorrhage with 8mm thickness residual collection is noted. A small sized hyperdense blood clot remains visualized. No intracranial mass effect is noted. Previous mild rightward midline shift is resolved. Bilateral ventriculomegaly is again noted. Left superficial temporal branch glue embolization materials are also redemonstrated. IMPRESSION: Decreased left frontoparietal convexity subdural hemorrhage.
FINDINGS: Interval decrease of the left frontoparietal convexity subdural hemorrhage with 8mm thickness residual collection is noted. A small sized hyperdense blood clot remains visualized. No intracranial mass effect is noted. Previous mild rightward midline shift is resolved. Bilateral ventriculomegaly is again noted. Left superficial temporal branch glue embolization materials are also redemonstrated.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Endotracheal and enteric tubes. Examination is limited to due to artifact from bilateral arm down positioning. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube terminates approximately 2 cm above the carina. Layering secretions noted in the trachea, left, and right mainstem bronchi, right interlobar bronchus, and left lower lobe bronchus. Bilateral dependent consolidative opacities in the lower lobes. No pleural effusion or pneumothorax. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Esophagogastric tube courses throughout the esophagus. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Left renal hypodensities probably represent simple cysts, although evaluation is limited due to beam hardening artifact from patient's arms. No focal laceration. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube terminates in the proximal stomach, with sidehole just distal to the gastroesophageal junction.. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Decompressed around a Foley catheter, limiting wall evaluation. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute fracture. THORACIC SPINE: VERTEBRA: Anterior wedging of T10 vertebral body appears most likely chronic or developmental. No other fracture. DISC SPACES AND FACET JOINTS: Multilevel mild discogenic degenerative changes PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
3,024
CLINICAL HISTORY PROVIDED: Subarachnoid hemorrhage (SAH), follow up, I60.9 Nontraumatic subarachnoid hemorrhage, unspecified TECHNIQUE: Axial 5 mm thick CT images of the brain were performed without intravenous contrast. Scan field of view: 252 mm. DLP: 867 mGy cm. COMPARISON: CT head dated 11/9/2021. FINDINGS: There is interval acute on chronic subdural hemorrhage over the left parietal convexity measuring 1 cm in thickness. The right parietal convexity also shows thin chronic subdural collection. Previous residual subarachnoid hemorrhage is completely resolved. Triventricular dilatation is unchanged. The right frontal shunt catheter and pneumocephalus are no longer seen. No vascular territory cerebral ischemic pathology is noted. There is continued enlargement of superior cerebellar cistern. IMPRESSION: 1. Interval resolution of residual subarachnoid hemorrhage. 2. Acute on chronic subdural hemorrhage over the left parietal convexity. 3. Stable ventriculomegaly.
FINDINGS: There is interval acute on chronic subdural hemorrhage over the left parietal convexity measuring 1 cm in thickness. The right parietal convexity also shows thin chronic subdural collection. Previous residual subarachnoid hemorrhage is completely resolved. Triventricular dilatation is unchanged. The right frontal shunt catheter and pneumocephalus are no longer seen. No vascular territory cerebral ischemic pathology is noted. There is continued enlargement of superior cerebellar cistern.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Endotracheal and enteric tubes. Examination is limited to due to artifact from bilateral arm down positioning. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube terminates approximately 2 cm above the carina. Layering secretions noted in the trachea, left, and right mainstem bronchi, right interlobar bronchus, and left lower lobe bronchus. Bilateral dependent consolidative opacities in the lower lobes. No pleural effusion or pneumothorax. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Esophagogastric tube courses throughout the esophagus. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Left renal hypodensities probably represent simple cysts, although evaluation is limited due to beam hardening artifact from patient's arms. No focal laceration. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube terminates in the proximal stomach, with sidehole just distal to the gastroesophageal junction.. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Decompressed around a Foley catheter, limiting wall evaluation. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute fracture. THORACIC SPINE: VERTEBRA: Anterior wedging of T10 vertebral body appears most likely chronic or developmental. No other fracture. DISC SPACES AND FACET JOINTS: Multilevel mild discogenic degenerative changes PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
3,025
EXAM: CT Angio Lower Ext Bil wo+w contrast CLINICAL INFORMATION: History of ameloblastoma. CTA with runoff for surgical planning for fibular free flap reconstruction. COMPARISON: None. TECHNIQUE: CT Angio Lower Ext Bil wo+w contrast. Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 170 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3.80 ml per sec. Scan delay: Bolus Tracked. Scan field of view: 360 mm. DLP: 1199.51 mGy cm. FINDINGS: STRUCTURED REPORT: CTA Lower Extremities VASCULATURE: ABDOMINAL AORTA: No significant abnormality. RIGHT ILIAC ARTERIES: No significant abnormality. RIGHT FEMORAL \T\ POPLITEAL ARTERIES: No significant abnormality. RIGHT TIBIAL AND PERONEAL ARTERIES: No significant abnormality. RIGHT FOOT ARTERIES: No significant abnormality. LEFT ILIAC ARTERIES: No significant abnormality. LEFT FEMORAL \T\ POPLITEAL ARTERIES: No significant abnormality. LEFT TIBIAL AND PERONEAL ARTERIES: No significant abnormality. LEFT FOOT ARTERIES: No significant abnormality. ------------------------------------------------------------- LOWER ABDOMEN: BOWEL: No abnormality. PERITONEUM: Normal. OTHER: No other abnormality. PELVIS: VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Normal CTA runoff. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: STRUCTURED REPORT: CTA Lower Extremities VASCULATURE: ABDOMINAL AORTA: No significant abnormality. RIGHT ILIAC ARTERIES: No significant abnormality. RIGHT FEMORAL \T\ POPLITEAL ARTERIES: No significant abnormality. RIGHT TIBIAL AND PERONEAL ARTERIES: No significant abnormality. RIGHT FOOT ARTERIES: No significant abnormality. LEFT ILIAC ARTERIES: No significant abnormality. LEFT FEMORAL \T\ POPLITEAL ARTERIES: No significant abnormality. LEFT TIBIAL AND PERONEAL ARTERIES: No significant abnormality. LEFT FOOT ARTERIES: No significant abnormality. ------------------------------------------------------------- LOWER ABDOMEN: BOWEL: No abnormality. PERITONEUM: Normal. OTHER: No other abnormality. PELVIS: VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
Findings: Lucency at the base of the anterior nasal spine of the maxilla with corticated margins, likely chronic. There are no other acute maxillofacial or mandibular fractures. There is no evidence of orbital soft tissue injury. Mucosal thickening involving the frontoethmoidal recesses, ethmoid air cells, anterior sphenoid sinuses, and maxillary sinuses with mucous retention cysts within the maxillary sinuses bilaterally. The paranasal sinuses, middle ears, mastoid antra, and mastoid air cells are otherwise clear. Enteric and endotracheal tubes are present.
3,026
CT Angio Head wo+w contrast 1/7/2022 8:40 AM Clinical Information: cerebral aneurysm, I67.1 Cerebral aneurysm, nonruptured Comparison: CTA head dated 3/9/2021. Technique: 5 mm axial images were obtained without contrast from the base of the skull to the vertex. During the IV infusion of contrast, [] mm images were obtained from the base of skull through the vertex. Delayed contrast enhanced 5 mm axial images were then performed from the base of the skull to the vertex. 3-D CT angiographic images were generated from the axial data set. "Sliding MIP" images were also generated in the sagittal, axial, and coronal planes. Patient weight: 185 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 4 ml per sec. Scan delay: Bolus Tracked. Scan field of view: 219 mm. DLP: 2890 mGy cm. Findings: Head CT: No intracranial hemorrhage or acute cerebral ischemia is noted. Bilateral maxillary sinuses show air-fluid levels with frothy secretion, left greater than right. Head CTA: The wide neck saccular aneurysm of the right cavernous ICA measures 1.5 x 1.7 cm in sac diameter, stable when compared with previous exam. No intraluminal thrombus or daughter sac outpouching is noted. The right supraclinoid ICA remains patent. The left intracranial ICA and other major intracranial arteries are unremarkable. Impression: 1. Stable size of the right cavernous ICA wide neck saccular aneurysm. 2. Bilateral maxillary acute sinusitis.
Findings: Head CT: No intracranial hemorrhage or acute cerebral ischemia is noted. Bilateral maxillary sinuses show air-fluid levels with frothy secretion, left greater than right. Head CTA: The wide neck saccular aneurysm of the right cavernous ICA measures 1.5 x 1.7 cm in sac diameter, stable when compared with previous exam. No intraluminal thrombus or daughter sac outpouching is noted. The right supraclinoid ICA remains patent. The left intracranial ICA and other major intracranial arteries are unremarkable.
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 (
3,027
EXAM: CT Chest wo contrast CLINICAL INFORMATION: 35-year-old female with provided history of pleural effusions. COMPARISON: Chest CT 12/27/2021 and chest radiograph 1/6/2020 TECHNIQUE: CT Chest wo contrast. Scan field of view: 350 mm. DLP: 274.70 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. Limitations: None. Chest: Lines, tubes, and devices: A right pleural drainage catheter is noted. Left chest tube and mediastinal drains are noted. Retained epicardial wires. Lung parenchyma and pleura: Redemonstrated loculated bilateral pleural effusions, not substantially changed since the prior exam. Interval development of patchy hyperdense subpleural lesions in the left pleura, for example at image 40, may be representing hematomas. Thoracic inlet, heart, and mediastinum: Mediastinal fatty stranding with areas of air loculi, likely related to postoperative changes. Multiple bilateral axillary supraclavicular and mediastinal lymph nodes, probably reactive. The esophagus is nondilated. Interval tricuspid valve prosthesis. The overall heart size normal. Mild pericardial effusion. The thoracic aorta and main pulmonary arteries are normal in caliber. Bones and soft tissues: There is generalized extensive anasarca. Median sternotomy with intact sternotomy wires. No aggressive bone lesion. Upper abdomen: Large upper abdominal ascites. CONCLUSION: 1. Bilateral loculated pleural effusions with interval development of hyperdense left pleural areas, likely related to hematomas. 2. Expected postoperative changes along the mediastinum. 3. Extensive generalized anasarca and upper abdominal ascites. 4. Other findings as described.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. Limitations: None. Chest: Lines, tubes, and devices: A right pleural drainage catheter is noted. Left chest tube and mediastinal drains are noted. Retained epicardial wires. Lung parenchyma and pleura: Redemonstrated loculated bilateral pleural effusions, not substantially changed since the prior exam. Interval development of patchy hyperdense subpleural lesions in the left pleura, for example at image 40, may be representing hematomas. Thoracic inlet, heart, and mediastinum: Mediastinal fatty stranding with areas of air loculi, likely related to postoperative changes. Multiple bilateral axillary supraclavicular and mediastinal lymph nodes, probably reactive. The esophagus is nondilated. Interval tricuspid valve prosthesis. The overall heart size normal. Mild pericardial effusion. The thoracic aorta and main pulmonary arteries are normal in caliber. Bones and soft tissues: There is generalized extensive anasarca. Median sternotomy with intact sternotomy wires. No aggressive bone lesion. Upper abdomen: Large upper abdominal ascites.
FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: No focal consolidation, pleural effusion, or pneumothorax. Severe biapical centrilobular and paraseptal emphysema. Diaphragms are flattened. Transverse narrowing of the thoracic trachea. Bilateral basilar predominant bronchial wall thickening. HEART / VESSELS: Heart size is normal. Trace pericardial effusion. Mild coronary artery calcifications. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality.
3,028
CT Angio Head wo+w contrast Clinical Information: Headache, new or worsening. Comparison: CT head 11/30/2021. Technique: Nonenhanced axial CT images of the brain were obtained. During the IV infusion of contrast, arterial phase and delayed phase postcontrast axial images were then performed. Additional 3D post-processing was done with MIP and volume rendered images, which were reviewed for interpretation. Patient weight: 165 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 4 ml per sec. Scan delay: BOLUS TRACK, 190 SEC. sec. Scan field of view: 250 mm. DLP: 2826.40 mGy cm. Findings: CT Head: No evidence for large vascular territory stroke. Mild age-appropriate brain involution. Bilateral basal ganglia mineralizations. No intracranial hemorrhage, intracranial mass, mass effect or midline shift. Basal cisterns are patent. Bilateral orbits are unremarkable. Visualized paranasal sinuses, mastoid air cells and middle ear cavities are within normal limits. No acute osseous abnormalities. Delayed phase postcontrast images demonstrate no abnormal meningeal or parenchymal enhancement. CTA Head: Scattered intracranial vascular atherosclerosis. Otherwise, there is no evidence of intracranial vascular occlusion, flow-limiting stenosis, aneurysm, or vascular malformation. Bilateral intracranial ICAs, bilateral MCAs, bilateral ACAs, bilateral PCAs, bilateral intracranial vertebral arteries and basilar artery demonstrate no significant abnormalities. Visualized cortical veins and dural venous sinuses are patent. Impression: 1. No acute intracranial abnormality. Additional chronic and incidental changes as described above. 2. Mild atherosclerotic calcification of the intracranial vasculature without additional significant abnormality.
Findings: CT Head: No evidence for large vascular territory stroke. Mild age-appropriate brain involution. Bilateral basal ganglia mineralizations. No intracranial hemorrhage, intracranial mass, mass effect or midline shift. Basal cisterns are patent. Bilateral orbits are unremarkable. Visualized paranasal sinuses, mastoid air cells and middle ear cavities are within normal limits. No acute osseous abnormalities. Delayed phase postcontrast images demonstrate no abnormal meningeal or parenchymal enhancement. CTA Head: Scattered intracranial vascular atherosclerosis. Otherwise, there is no evidence of intracranial vascular occlusion, flow-limiting stenosis, aneurysm, or vascular malformation. Bilateral intracranial ICAs, bilateral MCAs, bilateral ACAs, bilateral PCAs, bilateral intracranial vertebral arteries and basilar artery demonstrate no significant abnormalities. Visualized cortical veins and dural venous sinuses are patent.
FINDINGS: STRUCTURED REPORT: CTA CAP VASCULATURE: CORONARY ARTERIES: There are no atherosclerotic calcifications of the native coronary arteries. PULMONARY ARTERIES: No central pulmonary embolus. Normal size. ASCENDING THORACIC AORTA: No significant abnormality. AORTIC ARCH: No significant abnormality. ARCH VESSELS: Similar small nonobstructing thrombus in left subclavian artery. DESCENDING THORACIC AORTA: Similar appearance of the mural thrombi in the descending thoracic aorta. ABDOMINAL AORTA: Similar nonobstructing mural thrombus in the suprarenal abdominal aorta (image 314 series 602). CELIAC AXIS: No significant abnormality. SMA: Postsurgical changes of the SMA thrombectomy. The SMA is now patent, although small portion of the SMA is obscured by artifact from adjacent clips. RIGHT RENAL: Three right renal arteries. LEFT RENAL: Two left renal arteries. IMA: No significant abnormality. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. ------------------------------------------------------------- LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Moderate bilateral pleural effusion, increased from prior with adjacent atelectasis. A few scattered groundglass opacities, most notably in the right middle lobe with additional mosaic attenuation in the right upper lobe and to a lesser extent in the left upper lobe.. HEART / OTHER VESSELS: Right internal jugular catheter terminates in the SVC. Normal heart size. No central pulmonary embolus, although technique is not optimized for pulmonary embolus evaluation. Small pericardial effusion. MEDIASTINUM / ESOPHAGUS: Small sliding hiatal hernia and fluid throughout the esophagus, suggesting gastroesophageal reflux. LYMPH NODES: None enlarged. CHEST WALL: Chest wall and flank edema. ABDOMEN and PELVIS: LIVER: Steatosis. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Redemonstrated wedge-shaped hypoattenuating lesions, likely infarcts. One of these demonstrates peripheral enhancement and capsular expansion. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Moderate volume of pneumoperitoneum. Moderate volume of free fluid throughout the abdomen with layering hematocrit, suggesting hemoperitoneum. Peritoneal thickening and enhancement, compatible with peritonitis. Postsurgical changes of small bowel resection and ileocecectomy. There is significant stranding surrounding the proximal small bowel anastomosis in the central abdomen, suggesting that this is possible site of perforation. There is fluid collection adjacent to this as well. Multiple areas of small bowel thickening and hyperenhancement noted. COLON / APPENDIX: Postsurgical changes of ileocecectomy. The remainder of the colon is fluid-filled and there is hyperenhancing of the colonic wall, likely reactive.. PERITONEUM / MESENTERY: Moderate pneumoperitoneum and moderate hemoperitoneum with peritoneal thickening and enhancement, suggesting peritonitis. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Collapsed around a Foley catheter. BODY WALL: Severe diffuse anasarca. Midline incisional staples. MUSCULOSKELETAL: No significant abnormality.
3,029
CT Neck Soft Tissue w contrast 1/7/2022 8:11 AM Clinical Information: Dysphagia. Lymphadenopathy in the neck. Comparison: None. Technique: Axial images of the neck were obtained following the administration of intravenous contrast. Reformatted coronal and sagittal images were also obtained. Patient weight: 223 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. IV contrast injection rate: 3 ml per sec. Scan delay: 45 sec. Scan field of view: 294 mm. DLP: 685 mGy cm. Findings: Enlarged necrotic right level IIA lymph node measuring approximately 2.9 x 2.1 cm. Other smaller bilateral cervical lymph nodes, not enlarged by CT size criteria. Mild right soft tissue fullness without discrete identifiable mass in the right oropharyngeal soft tissues. Dental amalgam artifact limits evaluation of the oral cavity. Otherwise, the nasopharynx and oropharynx are normal in appearance. The base of the tongue and lymphoid tissue within Waldeyer's ring are unremarkable. The hypopharynx and larynx appear normal. The parotid, submandibular, and thyroid glands appear normal. Included portions of the brain and skull base appear normal. Anterior spinal fusion extending from C4 to C7 level. Chronic pars interarticularis defect at left C6. Incomplete fusion of posterior arch of C6. Multilevel degenerative changes in the cervical spine. Impression: 1. Enlarged necrotic appearing right level IIA lymph node, concerning for metastatic lymphadenopathy. Mild asymmetric fullness of the right oropharyngeal soft tissues without identifiable discrete mass. Otherwise, no definite CT identifiable primary is seen in the imaged neck within the limitations of streak artifact from dental amalgam and anterior spinal fixation hardware. 2. Anterior spinal fusion extending from C4 to C7 level. Multilevel degenerative changes in the cervical spine.
Findings: Enlarged necrotic right level IIA lymph node measuring approximately 2.9 x 2.1 cm. Other smaller bilateral cervical lymph nodes, not enlarged by CT size criteria. Mild right soft tissue fullness without discrete identifiable mass in the right oropharyngeal soft tissues. Dental amalgam artifact limits evaluation of the oral cavity. Otherwise, the nasopharynx and oropharynx are normal in appearance. The base of the tongue and lymphoid tissue within Waldeyer's ring are unremarkable. The hypopharynx and larynx appear normal. The parotid, submandibular, and thyroid glands appear normal. Included portions of the brain and skull base appear normal. Anterior spinal fusion extending from C4 to C7 level. Chronic pars interarticularis defect at left C6. Incomplete fusion of posterior arch of C6. Multilevel degenerative changes in the cervical spine.
FINDINGS: STRUCTURED REPORT: CTA CAP VASCULATURE: CORONARY ARTERIES: There are no atherosclerotic calcifications of the native coronary arteries. PULMONARY ARTERIES: No central pulmonary embolus. Normal size. ASCENDING THORACIC AORTA: No significant abnormality. AORTIC ARCH: No significant abnormality. ARCH VESSELS: Similar small nonobstructing thrombus in left subclavian artery. DESCENDING THORACIC AORTA: Similar appearance of the mural thrombi in the descending thoracic aorta. ABDOMINAL AORTA: Similar nonobstructing mural thrombus in the suprarenal abdominal aorta (image 314 series 602). CELIAC AXIS: No significant abnormality. SMA: Postsurgical changes of the SMA thrombectomy. The SMA is now patent, although small portion of the SMA is obscured by artifact from adjacent clips. RIGHT RENAL: Three right renal arteries. LEFT RENAL: Two left renal arteries. IMA: No significant abnormality. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. ------------------------------------------------------------- LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Moderate bilateral pleural effusion, increased from prior with adjacent atelectasis. A few scattered groundglass opacities, most notably in the right middle lobe with additional mosaic attenuation in the right upper lobe and to a lesser extent in the left upper lobe.. HEART / OTHER VESSELS: Right internal jugular catheter terminates in the SVC. Normal heart size. No central pulmonary embolus, although technique is not optimized for pulmonary embolus evaluation. Small pericardial effusion. MEDIASTINUM / ESOPHAGUS: Small sliding hiatal hernia and fluid throughout the esophagus, suggesting gastroesophageal reflux. LYMPH NODES: None enlarged. CHEST WALL: Chest wall and flank edema. ABDOMEN and PELVIS: LIVER: Steatosis. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Redemonstrated wedge-shaped hypoattenuating lesions, likely infarcts. One of these demonstrates peripheral enhancement and capsular expansion. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Moderate volume of pneumoperitoneum. Moderate volume of free fluid throughout the abdomen with layering hematocrit, suggesting hemoperitoneum. Peritoneal thickening and enhancement, compatible with peritonitis. Postsurgical changes of small bowel resection and ileocecectomy. There is significant stranding surrounding the proximal small bowel anastomosis in the central abdomen, suggesting that this is possible site of perforation. There is fluid collection adjacent to this as well. Multiple areas of small bowel thickening and hyperenhancement noted. COLON / APPENDIX: Postsurgical changes of ileocecectomy. The remainder of the colon is fluid-filled and there is hyperenhancing of the colonic wall, likely reactive.. PERITONEUM / MESENTERY: Moderate pneumoperitoneum and moderate hemoperitoneum with peritoneal thickening and enhancement, suggesting peritonitis. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Collapsed around a Foley catheter. BODY WALL: Severe diffuse anasarca. Midline incisional staples. MUSCULOSKELETAL: No significant abnormality.
3,030
EXAM: CT Angio Chest wo+w contrast CLINICAL INFORMATION: 75-year-old female with history of hemoptysis COMPARISON: Noncontrast chest CT dated November 29, 2021 TECHNIQUE: CT Angio Chest wo+w contrast. Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 132 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3 ml per sec. Scan delay: Bolus Tracked. Scan field of view: 328 mm. KVP: 100 DLP: 188 mGy cm. FINDINGS: Quality of the study is excellent. Well opacified pulmonary arteries and its branches demonstrate no intraluminal filling defect. The thoracic aorta is normal in its course and caliber. Visualized proximal coronary arteries are unremarkable except for eccentric nonobstructive mid LAD calcified plaque. No hypertrophied bronchial arteries are identified. A moderate size hiatal hernia is present with few borderline size nodes in the mediastinum especially in the right lower paratracheal AP window and subcarinal region. Diffuse increased peribronchial thickening is present along with minimal centrilobular groundglass density nodularity especially in the upper lobes. There may be mild bronchiectasis in the lower lobes. There are few ill-defined focal areas of parenchymal opacities in the right lower lobe image 140-146 with an adjacent linear calcified density, right upper lobe image 104-107, series 7. There is no focal lytic or sclerotic bone lesion. CONCLUSION: 1. No pulmonary thromboembolism. 2. Bronchitis and probable mild bronchiectasis with multifocal ill-defined inflammatory focal changes in the right upper and right lower lobe. 3. Mild respiratory bronchiolitis changes in the upper lobes. 4. Moderate size hiatal hernia.
FINDINGS: Quality of the study is excellent. Well opacified pulmonary arteries and its branches demonstrate no intraluminal filling defect. The thoracic aorta is normal in its course and caliber. Visualized proximal coronary arteries are unremarkable except for eccentric nonobstructive mid LAD calcified plaque. No hypertrophied bronchial arteries are identified. A moderate size hiatal hernia is present with few borderline size nodes in the mediastinum especially in the right lower paratracheal AP window and subcarinal region. Diffuse increased peribronchial thickening is present along with minimal centrilobular groundglass density nodularity especially in the upper lobes. There may be mild bronchiectasis in the lower lobes. There are few ill-defined focal areas of parenchymal opacities in the right lower lobe image 140-146 with an adjacent linear calcified density, right upper lobe image 104-107, series 7. There is no focal lytic or sclerotic bone lesion.
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, intracranial mass, large territory infarct, or edema. Minimal parenchymal volume loss. Trace periventricular White matter lucencies consistent with microangiopathic chronic white matter change. Gray-white matter differentiation maintained. EXTRA-AXIAL SPACES: Normal with exception of being prominent in the setting of volume loss.. SKULL AND SKULL BASE: No fracture. No aggressive osseous lesion. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Minimal incompletely evaluated right maxillary sinus mucosal thickening. Left ethmoid osteoma. Paranasal sinuses otherwise clear. Mastoids are clear. OTHER: Central vascular calcifications.
3,031
CT Chest with contrast Clinical Information: 62-year-old male restaging for lung cancer, C34.91 Malignant neoplasm of unspecified part of right bronchus or lung Spec Inst: On or before onc clinic fu on 172022 Comparison: Outside chest CT dated 8/3/2021 and images from outside PET/CT dated 9/8/2021. Technique: Following injection of non-ionic contrast 2.5 mm images were obtained through the chest and upper abdomen. Patient weight: 142 lbs. IV contrast: Omnipaque 350, 60 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 55 sec. Scan field of view: 350 mm. DLP: 210.10 mGy cm. Findings: Index lesions: 1. Lower right paratracheal node measures 13 x 19 mm on series 201 image 54 and was 14 x 18 mm on the prior. 2. Lower right paraesophageal node measures 11 x 13 mm on image 74 and was approximately 11 x 16 mm on the prior on 8/3. Small left internal mammary node is present on image 61 and appears denser but unchanged in size since August. No other enlarged intrathoracic nodes are present. Mild dilatation of the mid and lower esophagus with a small amount of fluid is seen. Calcified and noncalcified plaque is seen in the aorta and proximal brachiocephalic arteries. Marked coronary artery calcification is noted. The heart size and mediastinum are otherwise normal. There has been interval surgery with wedge resection of the right lower lobe mass. Moderate loculated hydropneumothorax is seen which extends into the major fissure. Suture lines are present posteriorly in the right lower lobe and this surrounds a focal area of loculated hydropneumothorax. There is some increased soft tissue thickening along the suture line such as on series 201 image 75 unclear if that's scar tissue or remnant tumor. A new area of parenchymal opacity is seen anteriorly in the right lung apex measuring approximately 17 x 24 mm. Bilateral centrilobular and paraseptal emphysema is redemonstrated. Mild bronchial wall thickening with a few areas of bronchial opacification are noted. Tiny anterior LUL nodule on series 2 one image 49 is unchanged from the previous exam. Tiny LUL nodule on image 59 is also unchanged. Basilar LLL nodule on image 119 remains unchanged. The lungs are otherwise clear. No focal destructive osseous lesions identified. Limited images of the upper abdomen are unremarkable. Impression: 1. Interval wedge resection of RLL cavitary mass. Suture line surrounds a small area of what appears to be loculated hydropneumothorax. Additional soft tissue along the suture line is seen and unclear if that's scarring or residual tumor. Mediastinal and right hilar nodes are the same or slightly decreased in size. 2. Moderate to large right-sided hydropneumothorax is seen with fluid extending into the major fissure. 3. Irregular parenchymal opacity in the right lung apex. Unclear if that's atelectasis due to the adjacent fluid, focal infection or new area of neoplastic change. 4. A few tiny left lung nodules are unchanged from August 2021. Continued attention on follow-up is needed.
Findings: Index lesions: 1. Lower right paratracheal node measures 13 x 19 mm on series 201 image 54 and was 14 x 18 mm on the prior. 2. Lower right paraesophageal node measures 11 x 13 mm on image 74 and was approximately 11 x 16 mm on the prior on 8/3. Small left internal mammary node is present on image 61 and appears denser but unchanged in size since August. No other enlarged intrathoracic nodes are present. Mild dilatation of the mid and lower esophagus with a small amount of fluid is seen. Calcified and noncalcified plaque is seen in the aorta and proximal brachiocephalic arteries. Marked coronary artery calcification is noted. The heart size and mediastinum are otherwise normal. There has been interval surgery with wedge resection of the right lower lobe mass. Moderate loculated hydropneumothorax is seen which extends into the major fissure. Suture lines are present posteriorly in the right lower lobe and this surrounds a focal area of loculated hydropneumothorax. There is some increased soft tissue thickening along the suture line such as on series 201 image 75 unclear if that's scar tissue or remnant tumor. A new area of parenchymal opacity is seen anteriorly in the right lung apex measuring approximately 17 x 24 mm. Bilateral centrilobular and paraseptal emphysema is redemonstrated. Mild bronchial wall thickening with a few areas of bronchial opacification are noted. Tiny anterior LUL nodule on series 2 one image 49 is unchanged from the previous exam. Tiny LUL nodule on image 59 is also unchanged. Basilar LLL nodule on image 119 remains unchanged. The lungs are otherwise clear. No focal destructive osseous lesions identified. Limited images of the upper abdomen are unremarkable.
FINDINGS: The left frontoparietal residual subdural hemorrhagic collection after craniotomy evacuation shows no gross interval change again measuring approximately 12 to 13 mm transversely. There are continued 8 mm rightward midline shift and severe effacement of the left lateral ventricle and sulcal effacement of the left hemisphere. The gray-white differentiation of the brain is normally visualized. There is no evidence of large vascular territory infarction or acute hemorrhage.
3,032
Sinus CT 1/7/2022 8:20 AM Indication: Evaluate chronic sinusitis Comparison: None. Technique: Stealth protocol PNS CT with contiguous axial 0.6 mm thickness scans through the maxillofacial region. Coronal and sagittal images were formatted from the axial data. Findings: Diffuse sinonasal polyposis with near complete opacification of the right frontal, ethmoid, maxillary and sphenoid sinuses is noted. Partially aerated left sphenoid sinus contains frothy secretion. All sinus drainage passages are occluded. Pronounced reactive hyperostosis is noted around the bilateral sphenoid walls. There is no sinus wall destruction. Inferior nasal meatus airway remains bilaterally. The olfactory fossa is intact. The orbits and intracranial contents are unremarkable. Bilateral palatine tonsillar hyperplasia is noted. No nasopharyngeal mucosal lesion is identified. Impression: 1. Chronic pansinusitis with sinonasal polyposis. 2. Left sphenoid sinus acute inflammation.
Findings: Diffuse sinonasal polyposis with near complete opacification of the right frontal, ethmoid, maxillary and sphenoid sinuses is noted. Partially aerated left sphenoid sinus contains frothy secretion. All sinus drainage passages are occluded. Pronounced reactive hyperostosis is noted around the bilateral sphenoid walls. There is no sinus wall destruction. Inferior nasal meatus airway remains bilaterally. The olfactory fossa is intact. The orbits and intracranial contents are unremarkable. Bilateral palatine tonsillar hyperplasia is noted. No nasopharyngeal mucosal lesion is identified.
FINDINGS: For concomitant CT head without contrast findings see separately dictated report. CT angiogram of the brain: RIGHT INTRACRANIAL CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT INTRACRANIAL CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Fetal origin of the right PCA. There is no evidence of stenosis, occlusion, or aneurysmal dilation. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. Prior left craniotomy defect with similar left subdural hematoma and 8 mm of left-to-right midline shift as described on accompanying CT of the head. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Conventional three vessel branching. RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. RIGHT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT VERTEBRAL ARTERY: Origin evaluation considerably limited by quantum mottle artifact. There is no evidence of stenosis, occlusion, or aneurysmal dilation. Incompletely evaluated catheter in the right axillary and subclavian vein could be related to the SVC extending to the SVC with tip not included within the field-of-view. Calcification of the stylohyoid ligament bilaterally, which can predispose to Eagle syndrome.
3,033
EXAM: CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: Incisional hernia without obstruction or gangrene. History of rectal urethral fistula and pubis prostatic fistula status post cystoprostatectomy with ileal conduit urinary diversion and diverting loop ileostomy with VRAM. Flap reconstruction. COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis wo IV contrast. Scan field of view: 381 mm. DLP: 722.91 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: A peripheral right lower lobe lung nodule on image 31 series 2 is unchanged from 3/30/2018 CT, measuring 0.5 cm on image 14 series 3. DISTAL ESOPHAGUS: Normal. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Vascular calcification. Possible punctate left nonobstructing stone. Simple renal cysts LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis. PERITONEUM / MESENTERY: No ascites. RETROPERITONEUM: Normal. VESSELS: Atherosclerotic disease URINARY BLADDER: Status post cystoprostatectomy. Ill-defined soft tissue thickening/fluid collection in the bladder bed is not definitely seen today. REPRODUCTIVE ORGANS: Prostate is surgically absent. Ill-defined prostatectomy bed soft tissue thickening, without gross fluid collection today. BODY WALL: Surgically absent left rectus muscle with broad-based bulging of the left lower abdominal wall. Left mid ileostomy. Right mid ileal conduit. MUSCULOSKELETAL: Postsurgical changes of the left SI joint. Diffuse osteopenia of the pelvis is likely status post radiation. Musculoskeletal changes were evaluated in conjunction with Dr. Mark Langston, musculoskeletal radiologist. CONCLUSION: 1. Broad-based bulging of the left lower abdominal wall. Left mid ileostomy and right mid ileal conduit. 2. No definite metastatic disease in the abdomen pelvis. 3. Incidental findings as detailed above.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: A peripheral right lower lobe lung nodule on image 31 series 2 is unchanged from 3/30/2018 CT, measuring 0.5 cm on image 14 series 3. DISTAL ESOPHAGUS: Normal. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Vascular calcification. Possible punctate left nonobstructing stone. Simple renal cysts LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis. PERITONEUM / MESENTERY: No ascites. RETROPERITONEUM: Normal. VESSELS: Atherosclerotic disease URINARY BLADDER: Status post cystoprostatectomy. Ill-defined soft tissue thickening/fluid collection in the bladder bed is not definitely seen today. REPRODUCTIVE ORGANS: Prostate is surgically absent. Ill-defined prostatectomy bed soft tissue thickening, without gross fluid collection today. BODY WALL: Surgically absent left rectus muscle with broad-based bulging of the left lower abdominal wall. Left mid ileostomy. Right mid ileal conduit. MUSCULOSKELETAL: Postsurgical changes of the left SI joint. Diffuse osteopenia of the pelvis is likely status post radiation. Musculoskeletal changes were evaluated in conjunction with Dr. Mark Langston, musculoskeletal radiologist.
FINDINGS: For concomitant CT head without contrast findings see separately dictated report. CT angiogram of the brain: RIGHT INTRACRANIAL CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT INTRACRANIAL CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Fetal origin of the right PCA. There is no evidence of stenosis, occlusion, or aneurysmal dilation. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. Prior left craniotomy defect with similar left subdural hematoma and 8 mm of left-to-right midline shift as described on accompanying CT of the head. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Conventional three vessel branching. RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. RIGHT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT VERTEBRAL ARTERY: Origin evaluation considerably limited by quantum mottle artifact. There is no evidence of stenosis, occlusion, or aneurysmal dilation. Incompletely evaluated catheter in the right axillary and subclavian vein could be related to the SVC extending to the SVC with tip not included within the field-of-view. Calcification of the stylohyoid ligament bilaterally, which can predispose to Eagle syndrome.
3,034
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Continued fever. COMPARISON: CT 01/02/2022. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 158 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: 370 mm. DLP: 561.70 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: Liver is normal in size. There is mild diffuse periportal edema may be related to volume overload.. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Spleen is normal in size. Nonspecific subcentimeter hypodensity in the splenic parenchyma probably simple cyst. ADRENALS: Normal. KIDNEYS: Wedge-shaped hypoattenuating areas in the right kidney is predominantly in the upper and interpolar region. There is mild right hydronephrosis and proximal hydroureter secondary to obstructing proximal ureteric calculus measuring 9 mm. There has been interval migration of this calculus. Persistent mild dilatation of mid/distal right ureter. Stable simple right renal cyst. No perinephric collection. Left kidney demonstrates normal size and enhancement. No left renal hydronephrosis. LYMPH NODES: Nonspecific mildly prominent periportal and subcentimeter periaortic lymph nodes. STOMACH / SMALL BOWEL: Stomach and duodenum are partially distended. There is no abnormal dilatation of small bowel loops. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Aorta is nonaneurysmal. Aorta, IVC, iliac vasculature, portal, splenic and superior mesenteric veins and hepatic veins are patent. URINARY BLADDER: Partially distended. There is marked urinary bladder wall thickening as seen on recent CT. Foley's catheter is in place. REPRODUCTIVE ORGANS: Mildly enlarged prostate BODY WALL: Large sacral decubitus ulcer as seen before. Large ulcerative wound along the left greater trochanter, partially imaged. No discrete fluid collection in the floor of ulcer. No associated erosive/destructive changes to suggest acute osteomyelitis. Vs. Acute prostatitis. Stable focal sclerosis of left femoral head. Unchanged right femoral hardware. Metallic bullet fragments in the lumbar vertebrae. MUSCULOSKELETAL: As described above. Lumbar vertebrae demonstrate normal height.. CONCLUSION: 1. CT findings suggestive of right acute pyelonephritis. Mild hydronephrosis with a obstructing right upper ureteral calculus. 2. Marked diffuse urinary bladder wall thickening suggestive of cystitis in appropriate clinical setting. 3. Large sacral decubitus ulcer and defect along the left greater trochanter. No erosive/destructive osseous findings to suggest acute osteomyelitis. No discrete drainable abscess formation. Other stable findings as described above.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Liver is normal in size. There is mild diffuse periportal edema may be related to volume overload.. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Spleen is normal in size. Nonspecific subcentimeter hypodensity in the splenic parenchyma probably simple cyst. ADRENALS: Normal. KIDNEYS: Wedge-shaped hypoattenuating areas in the right kidney is predominantly in the upper and interpolar region. There is mild right hydronephrosis and proximal hydroureter secondary to obstructing proximal ureteric calculus measuring 9 mm. There has been interval migration of this calculus. Persistent mild dilatation of mid/distal right ureter. Stable simple right renal cyst. No perinephric collection. Left kidney demonstrates normal size and enhancement. No left renal hydronephrosis. LYMPH NODES: Nonspecific mildly prominent periportal and subcentimeter periaortic lymph nodes. STOMACH / SMALL BOWEL: Stomach and duodenum are partially distended. There is no abnormal dilatation of small bowel loops. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Aorta is nonaneurysmal. Aorta, IVC, iliac vasculature, portal, splenic and superior mesenteric veins and hepatic veins are patent. URINARY BLADDER: Partially distended. There is marked urinary bladder wall thickening as seen on recent CT. Foley's catheter is in place. REPRODUCTIVE ORGANS: Mildly enlarged prostate BODY WALL: Large sacral decubitus ulcer as seen before. Large ulcerative wound along the left greater trochanter, partially imaged. No discrete fluid collection in the floor of ulcer. No associated erosive/destructive changes to suggest acute osteomyelitis. Vs. Acute prostatitis. Stable focal sclerosis of left femoral head. Unchanged right femoral hardware. Metallic bullet fragments in the lumbar vertebrae. MUSCULOSKELETAL: As described above. Lumbar vertebrae demonstrate normal height..
Findings: RAPID images demonstrate CBF less than 30% volume: 0 ml and T. Max greater than 6seconds volume: 0 ml . Mismatch volume is 0 ml. There is no abnormal MTT, T max, CBV and CBF to suggest significant ischemia or infarction at the territory of the major intracranial arteries. Within limitation of the technique, postsurgical changes are again noted from left-sided craniotomy with underlying extra-axial collection. There is similar-appearing rightward midline shift with partial effacement of the left lateral ventricle.
3,035
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: History of ovarian cancer with elevated CA-125. COMPARISON: 11/1/2021 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 110 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Oral contrast Omnipaque: 17 oz. Saline flush: 75 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 66 sec. Scan field of view: 340 mm. DLP: 453.40 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Scattered cysts are unchanged. No new suspicious hepatic lesion. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Unchanged cysts in both kidneys. No solid renal mass. LYMPH NODES: Interval enlargement of multiple mesenteric lymph nodes including a representative node in the central mesentery that measures 1.7 x 1.2 cm on axial image 313. Enlarged right external iliac lymph node appears minimally increased in size, measuring 2.7 x 1.8 cm on axial image 383. No enlarged retroperitoneal lymph node is identified. Interval enlargement of several perirectal lymph nodes (for example on axial image 401). STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis. Otherwise normal. PERITONEUM / MESENTERY: Port catheter terminating in the anterior peritoneal cavity appears similar. No ascites or fluid collection. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is absent. No suspicious vaginal cuff nodularity. No suspicious adnexal lesion. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Increasing metastatic abdominopelvic adenopathy, as above. No definite evidence of local recurrence in the pelvis.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Scattered cysts are unchanged. No new suspicious hepatic lesion. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Unchanged cysts in both kidneys. No solid renal mass. LYMPH NODES: Interval enlargement of multiple mesenteric lymph nodes including a representative node in the central mesentery that measures 1.7 x 1.2 cm on axial image 313. Enlarged right external iliac lymph node appears minimally increased in size, measuring 2.7 x 1.8 cm on axial image 383. No enlarged retroperitoneal lymph node is identified. Interval enlargement of several perirectal lymph nodes (for example on axial image 401). STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis. Otherwise normal. PERITONEUM / MESENTERY: Port catheter terminating in the anterior peritoneal cavity appears similar. No ascites or fluid collection. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is absent. No suspicious vaginal cuff nodularity. No suspicious adnexal lesion. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
Findings: Noncontrast CT head: BRAIN PARENCHYMA: No intraparenchymal hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is appropriate for patient's age. Empty sella. No cerebellar tonsillar ectopia. EXTRA-AXIAL SPACES: No epidural, subdural, or subarachnoid hemorrhage. SKULL AND SKULL BASE: No acute fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Well aerated. MASTOIDS: Clear. SOFT TISSUES: Unremarkable. CT angiogram head: RIGHT INTRACRANIAL CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT INTRACRANIAL CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT venogram head: There is normal opacification of the superior sagittal sinus, transverse sinuses, sigmoid sinuses and visualized portions of the internal jugular veins. There is no venous sinus thrombosis. There is normal asymmetric size of the right transverse sinus relative to the left. The deep cerebral veins are patent. There is no CT evidence of cavernous sinus thrombosis.
3,036
CT Chest with contrast Clinical Information: 64-year-old female Ho of ovarian cancer, increased CA125, rule out recurrence, C56.9 Malignant neoplasm of unspecified ovary Comparison: 11/1/2021 Technique: Following injection of non-ionic contrast 2.5 mm images were obtained through the chest. Abdominal findings will be reported separately. Patient weight: 110 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Oral contrast Omnipaque: 17 oz. Saline flush: 75 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 66 sec. Scan field of view: 340 mm. Findings: The tip of the right-sided port catheter projects at the SVC atrial junction. New necrotic lower left paraesophageal lymph node measures 9 x 12 mm on series 202 image 175. Right upper paratracheal node measures 11 x 20 mm on series 202 image 87 and was 8 x 14 mm on the prior. Interval enlargement of subcarinal node is seen now measuring 15 mm in short axis on image 103 and was 9 mm on the prior. Enlarged right lower lobe peribronchial nodes on images 137 143 and 154 are new since the previous exam. Superior perivascular nodes have increased in size but are still less than 10 mm in transverse diameter. No additional enlarged intrathoracic nodes are present. Slight coronary artery calcification is seen. Small hiatal hernia is noted with areas of dilatation of the esophagus. The heart size and mediastinum are otherwise normal. No pleural effusions. Enlarging RLL nodules are seen with the nodule on series 202 image 181 measuring 12 x 18 mm and this was 9 x 10 mm on the prior. It now has a necrotic center and surrounding groundglass opacity. The right lower lobe basilar nodule on image 212 measures 14 x 22 mm and is new since the previous exam. It also shows a groundglass halo and abuts the pleura. Additional tiny nodules such as in the RUL on images 86 and 87, the RUL on image 154 in the LLL on image 170 are unchanged. The lungs are otherwise normal. No focal destructive osseous lesions identified. CT abdomen pelvis will be reported separately. Impression: 1. New RLL basilar nodule and interval increase in size of previously identified right lower lobe nodule concerning for metastatic disease. 2. Increasing mediastinal, right hilar and right lower lobe peribronchial adenopathy also concerning for metastatic disease.
Findings: The tip of the right-sided port catheter projects at the SVC atrial junction. New necrotic lower left paraesophageal lymph node measures 9 x 12 mm on series 202 image 175. Right upper paratracheal node measures 11 x 20 mm on series 202 image 87 and was 8 x 14 mm on the prior. Interval enlargement of subcarinal node is seen now measuring 15 mm in short axis on image 103 and was 9 mm on the prior. Enlarged right lower lobe peribronchial nodes on images 137 143 and 154 are new since the previous exam. Superior perivascular nodes have increased in size but are still less than 10 mm in transverse diameter. No additional enlarged intrathoracic nodes are present. Slight coronary artery calcification is seen. Small hiatal hernia is noted with areas of dilatation of the esophagus. The heart size and mediastinum are otherwise normal. No pleural effusions. Enlarging RLL nodules are seen with the nodule on series 202 image 181 measuring 12 x 18 mm and this was 9 x 10 mm on the prior. It now has a necrotic center and surrounding groundglass opacity. The right lower lobe basilar nodule on image 212 measures 14 x 22 mm and is new since the previous exam. It also shows a groundglass halo and abuts the pleura. Additional tiny nodules such as in the RUL on images 86 and 87, the RUL on image 154 in the LLL on image 170 are unchanged. The lungs are otherwise normal. No focal destructive osseous lesions identified. CT abdomen pelvis will be reported separately.
FINDINGS: CT of the head with and without contrast: BRAIN PARENCHYMA: No intraparenchymal hemorrhage, mass effect or edema. Periventricular and patchy subcortical white matter hypoattenuation consistent with chronic microangiopathy. Right basal ganglia chronic lacunar infarct. Gray-white matter differentiation is preserved. EXTRA-AXIAL SPACES: No epidural, subdural, or subarachnoid hemorrhage. SKULL AND SKULL BASE: No acute fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Well aerated. MASTOIDS: Clear. SOFT TISSUES: Unremarkable. CT angiogram of the brain: RIGHT INTRACRANIAL CAROTID: Calcific atherosclerosis within the cavernous and clinoid segments without significant luminal narrowing. There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT INTRACRANIAL CAROTID: Calcific atherosclerosis within the cavernous and clinoid segments with mild luminal narrowing. There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Atheromatous plaque protrudes into the lumen. RIGHT CAROTID: Calcific and noncalcific atherosclerosis within the carotid bulb. There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: Calcific and noncalcific atherosclerosis within the carotid bulb with approximately 50% stenosis of the proximal ICA. No occlusion or aneurysmal dilation. RIGHT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT VERTEBRAL ARTERY: Calcific atherosclerosis within the V3 segment. There is no evidence of stenosis, occlusion, or aneurysmal dilation.
3,037
EXAM: CT Wrist Right wo contrast CLINICAL INFORMATION: Wrist pain, injury COMPARISON: None. TECHNIQUE: CT Wrist Right wo contrast Scan field of view: 190 mm. DLP: 131 mGy cm. Findings: No wrist fracture is seen. Specifically, the scaphoid is unremarkable. Carpal bone alignment is normal. There is mild diffuse subcutaneous edema along the volar aspect of the hand. Impression: 1. No wrist fracture. 2. Volar superficial soft tissue swelling of the hand.
Findings: No wrist fracture is seen. Specifically, the scaphoid is unremarkable. Carpal bone alignment is normal. There is mild diffuse subcutaneous edema along the volar aspect of the hand.
FINDINGS: CT of the head with and without contrast: BRAIN PARENCHYMA: No intraparenchymal hemorrhage, mass effect or edema. Periventricular and patchy subcortical white matter hypoattenuation consistent with chronic microangiopathy. Right basal ganglia chronic lacunar infarct. Gray-white matter differentiation is preserved. EXTRA-AXIAL SPACES: No epidural, subdural, or subarachnoid hemorrhage. SKULL AND SKULL BASE: No acute fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Well aerated. MASTOIDS: Clear. SOFT TISSUES: Unremarkable. CT angiogram of the brain: RIGHT INTRACRANIAL CAROTID: Calcific atherosclerosis within the cavernous and clinoid segments without significant luminal narrowing. There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT INTRACRANIAL CAROTID: Calcific atherosclerosis within the cavernous and clinoid segments with mild luminal narrowing. There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Atheromatous plaque protrudes into the lumen. RIGHT CAROTID: Calcific and noncalcific atherosclerosis within the carotid bulb. There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: Calcific and noncalcific atherosclerosis within the carotid bulb with approximately 50% stenosis of the proximal ICA. No occlusion or aneurysmal dilation. RIGHT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT VERTEBRAL ARTERY: Calcific atherosclerosis within the V3 segment. There is no evidence of stenosis, occlusion, or aneurysmal dilation.
3,038
Sinus CT 1/7/2022 8:48 AM Indication: Evaluate chronic sinusitis Comparison: None. Technique: Stealth protocol PNS CT with contiguous axial 0.6 mm thickness scans through the maxillofacial region. Coronal and sagittal images were formatted from the axial data. Findings: Sinuses and drainage pathways: Frontal sinus: Clear on both sides. Frontoethmoidal recess: Patent. Maxillary sinus: Small air-fluid level with frothy secretion in the right maxillary antrum. Tiny air-fluid level dependently on the left. Ostiomeatal complex: Patent bilaterally. Ethmoid sinus: Clear. Bilateral ethmoid bulla. Sphenoid sinus: Focal mucoid secretion in the right sphenoid sinus at the ethmoid recess opening. Otherwise clearly aerated without mucosal thickening bilaterally. Sphenoethmoidal recess: Occluded on the right. Patent on the left. Nasal cavity: No polyp or mass. No significant variation of the nasal septum and turbinates. Olfactory fossa: Keros type 3 on the left, type 2 on the right. No bony dehiscence. Orbits: Normal Anterior cranial fossa: Unremarkable. Dentition: Unremarkable. Mandible and temporomandibular joint: Unremarkable. Impression: 1. Bilateral maxillary sinus air-fluid levels, right greater than left. 2. Focal mucoid secretion in the right sphenoid sinus obstructing the sphenoethmoidal recess.
Findings: Sinuses and drainage pathways: Frontal sinus: Clear on both sides. Frontoethmoidal recess: Patent. Maxillary sinus: Small air-fluid level with frothy secretion in the right maxillary antrum. Tiny air-fluid level dependently on the left. Ostiomeatal complex: Patent bilaterally. Ethmoid sinus: Clear. Bilateral ethmoid bulla. Sphenoid sinus: Focal mucoid secretion in the right sphenoid sinus at the ethmoid recess opening. Otherwise clearly aerated without mucosal thickening bilaterally. Sphenoethmoidal recess: Occluded on the right. Patent on the left. Nasal cavity: No polyp or mass. No significant variation of the nasal septum and turbinates. Olfactory fossa: Keros type 3 on the left, type 2 on the right. No bony dehiscence. Orbits: Normal Anterior cranial fossa: Unremarkable. Dentition: Unremarkable. Mandible and temporomandibular joint: Unremarkable.
FINDINGS/CONCLUSION: Persistent posterior dislocation of the right hip with comminuted transverse fracture of the right acetabulum involving the anterior and posterior columns. Unchanged appearance of the impaction fracture of the anterior inferior femoral head. Comminuted fracture of the posterior left ilium extending into the left SI joint with diastasis. Minimally displaced fractures of the left superior and inferior pubic rami. The pubic symphysis measures approximately 0.7 cm decreased from the prior study when it measured 1.0 cm. Unchanged fracture of the left L5 transverse process. Interval decreased size of the extraperitoneal perivesicular hematoma with mass effect on the urinary bladder.
3,039
EXAM: CT Chest wo contrast CLINICAL INFORMATION: 65-year-old male follow-up hepatocellular carcinoma, status post liver transplant COMPARISON: October 6, 2021 TECHNIQUE: CT Chest wo contrast. Scan field of view: 410 mm. DLP: 350.54 mGy cm. FINDINGS: Index lesions are measured in series 2. The left lower lobe nodule which was approximately 5 x 5 mm in axial image 70, series 11 now measures 8 x 6 mm in image 69. The right middle lobe subpleural elongated nodular density is also more prominent in image 59. There are two additional nodules in the right upper lobe on images 36 and 40. Asymmetric upper lobe dominant emphysema with ill-defined nondependent anterior lungs subpleural reticulations and linear banding. Diffuse increased peribronchial thickening is also noted without definitive bronchiectasis. Only small subcentimeter size nodes are noted in the mediastinum. Three-vessel atherosclerotic coronary artery disease changes. There is no pleural or pericardial effusion and no focal lytic or sclerotic bone lesion is noted. CONCLUSION: Multiple bilateral small noncalcified lung nodules with index nodules enlarged since prior study worrisome for metastatic disease versus opportunistic fungal infection.
FINDINGS: Index lesions are measured in series 2. The left lower lobe nodule which was approximately 5 x 5 mm in axial image 70, series 11 now measures 8 x 6 mm in image 69. The right middle lobe subpleural elongated nodular density is also more prominent in image 59. There are two additional nodules in the right upper lobe on images 36 and 40. Asymmetric upper lobe dominant emphysema with ill-defined nondependent anterior lungs subpleural reticulations and linear banding. Diffuse increased peribronchial thickening is also noted without definitive bronchiectasis. Only small subcentimeter size nodes are noted in the mediastinum. Three-vessel atherosclerotic coronary artery disease changes. There is no pleural or pericardial effusion and no focal lytic or sclerotic bone lesion is noted.
FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Mild subsegmental atelectasis in the lung bases. No focal consolidation, pleural effusion, or pneumothorax. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: No significant esophageal wall thickening or mucosal hyperenhancement. No pneumomediastinum or paraesophageal fluid collections. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Gastric mucosal hyperenhancement and mild gastric wall edema. MUSCULOSKELETAL: No significant abnormality.
3,040
EXAM: CT Pelvis wo IV contrast CLINICAL INFORMATION: 60-year-old male with end-stage renal disease; renal transplant evaluation. COMPARISON: None. TECHNIQUE: CT Pelvis wo IV contrast. Scan delay: 0 sec. Scan field of view: 450 mm. DLP: 651.11 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Pelvis Renal Transplant VASCULATURE: LOWER ABDOMINAL AORTA: Mild calcified atherosclerotic disease. RIGHT COMMON / INTERNAL ILIAC ARTERIES: Mild calcified atherosclerotic disease. RIGHT EXTERNAL ILIAC ARTERY: No calcified atherosclerotic disease. LEFT COMMON / INTERNAL ILIAC ARTERIES: Mild calcified atherosclerotic disease. LEFT EXTERNAL ILIAC ARTERY: No calcified atherosclerotic disease. LOWER ABDOMEN: BOWEL: No abnormality. PERITONEUM: Coiled peritoneal dialysis catheter noted within the anterior midline lower abdomen. OTHER: No other abnormality. PELVIS: LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Normal sized prostate with dystrophic calcifications noted. BODY WALL: Small fat-containing right inguinal hernia. MUSCULOSKELETAL: Benign-appearing heterogeneously sclerotic lesion seen near the right greater trochanter. CONCLUSION: Mild atherosclerotic disease as described above. Bilateral external iliac arteries are free of significant atherosclerotic disease.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Pelvis Renal Transplant VASCULATURE: LOWER ABDOMINAL AORTA: Mild calcified atherosclerotic disease. RIGHT COMMON / INTERNAL ILIAC ARTERIES: Mild calcified atherosclerotic disease. RIGHT EXTERNAL ILIAC ARTERY: No calcified atherosclerotic disease. LEFT COMMON / INTERNAL ILIAC ARTERIES: Mild calcified atherosclerotic disease. LEFT EXTERNAL ILIAC ARTERY: No calcified atherosclerotic disease. LOWER ABDOMEN: BOWEL: No abnormality. PERITONEUM: Coiled peritoneal dialysis catheter noted within the anterior midline lower abdomen. OTHER: No other abnormality. PELVIS: LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Normal sized prostate with dystrophic calcifications noted. BODY WALL: Small fat-containing right inguinal hernia. MUSCULOSKELETAL: Benign-appearing heterogeneously sclerotic lesion seen near the right greater trochanter.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Dependent atelectasis bilaterally. Scattered emphysematous changes, paraseptal and centrilobular, within the upper lobes. HEART / VESSELS: Extensive coronary artery calcifications. MEDIASTINUM / ESOPHAGUS: Large hiatal hernia. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: See rib findings detailed below. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Mild parenchymal fatty atrophy of the head and uncinate process. Otherwise normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Hiatal hernia as above. No acute abnormality. COLON / APPENDIX: Normal. Normal appendix. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Extensive atherosclerotic calcifications of the abdominal aorta and branch vasculature with diminutive appearance of an occluded right common iliac and external iliac artery, which reconstitutes at the common femoral artery, overlying which there are postsurgical changes. There is an occluded and apparently abandoned bypass graft extending from the left common femoral artery. Incompletely evaluated left superficial femoral arterial stent. URINARY BLADDER: Distended but otherwise normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Postsurgical findings as above. MUSCULOSKELETAL: Mildly displaced and angulated subcapital left femoral fracture with fracture line extension longitudinally through the femoral neck. No femoral head dislocation. Decreased bone mineral density limits evaluation for nondisplaced fracture. Prior left-sided rib fractures. No displaced acute rib fracture is identified. Manubrial cortical irregularity on the left without adjacent stranding to suggest that this is an acute fracture. THORACIC SPINE: VERTEBRA: Compression fracture of T9 with 40% loss of vertebral body height. Compression deformity of the superior endplate of T7 with 10% loss of vertebral body height. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: Minor superior endplate compression at L1-L3. No acute appearing alignment abnormality. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
3,041
Lung Cancer Screening Clinical Information: Lung cancer screening Technique: Scan field of view: 200 mm. Height: 69 in. Patient weight: 200 lbs. CTDI vol: 2.44 mGy. DLP: 91.27 mGy cm. 0.60 mm images were obtained through the chest. The CT is jointly interpreted by Drs. Singh and Ahmed Smoking Status: Former If not current, quit years ago: 2 Pack Years: 30 Screen Year: 1 Comparison: None Interpretation and recommendations are based on 2019 version of ACR LungRads recommendations Findings: Several calcified nodes are present in the subcarinal/right paraesophageal and right hilar region. Mild upper lobe centrilobular emphysema. Densely calcified nodules are seen in the right middle lobe on images 144, 158 and faintly calcified nodule in the right upper lobe in image 65 and left upper lobe image 93, series 3. There is minimal dependent lower lobe subpleural nodularity especially on the right. There is no pleural or pericardial effusion. Coronary artery calcification: The visual score of calcification is 2. (Based on a publication by Kirsch et al (Detection of Coronary calcium During Standard Chest Computed Tomography Correlates With Multi-Detector Computed Tomography Coronary Artery Calcium score, Int J Cardiovasc Imaging (2012) 28:1249-1256), visual score >7 is associated with an Agatston score > 400 and independently validated increased incidence of cardiovascular mortality). The visualized liver, spleen, adrenals, and bowel are unremarkable. Bones: No focal lytic or sclerotic bone lesion is seen. Impression: Mild COPD with evidence of prior healed granulomatous infection without any suspicious lung nodule. LungRads category: 1 Lung-Rads Modifier S: No clinically significant or potentially clinically significant findings. Recommendation: Continue low-dose yearly lung cancer screening CT. ====================================================================================== REFERENCES: http://www.acr.org/\R\/media/ACR/Documents/PDF/QualitySafety/Resources/LungRADS/AssessmentCateg ries http://www.acr.org/Quality-Safety/Lung-Cancer-Screening-Center Category 0: Incomplete. Category 1: Negative - No nodules or definitely benign nodules. Category 2: Benign Appearance or Behavior - Nodules with a very low likelihood of becoming a clinically active cancer due to size or lack of growth. Category 3: Probably benign finding(s) - Short term follow-up suggested; includes nodules with a low likelihood of becoming a clinically active cancer. Category 4A: Suspicious - Findings for which additional diagnostic testing is recommended. Category 4B and 4X: Very Suspicious - Findings for which additional diagnostic testing and/or tissue sampling is recommended. Modifier S: Other Findings - Clinically significant or potentially clinically significant findings (non-lung cancer). References: http://www.acr.org/\R\/media/ACR/Documents/PDF/QualitySafety/Resources/LungRADS/AssessmentCateg ries http://www.acr.org/Quality-Safety/Lung-Cancer-Screening-Center
Findings: Several calcified nodes are present in the subcarinal/right paraesophageal and right hilar region. Mild upper lobe centrilobular emphysema. Densely calcified nodules are seen in the right middle lobe on images 144, 158 and faintly calcified nodule in the right upper lobe in image 65 and left upper lobe image 93, series 3. There is minimal dependent lower lobe subpleural nodularity especially on the right. There is no pleural or pericardial effusion. Coronary artery calcification: The visual score of calcification is 2. (Based on a publication by Kirsch et al (Detection of Coronary calcium During Standard Chest Computed Tomography Correlates With Multi-Detector Computed Tomography Coronary Artery Calcium score, Int J Cardiovasc Imaging (2012) 28:1249-1256), visual score >7 is associated with an Agatston score > 400 and independently validated increased incidence of cardiovascular mortality). The visualized liver, spleen, adrenals, and bowel are unremarkable. Bones: No focal lytic or sclerotic bone lesion is seen.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Dependent atelectasis bilaterally. Scattered emphysematous changes, paraseptal and centrilobular, within the upper lobes. HEART / VESSELS: Extensive coronary artery calcifications. MEDIASTINUM / ESOPHAGUS: Large hiatal hernia. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: See rib findings detailed below. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Mild parenchymal fatty atrophy of the head and uncinate process. Otherwise normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Hiatal hernia as above. No acute abnormality. COLON / APPENDIX: Normal. Normal appendix. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Extensive atherosclerotic calcifications of the abdominal aorta and branch vasculature with diminutive appearance of an occluded right common iliac and external iliac artery, which reconstitutes at the common femoral artery, overlying which there are postsurgical changes. There is an occluded and apparently abandoned bypass graft extending from the left common femoral artery. Incompletely evaluated left superficial femoral arterial stent. URINARY BLADDER: Distended but otherwise normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Postsurgical findings as above. MUSCULOSKELETAL: Mildly displaced and angulated subcapital left femoral fracture with fracture line extension longitudinally through the femoral neck. No femoral head dislocation. Decreased bone mineral density limits evaluation for nondisplaced fracture. Prior left-sided rib fractures. No displaced acute rib fracture is identified. Manubrial cortical irregularity on the left without adjacent stranding to suggest that this is an acute fracture. THORACIC SPINE: VERTEBRA: Compression fracture of T9 with 40% loss of vertebral body height. Compression deformity of the superior endplate of T7 with 10% loss of vertebral body height. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: Minor superior endplate compression at L1-L3. No acute appearing alignment abnormality. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
3,042
RADIOLOGIC EXAM: CT Head wo contrast CLINICAL INFORMATION: Facial palsy COMPARISON: 11/25/17 TECHNIQUE: CT Head wo contrastScan field of view: 238 mm. DLP: 1310 mGy cm. STRUCTURED REPORT: CT Head 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. Cavum septi pellucidum et vergae. ORBITS: Normal. SINUSES: Normal. CONCLUSION: No acute intracranial process.
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. Cavum septi pellucidum et vergae. ORBITS: Normal. SINUSES: Normal.
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 (
3,043
EXAM: CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: Squamous cell carcinoma of the penis COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis wo IV contrast. Scan field of view: 450 mm. Oral contrast Omnipaque: 16 oz. DLP: 457.88 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately reported chest CT. ABDOMEN and PELVIS: LIVER: Nonsteatotic. Noncirrhotic morphology. No concerning mass or lesion. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Normal. Adjacent accessory spleen noted. ADRENALS: Normal. KIDNEYS: Significant renal atrophy bilaterally. Bilateral renal vascular calcifications noted. LYMPH NODES: None enlarged. Multiple surgical clips seen within the right inguinal region, perhaps related to prior nodal excision. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered colonic diverticula without surrounding inflammation. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild scattered calcified atherosclerosis involving the descending aorta and branching vessels. No significant stenosis visualized. The abdominal aorta is normal in caliber. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: There is extensive subcutaneous edema within the visualized scrotum. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute or aggressive osseous abnormality. Moderate degenerative changes involving the bilateral hip joints, sacroiliac joints, and lumbar spine. Bulky near bridging anterior osteophytes are seen at the L3-L4 level. Postoperative changes involving the posterior wall of the right acetabulum are noted. CONCLUSION: 1. No evidence of metastatic disease within the abdomen/pelvis. 2. Marked subcutaneous scrotal edema. 3. Chronic/incidental findings as outlined above. Please see separately reported chest CT. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately reported chest CT. ABDOMEN and PELVIS: LIVER: Nonsteatotic. Noncirrhotic morphology. No concerning mass or lesion. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Normal. Adjacent accessory spleen noted. ADRENALS: Normal. KIDNEYS: Significant renal atrophy bilaterally. Bilateral renal vascular calcifications noted. LYMPH NODES: None enlarged. Multiple surgical clips seen within the right inguinal region, perhaps related to prior nodal excision. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered colonic diverticula without surrounding inflammation. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild scattered calcified atherosclerosis involving the descending aorta and branching vessels. No significant stenosis visualized. The abdominal aorta is normal in caliber. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: There is extensive subcutaneous edema within the visualized scrotum. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute or aggressive osseous abnormality. Moderate degenerative changes involving the bilateral hip joints, sacroiliac joints, and lumbar spine. Bulky near bridging anterior osteophytes are seen at the L3-L4 level. Postoperative changes involving the posterior wall of the right acetabulum are noted.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Dependent atelectasis bilaterally. Scattered emphysematous changes, paraseptal and centrilobular, within the upper lobes. HEART / VESSELS: Extensive coronary artery calcifications. MEDIASTINUM / ESOPHAGUS: Large hiatal hernia. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: See rib findings detailed below. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Mild parenchymal fatty atrophy of the head and uncinate process. Otherwise normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Hiatal hernia as above. No acute abnormality. COLON / APPENDIX: Normal. Normal appendix. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Extensive atherosclerotic calcifications of the abdominal aorta and branch vasculature with diminutive appearance of an occluded right common iliac and external iliac artery, which reconstitutes at the common femoral artery, overlying which there are postsurgical changes. There is an occluded and apparently abandoned bypass graft extending from the left common femoral artery. Incompletely evaluated left superficial femoral arterial stent. URINARY BLADDER: Distended but otherwise normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Postsurgical findings as above. MUSCULOSKELETAL: Mildly displaced and angulated subcapital left femoral fracture with fracture line extension longitudinally through the femoral neck. No femoral head dislocation. Decreased bone mineral density limits evaluation for nondisplaced fracture. Prior left-sided rib fractures. No displaced acute rib fracture is identified. Manubrial cortical irregularity on the left without adjacent stranding to suggest that this is an acute fracture. THORACIC SPINE: VERTEBRA: Compression fracture of T9 with 40% loss of vertebral body height. Compression deformity of the superior endplate of T7 with 10% loss of vertebral body height. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: Minor superior endplate compression at L1-L3. No acute appearing alignment abnormality. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
3,044
EXAM: CT Chest wo contrast CLINICAL INFORMATION: 69-year-old male follow-up squamous cell carcinoma of the penis COMPARISON: March 1, 2021 TECHNIQUE: CT Chest wo contrast. Scan field of view: 390 mm. DLP: 307.60 mGy cm. FINDINGS: Previously noted patchy airspace consolidative changes in posterior segment right upper lobe and dependent bilateral lower lobes left more than right have resolved with only minimal residual linear parenchymal changes noted in the left lower lobe and inferior lingula. There is no discrete lung nodule or mass. No mediastinal adenopathy seen. Atherosclerotic calcification of coronary artery is again noted. There is no pleural or pericardial effusion and visualized bones are unremarkable. CONCLUSION: No intrathoracic metastasis or new disease.
FINDINGS: Previously noted patchy airspace consolidative changes in posterior segment right upper lobe and dependent bilateral lower lobes left more than right have resolved with only minimal residual linear parenchymal changes noted in the left lower lobe and inferior lingula. There is no discrete lung nodule or mass. No mediastinal adenopathy seen. Atherosclerotic calcification of coronary artery is again noted. There is no pleural or pericardial effusion and visualized bones are unremarkable.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Dependent atelectasis bilaterally. Scattered emphysematous changes, paraseptal and centrilobular, within the upper lobes. HEART / VESSELS: Extensive coronary artery calcifications. MEDIASTINUM / ESOPHAGUS: Large hiatal hernia. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: See rib findings detailed below. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Mild parenchymal fatty atrophy of the head and uncinate process. Otherwise normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Hiatal hernia as above. No acute abnormality. COLON / APPENDIX: Normal. Normal appendix. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Extensive atherosclerotic calcifications of the abdominal aorta and branch vasculature with diminutive appearance of an occluded right common iliac and external iliac artery, which reconstitutes at the common femoral artery, overlying which there are postsurgical changes. There is an occluded and apparently abandoned bypass graft extending from the left common femoral artery. Incompletely evaluated left superficial femoral arterial stent. URINARY BLADDER: Distended but otherwise normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Postsurgical findings as above. MUSCULOSKELETAL: Mildly displaced and angulated subcapital left femoral fracture with fracture line extension longitudinally through the femoral neck. No femoral head dislocation. Decreased bone mineral density limits evaluation for nondisplaced fracture. Prior left-sided rib fractures. No displaced acute rib fracture is identified. Manubrial cortical irregularity on the left without adjacent stranding to suggest that this is an acute fracture. THORACIC SPINE: VERTEBRA: Compression fracture of T9 with 40% loss of vertebral body height. Compression deformity of the superior endplate of T7 with 10% loss of vertebral body height. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: Minor superior endplate compression at L1-L3. No acute appearing alignment abnormality. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
3,045
EXAM: CT Chest wo contrast CLINICAL INFORMATION: 67-year-old male status post liver transplant for hepatocellular carcinoma. COMPARISON: July 9, 2021 TECHNIQUE: CT Chest wo contrast. Scan field of view: 380 mm. DLP: 307.37 mGy cm. FINDINGS: Few scattered calcified lung granulomas and mediastinal and hilar nodal calcifications. No other focal airspace or interstitial lung parenchymal abnormality or new lung nodule identified. There is no pleural or pericardial effusion and visualized bones are unremarkable. CONCLUSION: 1. Stable chest CT without intrathoracic metastasis or new disease. 2. Sequelae of prior healed granulomatous infection
FINDINGS: Few scattered calcified lung granulomas and mediastinal and hilar nodal calcifications. No other focal airspace or interstitial lung parenchymal abnormality or new lung nodule identified. There is no pleural or pericardial effusion and visualized bones are unremarkable.
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 (
3,046
EXAM: CT Chest wo contrast CLINICAL INFORMATION: 84-year-old female evaluate for loculated right pleural effusion. COMPARISON: 12/31/2021.. TECHNIQUE: CT Chest wo contrast. Scan field of view: 451 mm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. ETT tip projects in appropriate position. Distal feeding tube is coiled back on itself in the fundus the stomach with the metallic tip projecting in the antrum. Tip of the right IJ line is in the distal SVC. Multiple low-attenuation thyroid nodules are again seen with the largest extending off the inferior isthmus. Calcified subcarinal and right hilar nodes are redemonstrated. Prominent soft tissue in the AP window in series 3 image 77 is a combination of lymph nodes and tortuous bronchial artery branches on the previous CT. Lower right paratracheal node is enlarged at 13 mm in short axis on image 80 but contains a fatty hila. Enlarged left hilar node on image 106 is similar to the previous exam. No axillary adenopathy. Elevation of the right hemidiaphragm is again seen with adjacent increased right pleural effusion and right basilar atelectasis. Marked secretions are seen in the right bronchus intermedius with opacification of the lobar bronchi to the lower lobe and middle lobe. Opacification of segmental branches to the medial left lower lobe is seen with small effusion and adjacent atelectasis. Breathing motion further limits evaluation. Patchy areas of groundglass density are seen posterior laterally in the right upper lobe with patchy consolidation and tree-in-bud opacities in the superior segment of the right lower lobe. This is new since the previous exam. The remainder of the lungs are clear. CT abdomen and pelvis will be dictated separately. No focal destructive osseous lesions. CONCLUSION: 1. Interval increase in bilateral pleural effusions and adjacent atelectasis. Prominent secretions in the right lower and right middle lobe bronchi in the medial left lower lobe bronchi concerning for aspiration. 2. New peripheral groundglass opacities in the right upper lobe and patchy consolidation with tree-in-bud opacities in the superior right lower lobe which could reflect aspiration or pneumonia. 3. Enlarged right paratracheal and left hilar nodes.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. ETT tip projects in appropriate position. Distal feeding tube is coiled back on itself in the fundus the stomach with the metallic tip projecting in the antrum. Tip of the right IJ line is in the distal SVC. Multiple low-attenuation thyroid nodules are again seen with the largest extending off the inferior isthmus. Calcified subcarinal and right hilar nodes are redemonstrated. Prominent soft tissue in the AP window in series 3 image 77 is a combination of lymph nodes and tortuous bronchial artery branches on the previous CT. Lower right paratracheal node is enlarged at 13 mm in short axis on image 80 but contains a fatty hila. Enlarged left hilar node on image 106 is similar to the previous exam. No axillary adenopathy. Elevation of the right hemidiaphragm is again seen with adjacent increased right pleural effusion and right basilar atelectasis. Marked secretions are seen in the right bronchus intermedius with opacification of the lobar bronchi to the lower lobe and middle lobe. Opacification of segmental branches to the medial left lower lobe is seen with small effusion and adjacent atelectasis. Breathing motion further limits evaluation. Patchy areas of groundglass density are seen posterior laterally in the right upper lobe with patchy consolidation and tree-in-bud opacities in the superior segment of the right lower lobe. This is new since the previous exam. The remainder of the lungs are clear. CT abdomen and pelvis will be dictated separately. No focal destructive osseous lesions.
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: Right lower quadrant and ileostomy. No small bowel obstruction. Multiple loops of small bowel appear tethered to the anterior abdominal wall, similar to prior. COLON / APPENDIX: Postsurgical changes of total proctocolectomy with similar appearance of ill-defined presacral soft tissue stranding. PERITONEUM / MESENTERY: Trace free pelvic fluid. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is normal in size. Right dominant ovarian follicle. BODY WALL: Rectus diastases. MUSCULOSKELETAL: No significant abnormality.
3,047
EXAM: CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: 84-year-old female with nausea and vomiting. COMPARISON: CT abdomen pelvis 12/31/2021 TECHNIQUE: CT Abdomen and Pelvis wo IV contrast. Scan field of view: 451 mm. Oral contrast Omnipaque: 16.9 oz. DLP: 1006 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis CT chest findings are reported separately. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: Gallbladder surgically absent. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral simple renal cysts. Otherwise normal for technique. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Distal aspect of an enteric tube terminates near the distal stomach. Stomach and small bowel are otherwise normal for technique. COLON / APPENDIX: Scattered colonic diverticuli without associated inflammation. Moderate amount of high-density oral contrast seen within portions of the ascending colon. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Advanced atherosclerotic disease. 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: Small fat-containing left inguinal hernia. MUSCULOSKELETAL: No suspicious osseous lesion. Severe right and moderate left degenerative changes of the femoroacetabular joints. Multilevel endplate and facet degenerative changes of the lumbar spine. CONCLUSION: No acute or notable abnormality of the abdomen or pelvis. CT chest findings are reported separately.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis CT chest findings are reported separately. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: Gallbladder surgically absent. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral simple renal cysts. Otherwise normal for technique. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Distal aspect of an enteric tube terminates near the distal stomach. Stomach and small bowel are otherwise normal for technique. COLON / APPENDIX: Scattered colonic diverticuli without associated inflammation. Moderate amount of high-density oral contrast seen within portions of the ascending colon. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Advanced atherosclerotic disease. 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: Small fat-containing left inguinal hernia. MUSCULOSKELETAL: No suspicious osseous lesion. Severe right and moderate left degenerative changes of the femoroacetabular joints. Multilevel endplate and facet degenerative changes of the lumbar spine.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Interval mild improvement of bilateral groundglass opacities. Trace bilateral pleural effusions. No focal consolidations or pneumothorax. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Coronary artery calcifications. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral percutaneous nephrostomy tubes with improved hydronephrosis bilaterally. There is residual mild right hydronephrosis. Stable left moderate and right mild hydroureter to the level of the bladder. Interval improvement in bilateral perinephric fat stranding. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No significant abnormality. COLON / APPENDIX: No abnormality. Oral contrast reaches the right colon.. PERITONEUM / MESENTERY: Ventriculostomy catheter is coiled within the left lower abdomen. Trace free fluid in the pelvis. RETROPERITONEUM: Normal. VESSELS: Severe splenic artery and bilateral external iliac calcifications. URINARY BLADDER: Decompressed around Foley catheter. Small-volume intraluminal air. REPRODUCTIVE ORGANS: The uterus is normal in size. BODY WALL: Significant edema of the left lateral abdominal and right thigh soft tissues, not significantly changed from prior. Ventriculostomy catheter tracks along the anterior abdominal wall and into the peritoneum. MUSCULOSKELETAL: Redemonstrated spina bifida and severe levoscoliosis. New left trace simple fluid within the left hip joint and unchanged right simple fluid within the right hip joint with significant thickened synovium bilaterally. Findings suggestive of renal osteodystrophy. No acute erosive changes or periosteal reaction to suggest acute osteomyelitis. Stable degenerative changes.
3,048
EXAM: CT Chest with contrast CLINICAL INFORMATION: 73-year-old male follow-up lung cancer COMPARISON: August 20, 2021 TECHNIQUE: CT Chest with contrast. Patient weight: 178 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: 380 mm. DLP: 1100.18 mGy cm. FINDINGS: Enlarged nodes in the prevascular, subcarinal and right hilar region persist as before. A large hiatal hernia is noted as before. Left upper lobectomy and postradiation changes in the left lower lobe are present without any new discrete lung nodule or mass. There is minimal left pleural thickening and dependent small loculated effusion. Pericardium is normal in thickness without effusion. There is no focal lytic or sclerotic bone lesion. CONCLUSION: Stable chest CT with persistent mediastinal and right hilar adenopathy and postsurgical and postradiation changes in the left lung without new intrathoracic abnormality
FINDINGS: Enlarged nodes in the prevascular, subcarinal and right hilar region persist as before. A large hiatal hernia is noted as before. Left upper lobectomy and postradiation changes in the left lower lobe are present without any new discrete lung nodule or mass. There is minimal left pleural thickening and dependent small loculated effusion. Pericardium is normal in thickness without effusion. There is no focal lytic or sclerotic bone lesion.
FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Bilateral patchy opacities throughout both lungs. No pleural effusion or pneumothorax. The central airways are patent. HEART / OTHER VESSELS: Mild cardiomegaly. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Splenomegaly. There is no significant abnormality. MUSCULOSKELETAL: No significant abnormality.
3,049
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 73-year-old male with history of lung cancer; follow-up. COMPARISON: Multiple prior CTs of the abdomen pelvis, most recent 8/20/2021 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 178 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: 380 mm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis CT chest findings are reported separately. ABDOMEN and PELVIS: LIVER: Redemonstration of several well-circumscribed hypodensities compatible with cysts. Multiple additional hypodensities scattered throughout the liver are technically indeterminate but appear grossly stable in size and appearance when compared to multiple prior studies dating back to 2016. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Redemonstration of a couple well-circumscribed hypodensities within the spleen. While the larger lesion is not significantly changed over multiple prior studies, the smaller lesion seen on axial series 2, image 226 has increased in conspicuity. ADRENALS: Normal. KIDNEYS: Bilateral renal cortical scarring. Multiple nonobstructing right renal calculi, largest in the interpolar region and measuring 4 mm on axial series 2, image 303. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Moderate hiatal hernia. COLON / APPENDIX: Scattered colonic diverticuli without associated inflammation. PERITONEUM / MESENTERY: Small volume simple pelvic free fluid. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Diffuse circumferential thickening of the urinary bladder wall, not significantly changed from prior. REPRODUCTIVE ORGANS: Prostate is moderately enlarged. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. No definite evidence of metastatic disease in the abdomen or pelvis. 2. Increased conspicuity of a subcentimeter hypodensity seen within the spleen, indeterminate. Recommend close attention on follow-up. 3. Redemonstration of small volume simple appearing pelvic free fluid of uncertain etiology. 4. Moderate-sized hiatal hernia. 5. Diffuse circumferential thickening of the urinary bladder wall, not significantly changed and perhaps treatment related. If there is clinical concern for cystitis, recommend correlation with urinalysis.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis CT chest findings are reported separately. ABDOMEN and PELVIS: LIVER: Redemonstration of several well-circumscribed hypodensities compatible with cysts. Multiple additional hypodensities scattered throughout the liver are technically indeterminate but appear grossly stable in size and appearance when compared to multiple prior studies dating back to 2016. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Redemonstration of a couple well-circumscribed hypodensities within the spleen. While the larger lesion is not significantly changed over multiple prior studies, the smaller lesion seen on axial series 2, image 226 has increased in conspicuity. ADRENALS: Normal. KIDNEYS: Bilateral renal cortical scarring. Multiple nonobstructing right renal calculi, largest in the interpolar region and measuring 4 mm on axial series 2, image 303. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Moderate hiatal hernia. COLON / APPENDIX: Scattered colonic diverticuli without associated inflammation. PERITONEUM / MESENTERY: Small volume simple pelvic free fluid. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Diffuse circumferential thickening of the urinary bladder wall, not significantly changed from prior. REPRODUCTIVE ORGANS: Prostate is moderately enlarged. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Refer to the concurrent dedicated CT chest report. ABDOMEN and PELVIS: LIVER: No suspicious hepatic focal lesions identified. Redemonstration of extensive hepatic cysts of variable size in some of them shows peripheral calcifications, unchanged. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Proteinaceous/hemorrhagic cyst at the upper pole of the right kidney, unchanged. Interval insertion of left ureteric stent with resolution of left hydroureteronephrosis. No renal lesion is identified. LYMPH NODES: Interval mild decrease in size of heterogeneous enhancing nodular mass along the left pelvic sidewall measures 3.6 x 2.5 cm which was measured 6.7 x 5.0 cm. Stable mildly enlarged lymph node in the left para-aortic region measuring up to 10 mm. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Uncomplicated colonic diverticulosis. Moderate amount of colonic fecal burden is noted. Otherwise, colon and appendix are normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate atheromatous calcification the abdominal aorta is branches. Moderate narrowing at the ostium of the SMA and bilateral renal arteries, unchanged.. URINARY BLADDER: No focal mass or mural thickening is identified. There is mild mass affect over the left posterolateral aspect of the wall from enlarged pelvic sidewall lymph node. REPRODUCTIVE ORGANS: Prostate is absent. BODY WALL: Small fat-containing left inguinal hernia, unchanged. MUSCULOSKELETAL: There is interval mixed sclerotic lesion in the S3 and S4 vertebral bodies and there is mild buckling of the anterior cortex of S1 vertebral body. No additional lytic or sclerotic lesion is identified. Diffuse postoperative changes and multilevel sclerotic changes in the spine and pelvis
3,050
CT Head wo contrast 1/7/2022 9:46 AM Clinical Information: neuro change, IVH Comparison: CT head 1/4/2022 Technique: Unenhanced axial brain CT. Bone and soft tissue windows were reviewed. Sagittal and coronal images were generated from the axial data. Scan field of view: 250 mm. DLP: 1178 mGy cm. Findings:Interval appearance of bilateral frontal, bilateral anterior temporal and left frontoparietal subdural predominantly low-attenuation heterogenous fluid collection with a maximum thickness of approximately 4 mm in the left frontal region slightly more prominent compared to prior study suggesting subdural fluid with hemorrhage staining. Stable small hemorrhage layering along the right tentorial leaflet. Otherwise no large intracranial Lead. Small subarachnoid hemorrhage in the left parietotemporal region. No evidence for large vascular territory stroke. No hydrocephalus. Periventricular white matter hypoattenuation, similar compared to prior study. Basal cisterns are patent. Atherosclerotic calcifications. Extensive maxillofacial and orbital fractures, not significantly changed from prior study. No new acute calvarial findings. Hemosinus in paranasal sinuses. Partial visualization of endotracheal tube and oropharyngeal tube. Left parietal scalp hematoma/swelling. Conclusion: 1. Interval appearance of bilateral frontal and left frontoparietal subdural fluid collections suggesting posttraumatic bilateral subdural hygromas with hemorrhagic staining. Small hemorrhage layering along the tentorial leaflet on the right measuring approximately 2 mm. 2. Small left frontoparietal subarachnoid hemorrhage. 3. Otherwise no significant interval change compared to prior study. Redemonstration of extensive maxillofacial fractures and paranasal sinus blood.
Findings:Interval appearance of bilateral frontal, bilateral anterior temporal and left frontoparietal subdural predominantly low-attenuation heterogenous fluid collection with a maximum thickness of approximately 4 mm in the left frontal region slightly more prominent compared to prior study suggesting subdural fluid with hemorrhage staining. Stable small hemorrhage layering along the right tentorial leaflet. Otherwise no large intracranial Lead. Small subarachnoid hemorrhage in the left parietotemporal region. No evidence for large vascular territory stroke. No hydrocephalus. Periventricular white matter hypoattenuation, similar compared to prior study. Basal cisterns are patent. Atherosclerotic calcifications. Extensive maxillofacial and orbital fractures, not significantly changed from prior study. No new acute calvarial findings. Hemosinus in paranasal sinuses. Partial visualization of endotracheal tube and oropharyngeal tube. Left parietal scalp hematoma/swelling.
FINDINGS: Tiny left thyroid nodules are unchanged. The central airways are patent. The thoracic aorta is nonaneurysmal. The pulmonary arteries are not dilated. The heart is not enlarged. No pericardial effusion. Moderate three-vessel coronary calcifications. No enlarged supraclavicular, axillary, mediastinal or hilar lymph nodes. The esophagus is not dilated. Surgical changes are seen at the gastroesophageal junction. There is no acute lung abnormality. There is mild biapical pleural parenchymal scarring. No new or enlarging lung nodules. Tiny mucus plug within the posterior basal right lower lobe on image 152 of series 2. No pleural effusion or pleural thickening. The CT of the abdomen and pelvis will be dictated separately. No acute or aggressive osseous abnormality.
3,051
EXAM: CT Angio Chest wo+w contrast CLINICAL INFORMATION: 2/11/21 COMPARISON: 2/11/21 TECHNIQUE: CT Angio Chest wo+w contrast. Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 196 lbs. IV contrast: Omnipaque 350, 60 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracker Scan field of view: 338 mm. KVP: 100 DLP: 337.60 mGy cm. 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: Patchy and nodular consolidative and groundglass opacities within the left greater than right lower lobes, lingula, right middle lobe, posterior left upper lobe. Small amount of aspirated secretions within the dependent trachea. Trace right pleural effusion. No pneumothorax. HEART / OTHER VESSELS: Mild cardiomegaly with enlarged right heart chambers. There is also mild enlargement of the pulmonary trunk. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: No acute abnormality MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. No pulmonary embolism. 2. Multifocal patchy and nodular airspace opacities likely reflecting aspiration pneumonia/pneumonitis. Small amount of aspirated secretions within the trachea. 3. Trace right pleural effusion. 4. Findings suggestive of pulmonary arterial hypertension and additional incidental findings as above.
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: Patchy and nodular consolidative and groundglass opacities within the left greater than right lower lobes, lingula, right middle lobe, posterior left upper lobe. Small amount of aspirated secretions within the dependent trachea. Trace right pleural effusion. No pneumothorax. HEART / OTHER VESSELS: Mild cardiomegaly with enlarged right heart chambers. There is also mild enlargement of the pulmonary trunk. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: No acute abnormality MUSCULOSKELETAL: No significant abnormality.
FINDINGS: CTA: The coordinates of the inferior epigastric and their branches relative to the umbilicus are also included with images that are electronically available in iSite Enterprise. STRUCTURED REPORT: CTA Abdomen Pelvis VASCULATURE: DISTAL DESCENDING THORACIC AORTA: No significant abnormality. ABDOMINAL AORTA: Minimal atherosclerotic calcification of the abdominal aorta without aneurysm. CELIAC AXIS: No significant abnormality. SMA: No significant abnormality. RIGHT RENAL: No significant abnormality. LEFT RENAL: No significant abnormality. IMA: No significant abnormality. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. ------------------------------------------------------------- LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Postsurgical changes from Roux-en-Y gastric bypass are present. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Postsurgical changes from bilateral mastectomy. Right-sided expander is in place. MUSCULOSKELETAL: No significant abnormality.
3,052
EXAM: CT Chest wo contrast CLINICAL INFORMATION: Neuroendocrine tumor COMPARISON: 1/14/2021. TECHNIQUE: CT Chest wo contrast. Scan field of view: 320 mm. DLP: 524 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. . No enlarged intrathoracic lymph nodes are identified. Fluid in the pericardial recesses is slightly denser than on the prior exam. Small hiatal hernia is redemonstrated. Calcific atherosclerosis is seen in the aorta and coronary arteries. Pericardial thickening shows some decrease from the previous exam with small pericardial effusion again noted. Within the limits of a noncontrast exam, the heart size and the mediastinum are otherwise normal. No pleural effusion. The RLL nodule on series 2 image 68 is unchanged back to 2018. Tiny peripheral RUL nodule on image 31 is also unchanged back to 2018. Two small left apical nodules on images 16 and 22 remain unchanged from December 2018. Tiny peripheral LUL nodules on images 47 and 54 and LLL nodule on image 76 are also unchanged from 2018. A few tiny calcified granulomas are seen. The lungs are otherwise normal. Low-attenuation lesion in the spleen with calcified rim is similar to previous exams but has decreased in size since 2018. Limited noncontrast images the upper abdomen are otherwise unremarkable. No focal destructive osseous lesions. CONCLUSION: 1. Scattered tiny nodules unchanged back to 2018 consistent with benign nodules. No adenopathy. No convincing evidence of intrathoracic metastases. 2. Mild pericardial thickening has decreased from the previous exam.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. . No enlarged intrathoracic lymph nodes are identified. Fluid in the pericardial recesses is slightly denser than on the prior exam. Small hiatal hernia is redemonstrated. Calcific atherosclerosis is seen in the aorta and coronary arteries. Pericardial thickening shows some decrease from the previous exam with small pericardial effusion again noted. Within the limits of a noncontrast exam, the heart size and the mediastinum are otherwise normal. No pleural effusion. The RLL nodule on series 2 image 68 is unchanged back to 2018. Tiny peripheral RUL nodule on image 31 is also unchanged back to 2018. Two small left apical nodules on images 16 and 22 remain unchanged from December 2018. Tiny peripheral LUL nodules on images 47 and 54 and LLL nodule on image 76 are also unchanged from 2018. A few tiny calcified granulomas are seen. The lungs are otherwise normal. Low-attenuation lesion in the spleen with calcified rim is similar to previous exams but has decreased in size since 2018. Limited noncontrast images the upper abdomen are otherwise unremarkable. No focal destructive osseous lesions.
Findings: There is diffuse opacification of the bilateral maxillary sinuses and partial vessels is not the bilateral ethmoid sinuses and floor of the right frontal sinus with obstruction of the right ostiomeatal complex. There is also obstruction of the left maxillary ostium. Right frontal ostium is obstructed. Left frontal ostium is patent. There are hypodense signal within the bilateral maxillary sinuses, likely inspissated secretions. There is mild mucosal thickening at the bilateral sphenoid ostia, resulting in obstruction. There is polypoid lesions in the posterior nasal cavity, right greater than left with moderate to severe right nasal obstruction. Posterior nasopharynx shows minimal soft tissue densities and right-sided possibly polyposis. Nasal septum is deviated to left side with bony spur. Bilateral cribriform plates and fovea ethmoidalis are symmetric and Keros type II.
3,053
CLINICAL HISTORY PROVIDED: Low back pain, > 6 wks, M54.16 Radiculopathy, lumbar region TECHNIQUE: Multiple contiguous axial images of the cervical spine were formatted from helical acquisition. Sagittal and coronal reconstruction images were also reformatted in postprocessing for evaluation of alignment. Scan field of view: 200 mm. DLP: 711.84 mGy cm. Scan field of view: 200 mm. DLP: 711.84 mGy cm. COMPARISON: MR lumbar spine dated 5/15/2020. FINDINGS: Reduced disc space with endplate irregularity and mild marginal osteophytosis are seen at L5-S1. Mild neural foraminal narrowing is associated bilaterally. There is no evidence of acute bony pathology. The alignment and vertebral body heights are well-maintained. The bony spinal canal is capacious. The facet joints are intact. IMPRESSION: Mild spondylosis at L5-S1.
FINDINGS: Reduced disc space with endplate irregularity and mild marginal osteophytosis are seen at L5-S1. Mild neural foraminal narrowing is associated bilaterally. There is no evidence of acute bony pathology. The alignment and vertebral body heights are well-maintained. The bony spinal canal is capacious. The facet joints are intact.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Small hiatal hernia. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Multiple small hepatic cysts scattered throughout the liver. Additional subcentimeter foci of hypoattenuation scattered in the liver too small for accurate characterization also likely represent cysts. BILIARY TRACT: Mild intrahepatic and extra hepatic biliary ductal dilation, possibly related to patient's postcholecystectomy state. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Numerous cysts of varying degrees of complexity including intrinsic hypoattenuation in the left kidney without appreciable enhancement on postcontrast images. A few of these cysts at the upper pole and interpolar region may contain septations, none of which are nodular or masslike. No suspicious enhancing renal mass. Few subcentimeter cysts without intrinsic hyperattenuation or enhancement in the right kidney. No nephrolithiasis or hydronephrosis bilaterally. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Small hiatal hernia. Small bowel is normal in caliber. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Bilateral fat-containing inguinal hernias. MUSCULOSKELETAL: No significant abnormality.
3,054
EXAM: CT Chest High Resolution wo contrast CLINICAL INFORMATION: 26-year-old male with provided history of sickle cell disease with shortness of breath and concern for bronchiectasis. COMPARISON: No prior CT chest for comparison. CT abdomen dated 5/30/2018 and chest radiograph 12/17/2021 TECHNIQUE: CT Chest High Resolution wo contrast. Scan field of view: 303 mm. DLP: 352.70 mGy cm. High-resolution CT imaging of the chest was performed per protocol with inspiratory technique in supine position. FINDINGS: Limitations: None. Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: There is anterior left lower lobe consolidative opacity with air bronchogram. Additional subsegmental atelectasis/scarring involving the inferior lingula, left lower lobe are also noted. Subpleural reticulations are also noted mainly involving the lung bases. The trachea and main bronchi are patent. No pleural effusion. Thoracic inlet, heart, and mediastinum: No supraclavicular lymphadenopathy within the field of view. Mildly enlarged and subcentimeter shotty bilateral axillary lymph nodes, probably reactive. No mediastinal lymphadenopathy. Hilar lymphadenopathy is limited in this noncontrasted study. The esophagus is nondilated. The thoracic aorta is normal in caliber. Main pulmonary artery is normal in caliber. The overall heart size is normal. No pericardial effusion. No coronary calcification. Bones and soft tissues: No destructive bone lesion. Chest wall is unremarkable. Upper abdomen: Hepatomegaly and splenic atrophy, similar to prior. CONCLUSION: 1. Left lower lobe consolidative opacity with air bronchograms, suggestive of pneumonia. Additional bibasilar subpleural opacities and reticulations, may be sequelae of old infection/Covid. 2. Other findings as described.
FINDINGS: Limitations: None. Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: There is anterior left lower lobe consolidative opacity with air bronchogram. Additional subsegmental atelectasis/scarring involving the inferior lingula, left lower lobe are also noted. Subpleural reticulations are also noted mainly involving the lung bases. The trachea and main bronchi are patent. No pleural effusion. Thoracic inlet, heart, and mediastinum: No supraclavicular lymphadenopathy within the field of view. Mildly enlarged and subcentimeter shotty bilateral axillary lymph nodes, probably reactive. No mediastinal lymphadenopathy. Hilar lymphadenopathy is limited in this noncontrasted study. The esophagus is nondilated. The thoracic aorta is normal in caliber. Main pulmonary artery is normal in caliber. The overall heart size is normal. No pericardial effusion. No coronary calcification. Bones and soft tissues: No destructive bone lesion. Chest wall is unremarkable. Upper abdomen: Hepatomegaly and splenic atrophy, similar to prior.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Bilateral lung base groundglass consolidations and bilateral lower lobe atelectasis. No pleural effusion bilaterally. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Significant diffuse hepatic steatosis. Mild fatty sparing is seen along the gallbladder fossa. No suspicious hepatic lesions. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Within the upper limits of normal in size. 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. Incidentally noted retroaortic left renal vein. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing periumbilical hernia. MUSCULOSKELETAL: No aggressive osseous lesions.
3,055
CT Neck Soft Tissue w contrast 1/7/2022 8:54 AM Clinical Information: Squamous cell carcinoma lower lip, status post resection and flap. Comparison: None. Technique: Axial images of the neck were obtained following the administration of intravenous contrast. Reformatted coronal and sagittal images were also obtained. Patient weight: 185 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. IV contrast injection rate: 3 ml per sec. Scan delay: 45 sec. Scan field of view: 260 mm. DLP: 658 mGy cm. Findings: Extensive dental amalgam artifacts limit evaluation of oral cavity and upper lip soft tissues. There is a small area of cutaneous hyperenhancement measuring approximately 7 x 5 mm in the left lower lip soft tissues (image 163, series 2). Postsurgical changes status post lower lip squamous cell carcinoma resection and flap placement. Correlate with clinical findings. Otherwise, the nasopharynx and oropharynx are normal in appearance. The base of the tongue and lymphoid tissue within Waldeyer's ring are unremarkable. The hypopharynx and larynx appear normal. Small sized bilateral cervical lymph nodes, not enlarged by CT size criteria. Visualized vascular structures in the neck are unremarkable. Discrete mass or lymphadenopathy is identified in the neck. The parotid, submandibular, and thyroid glands appear normal. Included portions of the brain and skull base appear normal. Dependent atelectatic changes in bilateral lungs. Atherosclerotic calcifications of the aortic arch and proximal arch vessels. Otherwise mediastinal structures are unremarkable. Degenerative changes in the cervical spine. Anterior spinal fixation at C5-C6. No acute osseous abnormalities. Bilateral pseudophakia. Age-appropriate brain involution. Prominent low-attenuation extra-axial fluid surrounding the cerebellum, likely subdural hygromas. Similar smaller fluid in bilateral frontal regions. Impression: 1. Status post lower lip squamous cell carcinoma resection and flap placement. Small focus of cutaneous enhancement in the left aspect of the lower lip measuring approximately 7 x 5 mm. Correlation with clinical findings is suggested. Dental amalgam artifacts limit evaluation. 2. No evidence for significant lymphadenopathy in the neck.
Findings: Extensive dental amalgam artifacts limit evaluation of oral cavity and upper lip soft tissues. There is a small area of cutaneous hyperenhancement measuring approximately 7 x 5 mm in the left lower lip soft tissues (image 163, series 2). Postsurgical changes status post lower lip squamous cell carcinoma resection and flap placement. Correlate with clinical findings. Otherwise, the nasopharynx and oropharynx are normal in appearance. The base of the tongue and lymphoid tissue within Waldeyer's ring are unremarkable. The hypopharynx and larynx appear normal. Small sized bilateral cervical lymph nodes, not enlarged by CT size criteria. Visualized vascular structures in the neck are unremarkable. Discrete mass or lymphadenopathy is identified in the neck. The parotid, submandibular, and thyroid glands appear normal. Included portions of the brain and skull base appear normal. Dependent atelectatic changes in bilateral lungs. Atherosclerotic calcifications of the aortic arch and proximal arch vessels. Otherwise mediastinal structures are unremarkable. Degenerative changes in the cervical spine. Anterior spinal fixation at C5-C6. No acute osseous abnormalities. Bilateral pseudophakia. Age-appropriate brain involution. Prominent low-attenuation extra-axial fluid surrounding the cerebellum, likely subdural hygromas. Similar smaller fluid in bilateral frontal regions.
FINDINGS: STRUCTURED REPORT: CTA Abdomen Pelvis VASCULATURE: ABDOMINAL AORTA: Juxtarenal abdominal aortic aneurysm is noted with mural thrombus visualized throughout. This measures approximately 4.6 x 4.6 cm in maximum dimension (series 8, image 222). CELIAC AXIS: Mild stenosis and tortuosity of the origin. Otherwise grossly patent. SMA: No significant abnormality. RIGHT RENAL: No significant abnormality. LEFT RENAL: Stenosis of the origin of the left renal artery (series 8, image 200). IMA: Not definitively opacified. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: Mild stenosis of the origin due to minimal extension of the distal aortic mural thrombus within the proximal common iliac artery. Moderate atherosclerotic disease is seen throughout the common, external, and internal iliac arteries without significant stenosis distally. LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: Moderate atherosclerotic disease is seen throughout the common, external, and internal iliac arteries without significant stenosis. ------------------------------------------------------------- Chest findings to be dictated separately. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is surgically absent. BODY WALL: Tiny fat-containing periumbilical hernia. MUSCULOSKELETAL: No aggressive osseous lesions.
3,056
EXAM: CT Chest with contrast CLINICAL INFORMATION: 59-year-old male status post liver transplant, follow-up lung nodule COMPARISON: November 29, 2021 TECHNIQUE: CT Chest with contrast. Patient weight: 203 lbs. IV contrast: Omnipaque 350, 60 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 2 ml per sec. Scan delay: 35 sec Scan field of view: 396 mm. DLP: 176 mGy cm. FINDINGS: Previously noted tiny nodules with surrounding groundglass density in the right upper lobe has resolved. A densely calcified left upper lobe granuloma is again noted without any new nodule or mass. There is mild asymmetric upper lobe dominant centrilobular emphysema and mild bilateral lower lobe bronchiectasis especially on the right. Only small subcentimeter size nodes in the mediastinum are stable. There is no pleural or pericardial effusion and visualized bones are unremarkable. CONCLUSION: Interval resolution of right upper lobe tiny nodule without new intrathoracic abnormality.
FINDINGS: Previously noted tiny nodules with surrounding groundglass density in the right upper lobe has resolved. A densely calcified left upper lobe granuloma is again noted without any new nodule or mass. There is mild asymmetric upper lobe dominant centrilobular emphysema and mild bilateral lower lobe bronchiectasis especially on the right. Only small subcentimeter size nodes in the mediastinum are stable. There is no pleural or pericardial effusion and visualized bones are unremarkable.
FINDINGS: Vascular findings: Calcified and noncalcified atherosclerotic plaque is seen along the aortic arch and descending thoracic aorta. A few areas of ulcerated plaque are seen along the descending thoracic aorta. No thoracic aortic dissection. The distal descending thoracic aorta is aneurysmal. The remaining portion of the thoracic aorta is nonaneurysmal. Aortic measurements are as follows (using center line technique): Aortic root at the level of the sinuses: 33 x 31 x 31 mm as measured from sinus to commissure. Mid-ascending thoracic aorta: 34 x 33 mm. Aortic arch: 32 x 26 mm. Proximal descending thoracic aorta: 40 x 36 mm. Mid descending thoracic aorta: 33 x 29 mm. Distal descending thoracic aorta: 48 x 41 mm. Irregular atherosclerotic plaque extends into the proximal left subclavian artery with some areas of focal moderate severe stenosis. Calcific plaques also seen at the origin of the brachiocephalic artery and left common carotid artery. These vessels are all patent. There are moderate three-vessel coronary calcifications. The heart is not enlarged. No pericardial effusion. Nonvascular findings: The supraclavicular region is unremarkable. Central airways are patent. No enlarged thoracic lymph nodes. The esophagus is patulous. There is a small hiatal hernia. There is no acute lung abnormality. Minimal linear atelectasis in the bilateral lower lobes. There is moderate upper lobe predominant emphysema with biapical pleural parenchymal scarring. Benign appearing 3 mm fissural nodule along the minor fissure. No suspicious lung nodules. No pleural effusion or pleural thickening. The CT of the abdomen and pelvis will be dictated separately. No acute or aggressive osseous abnormality. ACDF hardware in the lower cervical spine. Healed right second and third rib fractures.
3,057
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: History of liver metastatic disease, status post post liver lesion ablation COMPARISON: 11/22/2021 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 112 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: 340 mm. DLP: 295.98 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: There is a small right lower lobe nodule that measures 6 mm (series 2 image 37), previously measuring 4 mm but not definitely seen on 10/4/2021. Stable bibasilar emphysematous changes and peripheral chronic scarring. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Mild hepatomegaly. Noncirrhotic morphology. Previously described hepatic ablation defects are again visualized. There are two anterior hepatic ablation defects. The more superior anterior ablation defect has decreased in size compared to prior exam, but still is seen involving the adjacent anterior abdominal wall to a lesser extent than before. The more inferior anterior ablation defect has also decreased in size since prior exam but also still involves the adjacent anterior abdominal wall. Small adjacent hypoattenuating lesion is seen, likely simple hepatic cyst. The hepatic dome ablation defect has also decreased in size compared to prior exam, but appears to the adjacent hemidiaphragm and pleura, unchanged compared to prior exam. No new concerning mass or lesion identified. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. Mild pelviectasis bilaterally, unchanged. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. The appendix is normal. PERITONEUM / MESENTERY: Multiple enhancing soft tissue nodular implants near the anterior liver capsule and along the adjacent peritoneal surface (for example on axial series 2, image 71. Additional heterogeneously enhancing lesion seen anterior to the bladder wall along the anterior peritoneal surface, measuring approximately 2.4 x 1.5 cm on axial series 2, image 263. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerosis involving the abdominal aorta and branching vessels. No severe stenosis identified. Prominent parametrial vessels bilaterally. URINARY BLADDER: The bladder appears unremarkable. However, there is an adjacent lesion that is heterogeneously enhancing and measures approximately 2.4 x 1.5 cm (series 2 image 263). REPRODUCTIVE ORGANS: Slightly enlarged antegrade uterus with diffuse heterogenous enhancement. Postsurgical changes surrounding the cervix are stable. No adnexal masses are visualized. BODY WALL: Changes related to ablation defects as described above. Otherwise, no acute abnormality. MUSCULOSKELETAL: Interval decrease in size of the heterogeneous lesion involving the right anterior lower chest/upper abdominal wall. There is a compression fracture involving the L1 superior endplate, stable compared to prior exam. No new fracture or aggressive osseous abnormality visualized. Mild degenerative changes involving the lumbar spine, most severe at the L5-S1 level. CONCLUSION: 1. Interval decrease in size of previously visualized hepatic ablation defects as well as a right anterior lower chest/abdominal wall lesion. 2. Interval development of an enhancing nodular implants along the peritoneal surface, consistent with peritoneal carcinomatosis. 3. There is a small right lower lobe lung nodule that has increased in size compared to prior exam, raising concern for metastatic disease. Recommend close attention on follow-up exam. 3. Prominent parametrial and gonadal veins, findings which may be seen in the setting of pelvic congestion syndrome. Recommend clinical correlation. 4. Other chronic/incidental findings as outlined above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: There is a small right lower lobe nodule that measures 6 mm (series 2 image 37), previously measuring 4 mm but not definitely seen on 10/4/2021. Stable bibasilar emphysematous changes and peripheral chronic scarring. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Mild hepatomegaly. Noncirrhotic morphology. Previously described hepatic ablation defects are again visualized. There are two anterior hepatic ablation defects. The more superior anterior ablation defect has decreased in size compared to prior exam, but still is seen involving the adjacent anterior abdominal wall to a lesser extent than before. The more inferior anterior ablation defect has also decreased in size since prior exam but also still involves the adjacent anterior abdominal wall. Small adjacent hypoattenuating lesion is seen, likely simple hepatic cyst. The hepatic dome ablation defect has also decreased in size compared to prior exam, but appears to the adjacent hemidiaphragm and pleura, unchanged compared to prior exam. No new concerning mass or lesion identified. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. Mild pelviectasis bilaterally, unchanged. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. The appendix is normal. PERITONEUM / MESENTERY: Multiple enhancing soft tissue nodular implants near the anterior liver capsule and along the adjacent peritoneal surface (for example on axial series 2, image 71. Additional heterogeneously enhancing lesion seen anterior to the bladder wall along the anterior peritoneal surface, measuring approximately 2.4 x 1.5 cm on axial series 2, image 263. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerosis involving the abdominal aorta and branching vessels. No severe stenosis identified. Prominent parametrial vessels bilaterally. URINARY BLADDER: The bladder appears unremarkable. However, there is an adjacent lesion that is heterogeneously enhancing and measures approximately 2.4 x 1.5 cm (series 2 image 263). REPRODUCTIVE ORGANS: Slightly enlarged antegrade uterus with diffuse heterogenous enhancement. Postsurgical changes surrounding the cervix are stable. No adnexal masses are visualized. BODY WALL: Changes related to ablation defects as described above. Otherwise, no acute abnormality. MUSCULOSKELETAL: Interval decrease in size of the heterogeneous lesion involving the right anterior lower chest/upper abdominal wall. There is a compression fracture involving the L1 superior endplate, stable compared to prior exam. No new fracture or aggressive osseous abnormality visualized. Mild degenerative changes involving the lumbar spine, most severe at the L5-S1 level.
FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Bilateral patchy groundglass opacities. Bilateral perihilar bronchial wall thickening. No pleural effusion or pneumothorax. HEART / OTHER VESSELS: The heart is normal in size. Dual-chamber defibrillator leads are located in the right atrium and ventricle, in expected position. Coronary artery calcifications and mild scattered atherosclerotic calcifications of the thoracic aorta. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Left chest wall ICD. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No significant abnormality.
3,058
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Abdominal pain COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 132 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 30 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 80 secs Scan field of view: 360 mm. DLP: 422 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Bibasilar subsegmental atelectasis versus scarring. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Mild biliary duct dilatation is unchanged and likely related to prior cholecystectomy. GALLBLADDER: Surgically absent PANCREAS: Normal. SPLEEN: Normal. ADRENALS: There is a small subcentimeter right adrenal nodule which is unchanged, likely an adenoma KIDNEYS: There is bilateral renal scarring, particularly within the left lower lobe with asymmetrical atrophy of the right kidney. The asymmetrical atrophy of the right kidney is probably renal vascular in etiology. There are nonobstructing stones seen in the lower pole the right kidney. No obstructing ureteral calculus or hydronephrosis. LYMPH NODES: There are multiple shotty and borderline enlarged periaortic lymph nodes which are slightly worsened since the prior exam. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: There is a moderate amount of colonic fecal material. The distal rectosigmoid is collapsed. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: There is mild aortoiliac atherosclerosis without aneurysmal dilatation. There is increased stranding and thickening seen in the distal thoracic aorta and proximal abdominal aorta near the origins of the celiac and SMA. No dissection is seen. There is a severe stenosis or short segment occlusion of the right renal artery, perhaps slightly worsened. URINARY BLADDER: Collapsed and poorly evaluated. REPRODUCTIVE ORGANS: Hysterectomy changes are noted. 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. Focal periaortic thickening and stranding near the diaphragmatic hiatus and involving the proximal portions of the celiac, SMA, and right renal artery origins, as described. There is a very high-grade stenosis of the right renal artery versus less likely short segment occlusion with distal reconstitution. This perivascular stranding is indeterminate but could suggest vasculitis or infectious/inflammatory aortitis. 2. Shotty and borderline enlarged periaortic lymph nodes, possibly reactive. 3. Asymmetrical atrophy of the right kidney, likely renovascular in etiology, as above. Nonobstructing left nephrolithiasis 4. Additional findings above.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Bibasilar subsegmental atelectasis versus scarring. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Mild biliary duct dilatation is unchanged and likely related to prior cholecystectomy. GALLBLADDER: Surgically absent PANCREAS: Normal. SPLEEN: Normal. ADRENALS: There is a small subcentimeter right adrenal nodule which is unchanged, likely an adenoma KIDNEYS: There is bilateral renal scarring, particularly within the left lower lobe with asymmetrical atrophy of the right kidney. The asymmetrical atrophy of the right kidney is probably renal vascular in etiology. There are nonobstructing stones seen in the lower pole the right kidney. No obstructing ureteral calculus or hydronephrosis. LYMPH NODES: There are multiple shotty and borderline enlarged periaortic lymph nodes which are slightly worsened since the prior exam. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: There is a moderate amount of colonic fecal material. The distal rectosigmoid is collapsed. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: There is mild aortoiliac atherosclerosis without aneurysmal dilatation. There is increased stranding and thickening seen in the distal thoracic aorta and proximal abdominal aorta near the origins of the celiac and SMA. No dissection is seen. There is a severe stenosis or short segment occlusion of the right renal artery, perhaps slightly worsened. URINARY BLADDER: Collapsed and poorly evaluated. REPRODUCTIVE ORGANS: Hysterectomy changes are noted. No adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Mild degenerative changes are seen within the spine. No focal destructive osseous lesion is identified.
FINDINGS: STRUCTURED REPORT: CT HCC Follow-up IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: Trace hazy opacities in the right lower lung, likely atelectasis. Otherwise normal. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. Unchanged hepatic cysts and segments 8 and 5. TREATED LIVER LESIONS: 1. - Lesion Number: 1 - Description: Postoperative changes of TACE to the segment 4A lesion. - Location: Segment(s) 4A - Size of largest enhancing portion of the mass: Treated area measures 3.8 cm. Pretreatment lesion measured 4.6 cm. - 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): None. LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: Small paraesophageal varices. - Other varices or collaterals: Small coronary vein collaterals and paraumbilical collaterals. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: Surgically absent. Clips in the gallbladder fossa. LYMPH NODES: None enlarged. SPLEEN: Normal size and appearance. PERITONEUM / ASCITES: Trace ascites in pelvis. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Normal. STOMACH / SMALL BOWEL: Small hiatal hernia. Small bowel is unremarkable. COLON / APPENDIX: Pneumatosis involving the right colon. There is no abnormal bowel wall hypoenhancement. Supplying arterial vessels are patent. Calcification. Findings may represent an appendicolith is unchanged. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: Interval development of a dissection with aneurysmal dilatation of the celiac trunk which measures 12 mm x 11 mm (coronal, series 503 image 51). The true and false lumens are opacified. The common hepatic artery, left gastric, and splenic arteries appear to arise from the true lumen and are patent. Portal vein and extrahepatic areas are patent. SMA is patent. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Grade 1 anterolisthesis of L5 on S1. No aggressive osseous lesion. Degenerative changes throughout the spine.
3,059
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 70-year-old male with history of bladder cancer; surveillance examination. COMPARISON: Multiple prior CTs of the abdomen pelvis, most recently 12/7/2021 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 210 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 90 sec. Scan field of view: 455 mm. DLP: 1122 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis CT chest findings are reported separately. ABDOMEN and PELVIS: LIVER: Stable appearance of multiple subcentimeter hypodensities scattered throughout the liver, technically indeterminate but most suggestive of cysts. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral renal cortical scarring. Multiple bilateral nonobstructing calculi are observed, largest in the interpolar region of the right kidney and measuring approximately 2.1 cm on axial series 3, image 264. Mild thickening and enhancement of bilateral renal collecting systems. Portion of the mid/distal left ureter appears mildly narrowed with suspected irregular nodular enhancement (for example on axial series 3, image 315 and coronal series 4, image 100). Bilateral distal ureters have been mobilized with creation of an ileal urinary diversion. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Normal caliber abdominal aorta. Mild atherosclerotic disease. Apparent dissection seen involving portions of the celiac artery, not fully evaluated given the phase of contrast timing (axial series 3, image 200). URINARY BLADDER: Postsurgical changes related to cystectomy. REPRODUCTIVE ORGANS: Postsurgical changes related to prostatectomy. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Diffusely decreased bone mineralization. No suspicious osseous lesion. CONCLUSION: 1. Segment of mild mid/distal left ureteral narrowing with associated enhancing nodularity of the urothelium. Overall appearance is indeterminant but perhaps related to either peristalsis or sequelae of infectious/inflammatory etiology. Underlying neoplasm is not excluded. Recommend clinical correlation. Otherwise, no evidence of metastatic disease within the abdomen or pelvis. 2. Mild, smooth urothelial thickening and enhancement throughout both renal collecting systems. This may be inflammatory in nature, however, if there is concern for upper renal collecting system infection, recommend correlation with urinalysis. 3. Bilateral nonobstructing calculi. 4. Suspected dissection involving the celiac artery, suboptimally evaluated given the phase of contrast timing.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis CT chest findings are reported separately. ABDOMEN and PELVIS: LIVER: Stable appearance of multiple subcentimeter hypodensities scattered throughout the liver, technically indeterminate but most suggestive of cysts. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral renal cortical scarring. Multiple bilateral nonobstructing calculi are observed, largest in the interpolar region of the right kidney and measuring approximately 2.1 cm on axial series 3, image 264. Mild thickening and enhancement of bilateral renal collecting systems. Portion of the mid/distal left ureter appears mildly narrowed with suspected irregular nodular enhancement (for example on axial series 3, image 315 and coronal series 4, image 100). Bilateral distal ureters have been mobilized with creation of an ileal urinary diversion. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Normal caliber abdominal aorta. Mild atherosclerotic disease. Apparent dissection seen involving portions of the celiac artery, not fully evaluated given the phase of contrast timing (axial series 3, image 200). URINARY BLADDER: Postsurgical changes related to cystectomy. REPRODUCTIVE ORGANS: Postsurgical changes related to prostatectomy. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Diffusely decreased bone mineralization. No suspicious osseous lesion.
FINDINGS: MAXILLOFACIAL/SINUS: PARTIALLY VISUALIZED BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. SKULL AND SKULL BASE: No acute displaced fracture or aggressive osseous lesion. FACIAL BONES: Erosion and destruction of the right maxillary sinus as described below. No acute displaced fracture or aggressive osseous lesion. MANDIBLE: No acute displaced fracture or aggressive osseous lesion. REMAINING VISUALIZED BONES: No acute displaced fracture or aggressive osseous lesion. ORBITAL: No CT evidence of orbital soft tissue injury. SINUSES: Heterogeneously enhancing mass centered at the inferior/posterior aspect of the right maxillary sinus measuring approximately 1.4 x 1.4 cm on axial series 402 image 59. There is associated osseous destruction and resorption of the posterior and medial walls of the right maxillary sinus with posterior extension to involve the right pterygopalatine fossa best appreciated on sagittal series 206 image 277. There is also extensive resorption and destruction of the inferior aspect of the right maxilla extending from the anterior border of the right pterygoid plates to the anterior aspect of the right maxilla. Multiple tooth roots are involved by this invasive soft tissue component. Medially this mass extends to involve in a retrograde portions of the right hard palate with superior extension into the right nasal cavity. Laterally there is involvement of the right masticator space as well as the buccal space trigone.. Associated complex mucosal thickening and fluid is noted within the remainder of the right maxillary sinus. Trace fluid is noted within the left maxillary sinus. The remaining paranasal sinuses and mastoid air cells are clear. No associated extension is noted to involve the right orbit. NECK: SOFT TISSUES: The left masticator, parapharyngeal, retropharyngeal, carotid, sublingual, and submandibular spaces are unremarkable. The anterior neck soft tissue planes are unremarkable. LYMPH NODES: Multiple prominent level two lymph nodes one of which measures up to 1.2 cm in short axis on sagittal series 303 image 160. Some of these show central hypoenhancement. AERODIGESTIVE STRUCTURES: No asymmetric contrast enhancement or asymmetric soft tissue nodularity aside from previously described right heart palate involvement. PAROTID GLANDS/SUBMANDIBULAR GLANDS: Unremarkable. THYROID GLAND: Unremarkable. VASCULAR STRUCTURES: No evidence of dissection, occlusion, or aneurysm. OSSEOUS STRUCTURES: No fracture, dislocation, or destructive lesion. LUNG APICES: Limited evaluation. Apical pleural parenchymal scarring. Scattered emphysematous change. There appear to be scattered centrilobular nodules along both the major fissures in the upper lobes and superior segments of lower lobes.
3,060
EXAM: CT Chest with contrast CLINICAL INFORMATION: 70-year-old male follow-up urinary bladder cancer COMPARISON: October 8, 2021 TECHNIQUE: CT Chest with contrast. Patient weight: 210 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 9 sec. Scan field of view: 455 mm. DLP: 1122 mGy cm. FINDINGS: Index lesions are measured in series 3. Right hilar node in image 88 is 14 x 11 mm, it was 14 x 12 mm. Right middle lobe bronchopulmonary node in image 109 is 14 x 11 mm, it was 14 x 15 mm. Right lower lobe elongated nodule in image 136 is stable at 5 mm Few other small subcentimeter size nodes in the subcarinal region are stable. Several other scattered tiny nodules are unchanged. No new nodule or mass is noted. There is no pleural or pericardial and no focal lytic or sclerotic bone lesion is seen. CONCLUSION: Persistent scattered tiny lung nodules with slight interval reduction in size of right middle lobe bronchopulmonary node while other mediastinal nodes are stable. There is no new intrathoracic disease.
FINDINGS: Index lesions are measured in series 3. Right hilar node in image 88 is 14 x 11 mm, it was 14 x 12 mm. Right middle lobe bronchopulmonary node in image 109 is 14 x 11 mm, it was 14 x 15 mm. Right lower lobe elongated nodule in image 136 is stable at 5 mm Few other small subcentimeter size nodes in the subcarinal region are stable. Several other scattered tiny nodules are unchanged. No new nodule or mass is noted. There is no pleural or pericardial and no focal lytic or sclerotic bone lesion is seen.
FINDINGS: MAXILLOFACIAL/SINUS: PARTIALLY VISUALIZED BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. SKULL AND SKULL BASE: No acute displaced fracture or aggressive osseous lesion. FACIAL BONES: Erosion and destruction of the right maxillary sinus as described below. No acute displaced fracture or aggressive osseous lesion. MANDIBLE: No acute displaced fracture or aggressive osseous lesion. REMAINING VISUALIZED BONES: No acute displaced fracture or aggressive osseous lesion. ORBITAL: No CT evidence of orbital soft tissue injury. SINUSES: Heterogeneously enhancing mass centered at the inferior/posterior aspect of the right maxillary sinus measuring approximately 1.4 x 1.4 cm on axial series 402 image 59. There is associated osseous destruction and resorption of the posterior and medial walls of the right maxillary sinus with posterior extension to involve the right pterygopalatine fossa best appreciated on sagittal series 206 image 277. There is also extensive resorption and destruction of the inferior aspect of the right maxilla extending from the anterior border of the right pterygoid plates to the anterior aspect of the right maxilla. Multiple tooth roots are involved by this invasive soft tissue component. Medially this mass extends to involve in a retrograde portions of the right hard palate with superior extension into the right nasal cavity. Laterally there is involvement of the right masticator space as well as the buccal space trigone.. Associated complex mucosal thickening and fluid is noted within the remainder of the right maxillary sinus. Trace fluid is noted within the left maxillary sinus. The remaining paranasal sinuses and mastoid air cells are clear. No associated extension is noted to involve the right orbit. NECK: SOFT TISSUES: The left masticator, parapharyngeal, retropharyngeal, carotid, sublingual, and submandibular spaces are unremarkable. The anterior neck soft tissue planes are unremarkable. LYMPH NODES: Multiple prominent level two lymph nodes one of which measures up to 1.2 cm in short axis on sagittal series 303 image 160. Some of these show central hypoenhancement. AERODIGESTIVE STRUCTURES: No asymmetric contrast enhancement or asymmetric soft tissue nodularity aside from previously described right heart palate involvement. PAROTID GLANDS/SUBMANDIBULAR GLANDS: Unremarkable. THYROID GLAND: Unremarkable. VASCULAR STRUCTURES: No evidence of dissection, occlusion, or aneurysm. OSSEOUS STRUCTURES: No fracture, dislocation, or destructive lesion. LUNG APICES: Limited evaluation. Apical pleural parenchymal scarring. Scattered emphysematous change. There appear to be scattered centrilobular nodules along both the major fissures in the upper lobes and superior segments of lower lobes.
3,061
EXAM: CT Angio Chest wo+w contrast-dual-energy CLINICAL INFORMATION: Tachycardia, hypoxia concern for pulmonary thrombus embolism . Recent trauma with known fractures of the left manubrium, upper sternal body right ribs and L1 and L2. COMPARISON: 1/4/2022. TECHNIQUE: CT Angio Chest wo+w contrast. Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 187 lbs. IV contrast: Omnipaque 350, 60 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 327 mm. KVP: 90 DLP: 323 mGy cm. FINDINGS: ANGIOGRAM: The quality of exam for detection of pulmonary thromboembolism is excellent. No pulmonary thromboembolism is identified. Main pulmonary artery is mildly enlarged at 32 mm. No CT evidence of right heart failure. The thoracic aorta is normal in caliber and contour. No significant calcific atherosclerosis is seen in the aorta and coronary arteries. CHEST: Mildly enlarged subcarinal node measures 12 mm in short axis on series 906, image 41. No additional enlarged intrathoracic lymph nodes are identified. The esophagus is patulous. The heart size and mediastinum are otherwise normal. Small bilateral pleural effusions are seen right greater than left and increased from the previous exam. Adjacent dependent and compressive atelectasis is also slightly increased from prior. Additional new patchy groundglass opacities are seen laterally in the left upper lobe. A few small patchy areas in the right upper lobe are redemonstrated. There is areas of linear atelectasis in the RML and lingula and both lower lobes. Pleural-based lipoma is again seen laterally in the right hemithorax. Limited images of the upper abdomen are unremarkable. Multiple right rib fractures are redemonstrated. Nondisplaced fracture of the left manubrium and of the upper sternal body are redemonstrated. No new osseous lesions are identified. CONCLUSION: 1. No pulmonary thromboembolism identified. 2. Interval increase in still small bilateral pleural effusions with adjacent atelectasis. 3. New patchy groundglass opacities in the left upper lobe with patchy groundglass densities in the right upper lobe unchanged. This raises concern for possible infection. 4. Patulous esophagus suggesting possible reflux.
FINDINGS: ANGIOGRAM: The quality of exam for detection of pulmonary thromboembolism is excellent. No pulmonary thromboembolism is identified. Main pulmonary artery is mildly enlarged at 32 mm. No CT evidence of right heart failure. The thoracic aorta is normal in caliber and contour. No significant calcific atherosclerosis is seen in the aorta and coronary arteries. CHEST: Mildly enlarged subcarinal node measures 12 mm in short axis on series 906, image 41. No additional enlarged intrathoracic lymph nodes are identified. The esophagus is patulous. The heart size and mediastinum are otherwise normal. Small bilateral pleural effusions are seen right greater than left and increased from the previous exam. Adjacent dependent and compressive atelectasis is also slightly increased from prior. Additional new patchy groundglass opacities are seen laterally in the left upper lobe. A few small patchy areas in the right upper lobe are redemonstrated. There is areas of linear atelectasis in the RML and lingula and both lower lobes. Pleural-based lipoma is again seen laterally in the right hemithorax. Limited images of the upper abdomen are unremarkable. Multiple right rib fractures are redemonstrated. Nondisplaced fracture of the left manubrium and of the upper sternal body are redemonstrated. No new osseous lesions are identified.
FINDINGS: MAXILLOFACIAL/SINUS: PARTIALLY VISUALIZED BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. SKULL AND SKULL BASE: No acute displaced fracture or aggressive osseous lesion. FACIAL BONES: Erosion and destruction of the right maxillary sinus as described below. No acute displaced fracture or aggressive osseous lesion. MANDIBLE: No acute displaced fracture or aggressive osseous lesion. REMAINING VISUALIZED BONES: No acute displaced fracture or aggressive osseous lesion. ORBITAL: No CT evidence of orbital soft tissue injury. SINUSES: Heterogeneously enhancing mass centered at the inferior/posterior aspect of the right maxillary sinus measuring approximately 1.4 x 1.4 cm on axial series 402 image 59. There is associated osseous destruction and resorption of the posterior and medial walls of the right maxillary sinus with posterior extension to involve the right pterygopalatine fossa best appreciated on sagittal series 206 image 277. There is also extensive resorption and destruction of the inferior aspect of the right maxilla extending from the anterior border of the right pterygoid plates to the anterior aspect of the right maxilla. Multiple tooth roots are involved by this invasive soft tissue component. Medially this mass extends to involve in a retrograde portions of the right hard palate with superior extension into the right nasal cavity. Laterally there is involvement of the right masticator space as well as the buccal space trigone.. Associated complex mucosal thickening and fluid is noted within the remainder of the right maxillary sinus. Trace fluid is noted within the left maxillary sinus. The remaining paranasal sinuses and mastoid air cells are clear. No associated extension is noted to involve the right orbit. NECK: SOFT TISSUES: The left masticator, parapharyngeal, retropharyngeal, carotid, sublingual, and submandibular spaces are unremarkable. The anterior neck soft tissue planes are unremarkable. LYMPH NODES: Multiple prominent level two lymph nodes one of which measures up to 1.2 cm in short axis on sagittal series 303 image 160. Some of these show central hypoenhancement. AERODIGESTIVE STRUCTURES: No asymmetric contrast enhancement or asymmetric soft tissue nodularity aside from previously described right heart palate involvement. PAROTID GLANDS/SUBMANDIBULAR GLANDS: Unremarkable. THYROID GLAND: Unremarkable. VASCULAR STRUCTURES: No evidence of dissection, occlusion, or aneurysm. OSSEOUS STRUCTURES: No fracture, dislocation, or destructive lesion. LUNG APICES: Limited evaluation. Apical pleural parenchymal scarring. Scattered emphysematous change. There appear to be scattered centrilobular nodules along both the major fissures in the upper lobes and superior segments of lower lobes.
3,062
EXAM: CT Chest wo contrast CLINICAL INFORMATION: Evaluate pleural effusion for loculations. COMPARISON: None. TECHNIQUE: CT Chest wo contrast. Scan field of view: 364 mm. DLP: 273.90 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: Large left pleural effusion with complete left lung atelectasis and fluid/mucus filling of left lung bronchi. Moderate sized right pleural effusion with overlying atelectasis. Aerated right lung shows pulmonary edema and few areas of small nodularity in the periphery of the right upper lobe. HEART / VESSELS: No pericardial effusion. Right IJ permcath terminates in the mid right atrium. Enlarged pulmonary trunk measuring 3.8 cm in diameter. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Few mildly enlarged mediastinal lymph nodes such as a right lower paratracheal node measuring 15 mm in short axis on1 image 41, series 201. CHEST WALL: No significant abnormality. UPPER ABDOMEN: No acute abnormality. Hepatic cyst. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Large left pleural effusion and moderate sized right effusion with loculated appearing of the left effusion. 2. Complete left lung atelectasis 3. Pulmonary edema. Few areas of infectious versus inflammatory nodularity within the periphery of the right upper lobe.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Large left pleural effusion with complete left lung atelectasis and fluid/mucus filling of left lung bronchi. Moderate sized right pleural effusion with overlying atelectasis. Aerated right lung shows pulmonary edema and few areas of small nodularity in the periphery of the right upper lobe. HEART / VESSELS: No pericardial effusion. Right IJ permcath terminates in the mid right atrium. Enlarged pulmonary trunk measuring 3.8 cm in diameter. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Few mildly enlarged mediastinal lymph nodes such as a right lower paratracheal node measuring 15 mm in short axis on1 image 41, series 201. CHEST WALL: No significant abnormality. UPPER ABDOMEN: No acute abnormality. Hepatic cyst. MUSCULOSKELETAL: No significant abnormality.
FINDINGS: STRUCTURED REPORT: CTA Abdomen Pelvis VASCULATURE: Diffuse arterial wall calcifications involve the aorta and branch vessels. DISTAL DESCENDING THORACIC AORTA: See separate chest CT report. ABDOMINAL AORTA: Aortic dissection extends from the thoracic aorta to the level of the aorta adjacent to the SMA origin. There is no extension of dissection beyond this level. Infrarenal abdominal aortic aneurysm measures 3.9 x 3.4 cm (image 260 series 6). CELIAC AXIS: Supplied by the true lumen with narrowing at the origin. SMA: No significant abnormality. RIGHT RENAL: No significant abnormality. LEFT RENAL: No significant abnormality. IMA: No significant abnormality. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: Ectasia with severe arterial wall calcifications. No significant abnormality. LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: Ectasia with severe arterial wall calcifications. No significant abnormality. ------------------------------------------------------------- LOWER CHEST: See separate chest CT report. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Layering gallstones without wall thickening or stranding. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Tiny bilateral renal calyceal stones and vascular calcifications. Simple left renal cyst. Small amount of perinephric stranding. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Short segment of small bowel protrudes through a broad-based rectus muscle diastases and into a small umbilical hernia. Otherwise normal stomach and small bowel. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostatomegaly. BODY WALL: Rectus muscle diastases. No significant abnormality. MUSCULOSKELETAL: Diffuse osteopenia. Severe lumbar degenerative changes. Chronic degenerative changes in the right symphysis pubis with healed fractures and right total hip arthroplasty.
3,063
EXAM: CT Chest with contrast CLINICAL INFORMATION: History of renal cell carcinoma. COMPARISON: CT chest 6/25/2021 TECHNIQUE: CT Chest with contrast. Patient weight: 230 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 3 ml per sec. Scan delay: Bolus Tracked. Scan field of view: 470 mm. DLP: 2307 mGy cm. FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. Subsegmental atelectasis in the bilateral lower lobes with mild bronchiectasis. No suspicious pulmonary nodules or masses. No pleural effusion. HEART / VESSELS: The heart is normal in size with moderate coronary artery atherosclerotic calcifications. Moderate atherosclerotic disease of the thoracic aorta and proximal arch vessels. No large central pulmonary embolus. Trace pericardial effusion is present. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. MUSCULOSKELETAL: Decreased osseous mineralization. No aggressive osseous lesions. Moderate multilevel degenerative changes of the thoracic spine. Chronic right posterior disc osteophyte complex at T10-T11 with severe right lateral recess/subarticular zone stenosis secondary to ossified disc osteophyte complex, unchanged. CONCLUSION: 1. No evidence of intrathoracic metastatic disease. 2. Unchanged severe T10-T11 subarticular zone stenosis. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. Subsegmental atelectasis in the bilateral lower lobes with mild bronchiectasis. No suspicious pulmonary nodules or masses. No pleural effusion. HEART / VESSELS: The heart is normal in size with moderate coronary artery atherosclerotic calcifications. Moderate atherosclerotic disease of the thoracic aorta and proximal arch vessels. No large central pulmonary embolus. Trace pericardial effusion is present. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. MUSCULOSKELETAL: Decreased osseous mineralization. No aggressive osseous lesions. Moderate multilevel degenerative changes of the thoracic spine. Chronic right posterior disc osteophyte complex at T10-T11 with severe right lateral recess/subarticular zone stenosis secondary to ossified disc osteophyte complex, unchanged.
FINDINGS: AORTIC MEASUREMENTS: AORTIC ROOT AT THE SINUSES: 4.0 x 4.0 x 4.0 cm. MID-ASCENDING THORACIC AORTA: 6.9 x 6.2 cm. AORTIC ARCH: 4.0 x 3.3 cm. PROXIMAL DESCENDING THORACIC AORTA: 5.0 x 4.6 cm. MID DESCENDING THORACIC AORTA: 4.4 x 3.8 cm. DISTAL DESCENDING THORACIC AORTA: 4.1 x 3.5 cm. Ascending aortic dissection starts above the sinotubular junction and involves the arch and entire descending thoracic aortic aorta extending into the abdominal aorta. There is a large fenestration in the flap proximally with opacification of both true and false lumens up to mid descending thoracic aorta after which the false lumen is slightly less opacified. There is no thrombus in either lumen. All three neck vessels are patent. There is common origin of the right innominate and left common carotid artery. Atherosclerotic disease of the native coronary arteries which are obscured due to motion artifact. The LIMA to LAD graft and left SVG to obtuse marginal and a right SVG to distal RCA/posterior lateral LV branch is patent. There is atherosclerotic disease in the distal right SVG graft. No pleural or pericardial effusion is seen. Linear atelectasis in the left lower lobe due to slightly elevated left hemidiaphragm. No discrete lung nodule or mass or interstitial abnormality. No focal lytic or sclerotic bone lesion.
3,064
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 77-year-old female with renal cell carcinoma and secondary malignant neoplasm of bone. COMPARISON: CT abdomen and pelvis 6/25/2021 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 230 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 90 sec. Scan field of view: 470 mm. DLP: 2307 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately dictated same-day CT chest. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Mild intra and no extrahepatic biliary ductal dilatation, unchanged from prior.. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Mild thickening of the left adrenal gland. The right adrenal gland is unremarkable. KIDNEYS: Postsurgical changes from a prior right nephrectomy. Posterior left simple renal cyst is unchanged. Subcentimeter left renal hypodensity is too small to characterize; however, statistically a cyst. Similar appearance of the small nodule in the right nephrectomy bed measuring 1.3 x 0.6 cm (series 11 image 195), previously 1.2 x 0.4 cm. Series 9 image 241). LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Small hiatal hernia. COLON / APPENDIX: Diverticulosis. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Severe atherosclerotic disease of the abdominal aorta which is normal in caliber. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is surgically absent. There is a right ovarian cyst measuring 2.3 x 2.0 cm (series 11 image 310), previously 2.2 x 2.0 cm (series 9 image 376), stable since 2009. Left adnexa is unremarkable. BODY WALL: Small periumbilical fat-containing hernia. Additional stable ventral abdominal wall fat-containing hernias. MUSCULOSKELETAL: Lytic lesion of the posterior right acetabulum with extension to the cortex appears similar to prior (series 5 image 174). No new osseous lesions are seen. Degenerative changes throughout the thoracolumbar spine most pronounced at L4-L5 with grade 1 anterolisthesis of L4 on L5. CONCLUSION: 1. Unchanged small nodularity in the right nephrectomy bed and stable lytic lesion of the posterior right acetabulum. No evidence of new disease within the abdomen or pelvis. 2. Stable chronic and incidental findings as described above. 3. 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.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately dictated same-day CT chest. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Mild intra and no extrahepatic biliary ductal dilatation, unchanged from prior.. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Mild thickening of the left adrenal gland. The right adrenal gland is unremarkable. KIDNEYS: Postsurgical changes from a prior right nephrectomy. Posterior left simple renal cyst is unchanged. Subcentimeter left renal hypodensity is too small to characterize; however, statistically a cyst. Similar appearance of the small nodule in the right nephrectomy bed measuring 1.3 x 0.6 cm (series 11 image 195), previously 1.2 x 0.4 cm. Series 9 image 241). LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Small hiatal hernia. COLON / APPENDIX: Diverticulosis. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Severe atherosclerotic disease of the abdominal aorta which is normal in caliber. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is surgically absent. There is a right ovarian cyst measuring 2.3 x 2.0 cm (series 11 image 310), previously 2.2 x 2.0 cm (series 9 image 376), stable since 2009. Left adnexa is unremarkable. BODY WALL: Small periumbilical fat-containing hernia. Additional stable ventral abdominal wall fat-containing hernias. MUSCULOSKELETAL: Lytic lesion of the posterior right acetabulum with extension to the cortex appears similar to prior (series 5 image 174). No new osseous lesions are seen. Degenerative changes throughout the thoracolumbar spine most pronounced at L4-L5 with grade 1 anterolisthesis of L4 on L5.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal for technique. Small right hepatic lobe cyst. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Left renal cyst. No radiopaque urinary tract calculi are visualized. No hydronephrosis bilaterally. The visualized bilateral ureters are 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: No abnormality. BODY WALL: Periumbilical hernia containing a single loop of nondilated small bowel. MUSCULOSKELETAL: No aggressive osseous lesions.
3,065
CTA Coronary Artery CLINICAL INFORMATION: 48-year-old male with history of chest pain, hyperlipidemia, hypertension, and family history of ischemic heart disease. TECHNIQUE: Precontrast axial images through the heart were acquired for calcium score evaluation. Postcontrast images were helically acquired in prospective ECG gating to the heart with dual source 256 detectors Siemens CT scanner (Somatom 4th). 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 nitroglycerin sublingually. Patient weight: 165 lbs. IV contrast: Omnipaque 350, 70 ml, per protocol. Saline flush: 60 ml. IV contrast injection rate: 5 ml per sec. Scan delay: Bolus Tracked. Scan field of view: 170 mm. Heart Rate: 46 bpm. DLP: 355 mGy cm. COMPARISON: Echocardiogram on 11/3/2021 FINDINGS: Calcium score: Using a modified Agatston scoring method, the coronary artery calcification score is 90 which corresponds to the 91 percentile for the patient's age, gender and ethnicity, using the online available MESA calcium score calculator. Coronary arteries: * Dominance: Right heart dominant. * Coronary anatomy: There is normal origin of the coronary arteries. * LM: Normal origin of the left coronary artery arising from the left coronary cusp. No significant atherosclerotic plaque or stenosis. The left main coronary artery trifurcates into the left anterior descending, ramus intermedius, and left circumflex arteries. The left ramus intermedius artery is patent with minimal calcified atherosclerotic disease at the origin. * LAD: Normal course and caliber. Small multiple calcified atherosclerotic disease of the mid LAD without significant flow-limiting stenosis. The proximal and distal LAD is patent without significant atherosclerotic disease or stenosis. Small calcified plaques at the proximal and mid D1 branch with positive remodeling and mild stenosis. * LCx: Normal course and caliber. The sinoatrial artery arising from the left circumflex artery. Multiple calcified plaques of the proximal left circumflex artery without significant stenosis. The mid and distal left circumflex artery is patent. * RCA: Normal origin of the right coronary artery arising from the right coronary cusp. The conus artery also arises directly from the right coronary cusp. Small calcified plaques of the proximal and distal right coronary artery without significant stenosis. There is poor opacification of the distal RCA after the takeoff of PDA with small calcified plaque, however the posterolateral branches appears patent and well opacified by contrast. This is may be related to artifact. Prominent posterolateral artery branch. Heart and great vessels: Cardiac chambers: The cardiac chambers are normal in size with normal anatomy. No pericardial effusion. A note is made of accessory pulmonary vein. The visualized Thoracic aorta is normal caliber without significant atherosclerotic disease. The visualized Pulmonary arteries are normal in caliber without large central pulmonary embolus. Lungs and extracardiac structures: The scanned central tracheobronchial tree is patent. The scanned part of the mediastinum is unremarkable. The scanned lungs demonstrate bilateral dependent atelectasis. The scanned part of the upper abdomen is unremarkable. The scanned chest wall soft tissues and skeletal structures are unremarkable. CONCLUSION: 1. Normal origin of coronary arteries. Dominant RCA circulation. Mild multivessel atherosclerotic disease of the coronary arteries, CAD-RADS 2. 2. Coronary artery calcification score of 90 consistent with moderate cardiovascular disease risk. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: Calcium score: Using a modified Agatston scoring method, the coronary artery calcification score is 90 which corresponds to the 91 percentile for the patient's age, gender and ethnicity, using the online available MESA calcium score calculator. Coronary arteries: * Dominance: Right heart dominant. * Coronary anatomy: There is normal origin of the coronary arteries. * LM: Normal origin of the left coronary artery arising from the left coronary cusp. No significant atherosclerotic plaque or stenosis. The left main coronary artery trifurcates into the left anterior descending, ramus intermedius, and left circumflex arteries. The left ramus intermedius artery is patent with minimal calcified atherosclerotic disease at the origin. * LAD: Normal course and caliber. Small multiple calcified atherosclerotic disease of the mid LAD without significant flow-limiting stenosis. The proximal and distal LAD is patent without significant atherosclerotic disease or stenosis. Small calcified plaques at the proximal and mid D1 branch with positive remodeling and mild stenosis. * LCx: Normal course and caliber. The sinoatrial artery arising from the left circumflex artery. Multiple calcified plaques of the proximal left circumflex artery without significant stenosis. The mid and distal left circumflex artery is patent. * RCA: Normal origin of the right coronary artery arising from the right coronary cusp. The conus artery also arises directly from the right coronary cusp. Small calcified plaques of the proximal and distal right coronary artery without significant stenosis. There is poor opacification of the distal RCA after the takeoff of PDA with small calcified plaque, however the posterolateral branches appears patent and well opacified by contrast. This is may be related to artifact. Prominent posterolateral artery branch. Heart and great vessels: Cardiac chambers: The cardiac chambers are normal in size with normal anatomy. No pericardial effusion. A note is made of accessory pulmonary vein. The visualized Thoracic aorta is normal caliber without significant atherosclerotic disease. The visualized Pulmonary arteries are normal in caliber without large central pulmonary embolus. Lungs and extracardiac structures: The scanned central tracheobronchial tree is patent. The scanned part of the mediastinum is unremarkable. The scanned lungs demonstrate bilateral dependent atelectasis. The scanned part of the upper abdomen is unremarkable. The scanned chest wall soft tissues and skeletal structures are unremarkable.
FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Stable scattered less than 5 mm pulmonary nodules. No new suspicious pulmonary nodule. No focal consolidation, pleural effusion or pneumothorax. HEART / VESSELS: Nonopacification of the left IJ vein with probable clots seen in the left brachiocephalic vein along the port catheter. The left chest wall port is stable, tip is present in the upper SVC and is laterally oriented, unchanged. Heart size is normal. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormalities. UPPER ABDOMEN: Please see same day CT abdomen for abdomen findings. MUSCULOSKELETAL: Diffuse mixed lytic and sclerotic metastatic disease throughout the thoracic spine, ribs, and bilateral shoulder girdles. Chronic deformity of the right 10th rib
3,066
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Lung cancer COMPARISON: 10/5/2021 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 190 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: 412 mm. DLP: 987 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Probable cholelithiasis. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Stable left adrenal nodule, previously characterized as an adenoma. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Small hiatal hernia COLON / APPENDIX: Diverticulosis PERITONEUM / MESENTERY: No ascites. RETROPERITONEUM: Normal. VESSELS: Severe atherosclerotic disease. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus and ovaries are unremarkable BODY WALL: No significant abnormality. MUSCULOSKELETAL: Osteopenia.. CONCLUSION: 1. No evidence of metastatic disease in abdomen pelvis. 2. Incidental findings as detailed above.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Probable cholelithiasis. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Stable left adrenal nodule, previously characterized as an adenoma. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Small hiatal hernia COLON / APPENDIX: Diverticulosis PERITONEUM / MESENTERY: No ascites. RETROPERITONEUM: Normal. VESSELS: Severe atherosclerotic disease. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus and ovaries are unremarkable BODY WALL: No significant abnormality. MUSCULOSKELETAL: Osteopenia..
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Chest findings to be dictated separately; please see separate chest CT report same day. ABDOMEN and PELVIS: LIVER: Redemonstration of questionable subtle surface nodularity. A subcentimeter focal hypoattenuating lesion measures 8mm in the posterior segment of the right lobe image #55 series #201 with upstream segmental/subsegmental intrahepatic biliary ductal dilatation, unchanged. No new focal hepatic lesion BILIARY TRACT: Unchanged dilatation of the right posterior hepatic duct, similar to prior examinations GALLBLADDER: Cholelithiasis PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Small nonobstructing left renal interpolar calculus measuring 4 mm. No hydronephrosis. A few hypoattenuating subcentimeter lesions, likely cysts, unchanged. LYMPH NODES: Unchanged borderline enlarged node in the gastrohepatic ligament measuring 8 mm. No pathologically enlarged lymph nodes STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered colonic diverticula PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Recanalized umbilical vein consistent with portal venous hypertension. Mild aortobiiliac atherosclerotic disease without aneurysm. URINARY BLADDER: Decompressed REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Similar appearance of numerous osseous sclerotic lesions. No interval pathologic fracture is seen. Multiple compression deformities in the lumbar spine are unchanged..
3,067
CT Chest with contrast Clinical Information: 75-year-old female with previous history indicating right breast cancer restaging on treatment, C34.90 Malignant neoplasm of unspecified part of unspecified bronchus or lung, C79.31 Secondary malignant neoplasm of brain, R59.9 Enlarged lymph nodes, unspecified Spec Inst: BEFORE onc clinic visit in Jan 2022 Comparison: 10/5/2021 Technique: Following injection of non-ionic contrast 2.5 mm images were obtained through the chest. Abdominal findings will be reported separately. Patient weight: 190 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: 342 mm. DLP: 304 mGy cm. Findings: Enlarged subcarinal node measures 17 x 21 mm on series 2 image 57 and was 20 x 22 mm on the prior. New enlarged right hilar node measures 15 x 27 mm on image 54. This measured 7 x 10 mm on the prior. No additional enlarged intrathoracic nodes are present. Small hiatal hernia with circumferential wall thickening throughout the esophagus is again seen. Calcific atherosclerosis is seen in the aorta. The heart size and mediastinum are otherwise normal. No pleural effusion. New patchy groundglass opacities are seen in the right upper and right lower lobes in a perihilar central peribronchial pattern. Similar appearance is seen in the perihilar left lower lobe. New irregular opacity is present in the medial left lung base on series 2 image 46 and unclear if that's a nodule or infection. Groundglass nodular opacity in the LLL on image 61 measures 10 mm. In retrospect this was present on the October exam and is unchanged in size. Tiny subpleural nodule in the LLL on image 82 is unchanged back to the July 2021 exam as is tiny LLL nodule on image 59.. Tiny RLL nodule on image 72 is new. Additional tiny RLL nodule on image 81 is unchanged. Slight subpleural reticulation in the RUL and RML is again seen consistent with postradiation therapy to the right breast. Area of atelectasis or scarring in the RML is slight central nodularity along the scarring is unchanged. The lungs are otherwise normal. Postsurgical/posttreatment changes in the right breast are again noted. Tiny nodules in the left breast are redemonstrated now with adjacent biopsy markers. Lytic and sclerotic lesions in the thoracic spine are unchanged. CT abdomen and pelvis will be reported separately. Impression: 1.. New nodular opacity in the left lower lobe and unclear if this is a true nodule or an area of infection. 2. New bilateral perihilar groundglass opacities. Differential is infection versus possible post radiation change. Clinical correlation needed. 3. New enlarged right hilar node. Enlarged subcarinal node has decreased slightly in size from the previous exam. 4. Several scattered tiny nodules with new RLL nodule with the remainder are unchanged. Groundglass nodule in the left lower lobe is also unchanged. 5. Circumferential esophageal wall thickening, small nodules in the left breast and sclerotic and lytic thoracic spine lesions are unchanged. Additional incidental findings as above.
Findings: Enlarged subcarinal node measures 17 x 21 mm on series 2 image 57 and was 20 x 22 mm on the prior. New enlarged right hilar node measures 15 x 27 mm on image 54. This measured 7 x 10 mm on the prior. No additional enlarged intrathoracic nodes are present. Small hiatal hernia with circumferential wall thickening throughout the esophagus is again seen. Calcific atherosclerosis is seen in the aorta. The heart size and mediastinum are otherwise normal. No pleural effusion. New patchy groundglass opacities are seen in the right upper and right lower lobes in a perihilar central peribronchial pattern. Similar appearance is seen in the perihilar left lower lobe. New irregular opacity is present in the medial left lung base on series 2 image 46 and unclear if that's a nodule or infection. Groundglass nodular opacity in the LLL on image 61 measures 10 mm. In retrospect this was present on the October exam and is unchanged in size. Tiny subpleural nodule in the LLL on image 82 is unchanged back to the July 2021 exam as is tiny LLL nodule on image 59.. Tiny RLL nodule on image 72 is new. Additional tiny RLL nodule on image 81 is unchanged. Slight subpleural reticulation in the RUL and RML is again seen consistent with postradiation therapy to the right breast. Area of atelectasis or scarring in the RML is slight central nodularity along the scarring is unchanged. The lungs are otherwise normal. Postsurgical/posttreatment changes in the right breast are again noted. Tiny nodules in the left breast are redemonstrated now with adjacent biopsy markers. Lytic and sclerotic lesions in the thoracic spine are unchanged. CT abdomen and pelvis will be reported separately.
FINDINGS: SOFT TISSUES: The masticator, parapharyngeal, retropharyngeal, carotid, sublingual, and submandibular spaces are unremarkable. LYMPH NODES: No pathologic adenopathy by imaging size criteria. AERODIGESTIVE STRUCTURES: No asymmetric contrast enhancement or asymmetric soft tissue nodularity. PAROTID GLANDS/SUBMANDIBULAR GLANDS: Unremarkable. THYROID GLAND: Unremarkable. VASCULAR STRUCTURES: Complete thrombosis of the left internal jugular vein extending from the left jugular foramen to its confluence with the subclavian vein extending into the brachiocephalic vein, unchanged from same day CT chest in the visualized portions. There is mild surrounding stranding. Left chest wall port is noted within this region with its distal tip terminating at the cranial SVC. There is no thrombotic extension into the sigmoid sinus. Dural venous sinuses that are visualized are patent. No significant arterial abnormality. OSSEOUS STRUCTURES: Heterogeneous mixed lytic and sclerotic appearance of the cervical vertebral bodies most pronounced at C5. Technically age indeterminate anterior wedging of the C4 vertebral body. ORBITS: Unremarkable. PARANASAL SINUSES AND MASTOID AIR CELLS: Clear. PARTIALLY VISUALIZED INTRACRANIAL STRUCTURES: Please see separately dictated same day MR brain. LUNG APICES: Please see separately dictated same day CT chest. There is moderate dental caries in the residual teeth.
3,068
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 59-year-old male with history of neuroendocrine tumor; follow-up. COMPARISON: Multiple prior CTs of the abdomen pelvis, most recently 10/2/2020 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 250 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: Bolus Tracked. Scan field of view: 420 mm. DLP: 2310.35 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: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Stable appearance of a left renal cyst. LYMPH NODES: Stable appearance of mildly prominent mesenteric lymph nodes adjacent to the ileocolonic anastomosis. STOMACH / SMALL BOWEL: Ileocolonic anastomotic suture line noted. COLON / APPENDIX: Postsurgical changes associated with prior partial colectomy. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostate is moderately enlarged, measuring 5.7 cm in transverse dimension. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Postsurgical changes associated with prior partial colectomy. No evidence of local recurrence or metastatic disease within the abdomen or pelvis.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Stable appearance of a left renal cyst. LYMPH NODES: Stable appearance of mildly prominent mesenteric lymph nodes adjacent to the ileocolonic anastomosis. STOMACH / SMALL BOWEL: Ileocolonic anastomotic suture line noted. COLON / APPENDIX: Postsurgical changes associated with prior partial colectomy. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostate is moderately enlarged, measuring 5.7 cm in transverse dimension. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
FINDINGS/CONCLUSION: Persistent posterior dislocation of the right hip with comminuted transverse fracture of the right acetabulum involving the anterior and posterior columns. Unchanged appearance of the impaction fracture of the anterior inferior femoral head. Comminuted fracture of the posterior left ilium extending into the left SI joint with diastasis. Minimally displaced fractures of the left superior and inferior pubic rami. The pubic symphysis measures approximately 0.7 cm decreased from the prior study when it measured 1.0 cm. Unchanged fracture of the left L5 transverse process. Interval decreased size of the extraperitoneal perivesicular hematoma with mass effect on the urinary bladder.
3,069
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Concern for small bowel obstruction COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 105 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 2 ml per sec. Scan delay: 80 sec. Scan field of view: 324.50 mm. DLP: 351.30 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Nodularity and tree-in-bud opacities within the left lower lobe has overall mildly worsened with 13 mm nodular focus in the left lower lobe on image 26, series 201. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Stable minimally complex multilobular cyst and additional hepatic cysts are unchanged. Otherwise normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Dilated gas and fluid-filled small bowel with transition point again seen in the midline upper pelvis on image 190, series 201. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Trace perihepatic ascites is similar to prior. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Recurrent high-grade mechanical small bowel obstruction with transition point again seen at the midline upper pelvis. 2. Mild interval worsening nodularity and tree-in-bud opacities in the left lower lobe with new 13 mm left lower lobe nodule versus nodular consolidation. Recommend follow-up chest CT in 3 months. 3. Trace perihepatic ascites. *****IMPORTANT INCIDENTAL IMAGING FINDINGS REPORTED*****
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Nodularity and tree-in-bud opacities within the left lower lobe has overall mildly worsened with 13 mm nodular focus in the left lower lobe on image 26, series 201. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Stable minimally complex multilobular cyst and additional hepatic cysts are unchanged. Otherwise normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Dilated gas and fluid-filled small bowel with transition point again seen in the midline upper pelvis on image 190, series 201. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Trace perihepatic ascites is similar to prior. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
FINDINGS: STRUCTURED REPORT: CT HCC Screening IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: Small bilateral pleural effusions and bibasilar subsegmental atelectasis HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. No steatosis. LIVER LESIONS: None LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Patent intra- and extra-hepatic portal venous system. Interval resolution in previously observed left portal vein thrombus. Patent tips. Redemonstration of left gastric embolization and interval decrease in size of gastroesophageal varices. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: Small (
3,070
CT Neck Soft Tissue w contrast 1/7/2022 9:42 AM Clinical Information: Possible soft tissue mass in the neck on prior ultrasound. Comparison: Ultrasound neck 12/28/2021. Technique: Axial images of the neck were obtained following the administration of intravenous contrast. Reformatted coronal and sagittal images were also obtained. Patient weight: 143 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 180 sec. Scan field of view: 285 mm. DLP: 289.90 mGy cm. Findings: There is right greater than left enlargement of sternoclavicular joint without significant fluid density suggesting sinonasal hypertrophy. There is no significant adjacent fat stranding. Correlate with point tenderness to exclude acute inflammatory etiology. There is no evidence for underlying osseous erosion. Mild mucosal hyperemia of the nasopharyngeal and oropharyngeal mucosa may relate to inflammatory etiology. Otherwise nasopharynx and oropharynx are normal in appearance. The base of the tongue and lymphoid tissue within Waldeyer's ring are unremarkable. The hypopharynx and larynx appear normal. Small sized bilateral cervical lymph nodes, not enlarged by CT size criteria. 5 mm right thyroid hypoattenuating nodule. There is a small exophytic hyperattenuating nodule of similar in attenuation in the left thyroid lobe in the left tracheoesophageal groove measuring approximately 7 mm likely exophytic thyroid tissue. Otherwise bilateral thyroid glands are unremarkable. Symmetric nonspecific enlargement of bilateral submandibular glands. Bilateral parotid glands are unremarkable. Pseudophakia and bilateral orbits. Mucosal thickening in bilateral maxillary sinuses and ethmoid air cells. Bilateral mastoid air cells and middle ear cavities are unremarkable. Included portions of the brain and skull base appear normal. Multilevel degenerative changes of the cervical spine. No acute osseous abnormalities. Impression: 1. Likely degenerative hypertrophy of bilateral sternoclavicular joints, right greater than left. No joint effusion or adjacent inflammatory change or underlying osseous erosion. Correlate with point tenderness. 2. No definite evidence of mass in the neck, that is worrisome for metastatic disease. 3. Other incidental findings as described above.
Findings: There is right greater than left enlargement of sternoclavicular joint without significant fluid density suggesting sinonasal hypertrophy. There is no significant adjacent fat stranding. Correlate with point tenderness to exclude acute inflammatory etiology. There is no evidence for underlying osseous erosion. Mild mucosal hyperemia of the nasopharyngeal and oropharyngeal mucosa may relate to inflammatory etiology. Otherwise nasopharynx and oropharynx are normal in appearance. The base of the tongue and lymphoid tissue within Waldeyer's ring are unremarkable. The hypopharynx and larynx appear normal. Small sized bilateral cervical lymph nodes, not enlarged by CT size criteria. 5 mm right thyroid hypoattenuating nodule. There is a small exophytic hyperattenuating nodule of similar in attenuation in the left thyroid lobe in the left tracheoesophageal groove measuring approximately 7 mm likely exophytic thyroid tissue. Otherwise bilateral thyroid glands are unremarkable. Symmetric nonspecific enlargement of bilateral submandibular glands. Bilateral parotid glands are unremarkable. Pseudophakia and bilateral orbits. Mucosal thickening in bilateral maxillary sinuses and ethmoid air cells. Bilateral mastoid air cells and middle ear cavities are unremarkable. Included portions of the brain and skull base appear normal. Multilevel degenerative changes of the cervical spine. No acute osseous abnormalities.
Findings: There is mild opacification of the right ethmoid sinus. Remaining paranasal sinuses are clear. Bilateral ostiomeatal complexes are patent and unremarkable. The visualized osseous structures appear intact. The remaining visualized osseous and soft tissue structures appear within normal limits. Nasal septum is center in position. However, there are mild irregularity along the mucosal surface, possibility of ulcerations cannot be excluded. Recommended direct visualization. -
3,071
EXAM: CT Chest with contrast CLINICAL INFORMATION: 51-year-old female, for malignancy workup. COMPARISON: None available at this time. TECHNIQUE: CT Chest with contrast. Patient weight: 100 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 60 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 70 sec. Scan field of view: 295 mm. DLP: 340 mGy cm. FINDINGS: LOWER NECK: Subcentimeter lower cervical lymph nodes. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. Mild scarring in the left lower lobe and mild bronchiectasis in the left lower lobe. No suspicious pulmonary nodule or focal consolidation. No pleural effusion. HEART / VESSELS: Normal sized cardiac chambers. No central PE. Normal caliber pulmonary artery and thoracic aorta. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Will be reported separately. MUSCULOSKELETAL: No destructive osseous lesion. CONCLUSION: 1. No evidence of intrathoracic malignancy. 2. Mild left lower lobe bronchiectasis and scarring, likely related to prior aspiration/remote infection. 'STEEN CINDY . , , 51 year, 2 month, 24 days, CT220003661, Hataway Felicia, Jan 2022 'STEEN CINDY . , , 51 year, 2 month, 24 days, CT220003661, Hataway Felicia, Jan 2022 'STEEN CINDY . , , 51 year, 2 month, 24 days, CT220003661, Hataway Felicia, Jan 2022 'STEEN CINDY . , , 51 year, 2 month, 24 days, CT220003661, Hataway Felicia, Jan 2022 'STEEN CINDY . , , 51 year, 2 month, 24 days, CT220003661, Hataway Felicia, Jan 2022 'STEEN CINDY . , , 51 year, 2 month, 24 days, CT220003661, Hataway Felicia, Jan 2022 'STEEN CINDY . , , 51 year, 2 month, 24 days, CT220003661, Hataway Felicia, Jan 2022
FINDINGS: LOWER NECK: Subcentimeter lower cervical lymph nodes. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. Mild scarring in the left lower lobe and mild bronchiectasis in the left lower lobe. No suspicious pulmonary nodule or focal consolidation. No pleural effusion. HEART / VESSELS: Normal sized cardiac chambers. No central PE. Normal caliber pulmonary artery and thoracic aorta. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Will be reported separately. MUSCULOSKELETAL: No destructive osseous lesion.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately dictated CT chest. ABDOMEN and PELVIS: LIVER: Subtle ill-defined hypodensity slightly more prominent in the current exam in the left lobe around fissure for falciform ligament, could represent focal fat infiltration. No definite intrahepatic new focal lesion is identified. BILIARY TRACT: Similar mild intrahepatic and extra hepatic biliary ductal dilation, possibly related to prior cholecystectomy. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Subcentimeter foci of hypoattenuation are too small for accurate characterization. LYMPH NODES: Aortocaval lymph node is slightly decreased in size compared to prior measuring 1.6 x 1.1 cm on image 285 series 202, previously 2.1 x 1.4 cm. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Partially loculated ascites with associated peritoneal thickening and enhancement is overall similar in volume compared to prior. Perihepatic cystic implant with subtle soft tissue nodularity is similar in size measuring 5.4 x 2.8 cm on image 22 series 202, previously measuring the same. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is absent. No adnexal masses. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
3,072
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Malignancy workup. COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 100 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 60 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 70 sec. Scan field of view: 240 mm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Distended with gallstone lodged at the gallbladder neck. Mild inflammation of the gallbladder wall adjacent to the stone. No evidence of acute cholecystitis. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Punctate nonobstructing left renal calculus. Otherwise normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis. Otherwise normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Collapsed. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. No evidence of malignancy in the abdomen or pelvis. 2. Gallbladder neck calculus with distended gallbladder, but no evidence of acute cholecystitis at this time. 'STEEN CINDY . , , 51 year, 2 month, 24 days, CT220003662, Hataway Felicia, Jan 2022 'STEEN CINDY . , , 51 year, 2 month, 24 days, CT220003662, Hataway Felicia, Jan 2022 'STEEN CINDY . , , 51 year, 2 month, 24 days, CT220003662, Hataway Felicia, Jan 2022 'STEEN CINDY . , , 51 year, 2 month, 24 days, CT220003662, Hataway Felicia, Jan 2022 'STEEN CINDY . , , 51 year, 2 month, 24 days, CT220003662, Hataway Felicia, Jan 2022 'STEEN CINDY . , , 51 year, 2 month, 24 days, CT220003662, Hataway Felicia, Jan 2022 'STEEN CINDY . , , 51 year, 2 month, 24 days, CT220003662, Hataway Felicia, Jan 2022
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Distended with gallstone lodged at the gallbladder neck. Mild inflammation of the gallbladder wall adjacent to the stone. No evidence of acute cholecystitis. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Punctate nonobstructing left renal calculus. Otherwise normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis. Otherwise normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Collapsed. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Unchanged tiny low-attenuation lesions in the right lobe of the thyroid. Unchanged left upper mediastinal/left lower neck lymph node measuring 1.3 x 2.4 cm (series 202; image 24), previously about 2.4 x 1.6 cm. CHEST: LUNGS / AIRWAYS / PLEURA: Scattered calcified granulomas are again seen. Small nodular opacity measuring about 0.6 cm adjacent to the major fissure on the right upper lobe (series 202; image 71) is unchanged and may represent a small lymph node. Scattered areas of atelectasis versus scarring. Tiny areas of mucous plugging again seen in the left upper lobe bronchi and elsewhere. HEART / VESSELS: Top normal heart size. Moderate to severe coronary artery calcifications. Main pulmonary artery is enlarged at 3.3 cm suggesting some element of pulmonary artery hypertension. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. LYMPH NODES: Enlarged left upper mediastinal/left neck lymph node as noted above. CHEST WALL: A right chest port terminates in the right atrium. Soft tissues of the chest wall are otherwise unremarkable. UPPER ABDOMEN: Please note that the concurrently obtained CT scan of the Abdomen will be dictated separately. MUSCULOSKELETAL: No significant abnormality.
3,073
EXAM: CT Maxillofacial with contrast HISTORY: 73 years old Female with NASAL SCC, C30.0 Malignant neoplasm of nasal cavity TECHNIQUE: Contiguous axial helical CT images were obtained from above the frontal sinuses through the mandible with image reformats and with intravenous contrast. COMPARISON: None . FINDINGS: Enhancing mass involving the anterior left nasal soft tissues measuring 1.8 x 1.3 cm (image 79, series 301 with mild arthritic changes along the anterior nasal mucosal surface. Mild narrowing of the anterior left nasal cavity. There is no evidence of involvement of underlying osseous structures. Left orbital enucleation with prosthetic left eye. Right orbit is unremarkable. Visualized paranasal sinuses are unremarkable. Other visualized soft tissues in the maxillofacial region are unremarkable. Small 5 mm nodule along the deep lobe of parotid (image 61, series 301) may be a small lymph node. Small scattered upper cervical lymph nodes, not enlarged by CT size criteria. Likely a sebaceous cyst in the right periparotid region measuring approximately 1.4 x 1.1 cm. Complete occlusion of the left cervical and intracranial ICA with reconstitution at the left ICA terminus, likely chronic. Additional scattered vascular atherosclerosis. Surgical clips in the right submandibular region may be related to prior level II lymph node dissection. IMPRESSION: 1. Enhancing soft tissue mass in the left anterior nasal soft tissues, consistent with known squamous cell carcinoma. 2. Small nodule along the deep lobe of parotid may be a lymph node. However close attention at follow-up imaging is suggested to exclude other etiology. 3. No additional enhancing mass or lymphadenopathy suspicious for metastatic disease.
FINDINGS: Enhancing mass involving the anterior left nasal soft tissues measuring 1.8 x 1.3 cm (image 79, series 301 with mild arthritic changes along the anterior nasal mucosal surface. Mild narrowing of the anterior left nasal cavity. There is no evidence of involvement of underlying osseous structures. Left orbital enucleation with prosthetic left eye. Right orbit is unremarkable. Visualized paranasal sinuses are unremarkable. Other visualized soft tissues in the maxillofacial region are unremarkable. Small 5 mm nodule along the deep lobe of parotid (image 61, series 301) may be a small lymph node. Small scattered upper cervical lymph nodes, not enlarged by CT size criteria. Likely a sebaceous cyst in the right periparotid region measuring approximately 1.4 x 1.1 cm. Complete occlusion of the left cervical and intracranial ICA with reconstitution at the left ICA terminus, likely chronic. Additional scattered vascular atherosclerosis. Surgical clips in the right submandibular region may be related to prior level II lymph node dissection.
FINDINGS: The study is mildly degraded by metallic streak artifact from dental amalgam. SOFT TISSUES: Multilobulated, ulcerating and enhancing cutaneous/subcutaneous 4.7 x 1.7 cm left facial mass superficial to the zygomatic bone (series 6, image 45). Suspected invasion of the left lateral preseptal orbit/eyelid. Associated left premalar subcutaneous stranding and subcutaneous fascial thickening. Marked diffuse left facial dermal thickening. Additionally, a smaller multilobulated enhancing 1.5 x 1.0 cm cutaneous/subcutaneous lesion inferior to the left parotid and anterior to the sternocleidomastoid muscle (series 6, image 20). Suspected invasion of the superficial parotid lobe with linear extension towards the retromandibular vein (series 6, image 21). Marked asymmetric thickening of the parotid duct and enlargement of the left maxillary muscle belly (series 6, image 30). Regional subcutaneous stranding and irregular platysma muscle thickening deep to the lesion. Irregular prominence of the soft palate, right pharyngeal mucosa, and tongue base, resulting in oropharyngeal luminal narrowing (series 6, image 22). However, normal preservation of the parapharyngeal fat planes. LYMPH NODES: Prominent but nonenlarged left intraparotid and level 2/5 cervical nodes with loss of normal reniform morphology (for example: series 6; images 14, 16, 19, 22). FACIAL BONES: Leftward nasal septal deviation with bony spurring. MANDIBLE: Normal. REMAINING VISUALIZED BONES: No destructive lesion. Mild anterolisthesis of C2 on C3. SINONASAL CAVITIES: Partial opacification of the left greater than right maxillary sinuses with aerated secretions and mucosal thickening. Mild mucosal thickening of the ethmoid, sphenoid, and frontal sinuses. The mastoid air cells are clear bilaterally. VISUALIZED INTRACRANIAL STRUCTURES: Age-appropriate cerebral volume. The ventricular system is normal in caliber. Mild bilateral carotid siphon and left carotid bifurcations atherosclerotic calcifications. Otherwise normal. ORBITAL CONTENTS: The right orbit is normal. No definite postseptal invasion on the left.
3,074
EXAM: CT Pelvis wo IV contrast CLINICAL INFORMATION: 57-year-old male with end-stage renal disease undergoing renal transplant evaluation. COMPARISON: None. TECHNIQUE: CT Pelvis wo IV contrast. Scan delay: 0 sec. Scan field of view: 378 mm. DLP: 333.36 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Pelvis Renal Transplant VASCULATURE: LOWER ABDOMINAL AORTA: Moderate calcified atherosclerotic disease. RIGHT COMMON / INTERNAL ILIAC ARTERIES: Moderate calcified atherosclerotic disease. RIGHT EXTERNAL ILIAC ARTERY: No calcified atherosclerotic disease. LEFT COMMON / INTERNAL ILIAC ARTERIES: Moderate calcified atherosclerotic disease. LEFT EXTERNAL ILIAC ARTERY: No calcified atherosclerotic disease. LOWER ABDOMEN: BOWEL: No abnormality. PERITONEUM: Trace volume simple pelvic free fluid. OTHER: No other abnormality. PELVIS: LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: Mild lumbar facet arthrosis. Bilateral sacroiliac degenerative changes. CONCLUSION: Moderate atherosclerotic disease as described above. Bilateral external iliac arteries are free of significant atherosclerotic disease.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Pelvis Renal Transplant VASCULATURE: LOWER ABDOMINAL AORTA: Moderate calcified atherosclerotic disease. RIGHT COMMON / INTERNAL ILIAC ARTERIES: Moderate calcified atherosclerotic disease. RIGHT EXTERNAL ILIAC ARTERY: No calcified atherosclerotic disease. LEFT COMMON / INTERNAL ILIAC ARTERIES: Moderate calcified atherosclerotic disease. LEFT EXTERNAL ILIAC ARTERY: No calcified atherosclerotic disease. LOWER ABDOMEN: BOWEL: No abnormality. PERITONEUM: Trace volume simple pelvic free fluid. OTHER: No other abnormality. PELVIS: LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: Mild lumbar facet arthrosis. Bilateral sacroiliac degenerative changes.
FINDINGS: STRUCTURED REPORT: CTA Abdomen Pelvis VASCULATURE: DISTAL DESCENDING THORACIC AORTA: No significant abnormality. ABDOMINAL AORTA: No significant abnormality. CELIAC AXIS: Post surgical changes from supraceliac aortic to proper hepatic artery bypass. Mild luminal irregularity and narrowing of the proximal aspect of the graft is more prominent on today's exam, for example on image 166 series 4. The proper hepatic, right hepatic, and left hepatic arteries are patent without significant stenosis or aneurysm. Previously seen small outpouching from the proximal portion of the graft is not well visualized on today's exam. Similar postprocedural changes related to ligation of the common hepatic artery with decrease in size of the aneurysm and resolution of air. SMA: No significant abnormality. RIGHT RENAL: No significant abnormality. LEFT RENAL: No significant abnormality. IMA: No significant abnormality. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. ------------------------------------------------------------- LOWER CHEST: LUNG BASES / PLEURA: Faint groundglass opacity in the medial right lung base. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Heart is enlarged. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Nonobstructing calculi in the interpolar region of the right kidney. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered noninflamed colonic diverticula. Normal appendix. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing bilateral inguinal hernias.. MUSCULOSKELETAL: Stable small cyst within the right gluteus minor muscle. Otherwise, no significant abnormality.
3,075
CT Head wo contrast 1/10/2022 2:17 AM Clinical Information: follow up Comparison: 1/7/2022 Technique: Unenhanced axial brain CT. Scan field of view: 250 mm. DLP: 1105 mGy cm. Findings: Compared to prior study, there has been no significant change in the diffuse hypodense areas involving the left temporal, parietal lobes, consistent with evolving contusions. There is again evolving right parietal convexity extra-axial hemorrhage. There has been interval removal of the right frontal approach ventriculostomy catheter. The ventricular size and contour is slightly increased without definite hydrocephalus. There is minimal extra-axial hemorrhage along the left frontal convexity without definite mass effect. No significant change in the multiple osseous fractures involving the left calvarium. Impression: Interval removal of the left frontal approach ventriculostomy catheter with slightly prominent ventricles. No definite hydrocephalus. Otherwise no significant change from the prior study.
Findings: Compared to prior study, there has been no significant change in the diffuse hypodense areas involving the left temporal, parietal lobes, consistent with evolving contusions. There is again evolving right parietal convexity extra-axial hemorrhage. There has been interval removal of the right frontal approach ventriculostomy catheter. The ventricular size and contour is slightly increased without definite hydrocephalus. There is minimal extra-axial hemorrhage along the left frontal convexity without definite mass effect. No significant change in the multiple osseous fractures involving the left calvarium.
Findings: Evaluation of the oral cavity is degraded by streak artifact. Within this limitation, there is no obvious abnormal enhancing mass is noted.. There is dental caries involving the left maxillary molar teeth most prominently. There is no cervical adenopathy by CT size criteria. The thyroid gland and salivary glands appear normal. Mucosa of the aerodigestive tract appears unremarkable. Included portions of the brain and skull base appear normal. Atherosclerotic calcifications are noted throughout the vascular structures, most prominent in the right subclavian artery with moderate stenosis. Degenerative changes are noted in the cervical spine, most prominent at C5-6 with mild spinal canal narrowing. There is a stable irregular, mildly spiculated right upper lung nodule measuring 1.8 x 1 cm, similar to the prior exam. There are bilateral emphysematous changes.
3,076
EXAM: CT Chest High Resolution wo contrast CLINICAL INFORMATION: 21-year-old female with history of asthma, cough and chest pain COMPARISON: CTA of the chest dated July 26, 2021 TECHNIQUE: CT Chest High Resolution wo contrast. Scan field of view: 280 mm. DLP: 181.63 mGy cm. High-resolution CT imaging of the chest was performed per protocol with inspiratory and expiratory technique in prone position. FINDINGS: No airspace consolidation, interstitial abnormality or discrete lung nodule/mass. Minimal peribronchial thickening and mucous plugging noted in the right lower lobe subsegmental bronchial branches for example image 167, series 2. There is no expiratory air trapping or tracheobronchomalacia. No enlarged nodes are seen in the mediastinum. Prominent thymic tissue is present in the anterior mediastinum. There is no pleural or pericardial effusion and visualized bones are unremarkable. CONCLUSION: Minimal small airway disease changes without pneumonia or interstitial disease
FINDINGS: No airspace consolidation, interstitial abnormality or discrete lung nodule/mass. Minimal peribronchial thickening and mucous plugging noted in the right lower lobe subsegmental bronchial branches for example image 167, series 2. There is no expiratory air trapping or tracheobronchomalacia. No enlarged nodes are seen in the mediastinum. Prominent thymic tissue is present in the anterior mediastinum. There is no pleural or pericardial effusion and visualized bones are unremarkable.
FINDINGS: Index lesions are measured on series 2: 1. Right hilar lymph node measuring 15 x 18 mm on image 40 measured 18 x 22 mm previously. 2. Right paratracheal lymph nodes previously described have visually decreased but are difficult to measure due to extensive adjacent venous collaterals. 3. Left upper lobe bronchopulmonary lymph node on image 38 measures 8 x 14 mm compared to 11 x 15 mm previously. No new or enlarging thoracic lymph nodes. Previous right axillary lymph node dissection.. Surgical changes of bilateral mastectomy are again noted. Again seen is a defect within the right anterior chest wall at the site of prior mesh. This defect appears similar to the prior examination. Central airways are patent. The thoracic aorta is nonaneurysmal. The pulmonary arteries are not dilated. Again seen is occlusion of the left brachiocephalic vein just above the confluence with the SVC. Extensive collaterals are seen within the mediastinum. The heart is not enlarged. No pericardial effusion. The esophagus is not dilated. Subpleural consolidation within the anterior right upper lobe and to a lesser extent within the anterior left upper lobe appears similar. There are no new or enlarging lung nodules. No acute lung abnormality. No pleural effusion or pleural thickening. Unchanged left renal cyst. There is increased bony erosion adjacent to the right anterior chest wall defect most significant at the level of the sternomanubrial junction. There are also areas of erosion and sclerosis of the right anterior second through fifth ribs adjacent to the chest wall wound.
3,077
CT head without contrast Indication: ICH. Comparison: CT head dated 1/6/2022 Technique: Multiple contiguous axial images of the brain were obtained from base to the vertex without the use of intravenous contrast. Sagittal and coronal reconstruction images were formatted in postprocessing. Scan field of view: 210 mm. DLP: 1032 mGy cm. . Findings: Right frontal approach ventriculostomy catheter is redemonstrated with stable decompressed ventricular system. Redemonstration of mildly dilated left frontal horn secondary to mass effect from left temporal hemorrhage. Small volume of layering chronic hemorrhage within the left occipital horn appears similar. Expected evolution of multifocal parenchymal hemorrhages, residual hemorrhage within the left frontal lobe overall unchanged in size as compared to the prior study. No new intracranial abnormality. Impression: 1. Stable right frontal approach ventriculostomy catheter with stable size and configuration of the ventricles, with small volume intraventricular hemorrhage remaining within the left occipital horn and dilation of the left temporal horn. 2. Expected evolution of multifocal parenchymal hemorrhages, with residual hemorrhage most significant within the left frontal lobe, overall unchanged. 3. No new 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.
Findings: Right frontal approach ventriculostomy catheter is redemonstrated with stable decompressed ventricular system. Redemonstration of mildly dilated left frontal horn secondary to mass effect from left temporal hemorrhage. Small volume of layering chronic hemorrhage within the left occipital horn appears similar. Expected evolution of multifocal parenchymal hemorrhages, residual hemorrhage within the left frontal lobe overall unchanged in size as compared to the prior study. No new intracranial abnormality.
Findings: There is no evidence of acute infarction, hemorrhage or hydrocephalus. There is no vasogenic edema or mass effect. There is mild diffuse cerebral volume loss with ventricular prominence. There is a chronic right corona radiata lacunar infarct. There is a right maxillary sinus mucus retention cyst. The remaining visualized paranasal sinuses and mastoid air cells are clear. There is no acute osseous abnormality.
3,078
CLINICAL HISTORY: hydrocephalus EXAM: CT Head wo contrast TECHNIQUE: + mm thick serial axial images were obtained throughout the head without intravenous contrast. Scan field of view: 226 mm. DLP: 1011 mGy cm. COMPARISON: 1/2/2022 FINDINGS: Right frontoparietal craniectomy changes are again noted. There is expected evolution of right and left occipital lobe infarctions. There is also. There is also continued hypoattenuation within the right frontal lobe and small right frontal lobe parenchymal hemorrhage demonstrating expected evolution. There is progressive hypoattenuation within the left thalamus representing evolving infarction. The left frontal approach ventriculostomy catheter is unchanged in position. There is been interval enlargement of the ventricular system secondary to decreased diffuse brain edema. There is small amount of IVH within the right occipital horn. There is decreased but continued herniation of the right cerebral hemisphere through the craniectomy defect. There is increasing size of right subdural hypodense fluid collection. There is interval development of small hypodense fluid collection along the posterior interhemispheric fissure. There is no midline shift. Left frontal bone, left sphenoid and temporal bone skull fracture again noted. There is complete opacification of the mastoid air cells and the left middle ear. There is essentially complete opacification of the paranasal sinuses except for the right maxillary sinus. There is no acute abnormality of the orbits. CONCLUSION: 01. Resolving postsurgical changes related to right frontoparietal decompressive craniectomy. There is decreased overall brain edema and decreased but continued herniation of brain through the craniectomy defect. 02. No change in position of left frontal approach ventriculostomy catheter. Interval enlargement of ventricular system secondary to overall decreased brain edema. No hydrocephalus. 03. Evolution of multiple infarctions including the occipital lobes, right frontal lobe and left thalamus. There is also expected evolution of small right frontal lobe parenchymal hemorrhage.
FINDINGS: Right frontoparietal craniectomy changes are again noted. There is expected evolution of right and left occipital lobe infarctions. There is also. There is also continued hypoattenuation within the right frontal lobe and small right frontal lobe parenchymal hemorrhage demonstrating expected evolution. There is progressive hypoattenuation within the left thalamus representing evolving infarction. The left frontal approach ventriculostomy catheter is unchanged in position. There is been interval enlargement of the ventricular system secondary to decreased diffuse brain edema. There is small amount of IVH within the right occipital horn. There is decreased but continued herniation of the right cerebral hemisphere through the craniectomy defect. There is increasing size of right subdural hypodense fluid collection. There is interval development of small hypodense fluid collection along the posterior interhemispheric fissure. There is no midline shift. Left frontal bone, left sphenoid and temporal bone skull fracture again noted. There is complete opacification of the mastoid air cells and the left middle ear. There is essentially complete opacification of the paranasal sinuses except for the right maxillary sinus. There is no acute abnormality of the orbits.
Findings: The spinal alignment is normal. There is mild chronic appearing wedging of the superior endplate of T1-T3. There is a small Schmorl's node in the superior endplate of C7. Vertebral body heights are otherwise preserved. There are moderate degenerative changes with multilevel facet arthropathy, left greater than right. There is loss of disc height at C5-6 with disc osteophyte complex and uncovertebral DJD. There is moderate foraminal narrowing at C5-6. There is no acute fracture or facet malalignment. There is a large retrosternal mediastinal goiter with mass effect on the trachea, which appears similar to 3/30/2018 chest CT measuring approximately 1.3 cm in the maximum transverse dimension. There is mild scarring with calcification in the right lung apex.
3,079
EXAM: CT Head wo contrast, CT Thoracic Spine wo contrast, CT Cervical Spine wo contrast CLINICAL INFORMATION: Trauma, MVC COMPARISON: None. TECHNIQUE: CT Head wo contrast, CT Thoracic Spine wo contrast, CT Cervical Spine wo contrast Scan field of view: 223.10 mm. DLP: 1749 mGy cm. (accession CT220003669), Scan field of view: 190 mm. DLP: 526.60 mGy cm. (accession CT220003692), Scan field of view: 192 mm. DLP: 278 mGy cm. (accession CT220003670) FINDINGS: HEAD: Exam is limited by motion artifact. BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Increased attenuation overlying both cerebral convexities and anterior frontal lobes appears to be artifactual. No convincing extra-axial hemorrhage identified. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. 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 (
FINDINGS: HEAD: Exam is limited by motion artifact. BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Increased attenuation overlying both cerebral convexities and anterior frontal lobes appears to be artifactual. No convincing extra-axial hemorrhage identified. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. 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 (
FINDINGS/CONCLUSION: Motion artifact. No acute displaced fracture. Decreased bone mineralization Status post bilateral hip arthroplasties. Significant metallic streak artifact and decreased bone mineralization decreases sensitivity for subtle nondisplaced fractures. Osteolysis is noted around the left acetabular cup. The femoral head component is well-seated within their acetabular cups. No pubic symphyseal or SI joint diastasis. Multilevel degenerative changes of the visualized lumbar spine. Transitional lumbosacral anatomy. No acute findings within the abdomen and pelvis.
3,080
EXAM: CT Head wo contrast, CT Thoracic Spine wo contrast, CT Cervical Spine wo contrast CLINICAL INFORMATION: Trauma, MVC COMPARISON: None. TECHNIQUE: CT Head wo contrast, CT Thoracic Spine wo contrast, CT Cervical Spine wo contrast Scan field of view: 223.10 mm. DLP: 1749 mGy cm. (accession CT220003669), Scan field of view: 190 mm. DLP: 526.60 mGy cm. (accession CT220003692), Scan field of view: 192 mm. DLP: 278 mGy cm. (accession CT220003670) FINDINGS: HEAD: Exam is limited by motion artifact. BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Increased attenuation overlying both cerebral convexities and anterior frontal lobes appears to be artifactual. No convincing extra-axial hemorrhage identified. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. 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 (
FINDINGS: HEAD: Exam is limited by motion artifact. BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Increased attenuation overlying both cerebral convexities and anterior frontal lobes appears to be artifactual. No convincing extra-axial hemorrhage identified. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. 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 (
FINDINGS: Scattered heterogeneous peribronchovascular and peripheral groundglass and reticular opacities are seen bilaterally. There is no apical to basal gradient. The abnormalities in the lung bases are predominantly peribronchovascular with minimal peripheral involvement. There is some associated mild bronchiectasis bilaterally without significant bronchial wall thickening. No honeycombing or other cystic lung disease. The expiratory images were obtained with suboptimal expiratory effort there is some mosaicism on the suboptimal expiratory imaging. No pleural effusion or pleural thickening. The supraclavicular region is unremarkable. Central airways are patent. The thoracic aorta is nonaneurysmal. The pulmonary arteries are normal in caliber. Moderate to severe coronary artery calcifications. The heart is not enlarged. No pericardial effusion. No enlarged thoracic lymph nodes. Subcentimeter mediastinal lymph nodes are noted, some of which are calcified. The esophagus is not dilated. There is a small hiatal hernia. Multilevel degenerative changes are seen throughout the spine. No acute or aggressive osseous abnormality.
3,081
EXAM: CT Chest with contrast CLINICAL INFORMATION: 64-year-old male follow-up stage IV gastric cancer restaging evaluation COMPARISON: October 15, 2021 TECHNIQUE: CT Chest with contrast. Patient weight: 189 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 2 ml per sec. Scan delay: 97 sec. Scan field of view: 410 mm. DLP: 1171.43 mGy cm. FINDINGS: Subcentimeter size nodes in the mediastinum are slightly more prominent when compared with prior CT including upper anterior and posterior paratracheal, lower paratracheal, AP window, subcarinal as well as hilar/bronchopulmonary regions. No discrete lung nodule or mass is noted. There is stable rounded atelectasis in the right lower lobe with bilateral partly calcified pleural plaques. No pleural or pericardial effusion is seen. There is no focal lytic or sclerotic bone lesion. CONCLUSION: 1. Indeterminate slightly prominent mediastinal hilar and bronchopulmonary nodes without lung nodule or mass. 2. Asbestos related pleural disease.
FINDINGS: Subcentimeter size nodes in the mediastinum are slightly more prominent when compared with prior CT including upper anterior and posterior paratracheal, lower paratracheal, AP window, subcarinal as well as hilar/bronchopulmonary regions. No discrete lung nodule or mass is noted. There is stable rounded atelectasis in the right lower lobe with bilateral partly calcified pleural plaques. No pleural or pericardial effusion is seen. There is no focal lytic or sclerotic bone lesion.
FINDINGS: STRUCTURED REPORT: CTA Abdomen Pelvis Stent VASCULATURE: ENDOVASCULAR STENT: Stable positioning of the endovascular stent extending from the descending thoracic aorta to the level of the superior mesenteric artery origin. ENDOLEAK: Similar type II endoleak related to filling by the celiac axis and superior mesenteric artery. DISTAL DESCENDING THORACIC AORTA: Endovascular stent is in place traversing distal thoracic aortic aneurysm. ABDOMINAL AORTA: Native aneurysm sac at the level of the celiac axis origin measures 5.8 x 4.5 cm on image 246 series 3, previously measuring the same by my measurements. Distal abdominal aortic aneurysm with mural thrombus just proximal to the aortic bifurcation measure 7.1 x 5.8 cm on image 354 series 3, previously 6.1 x 5.3 cm by my measurements. CELIAC AXIS: Celiac axis arises from the excluded aneurysm sac/false lumen. Similar dissection flap in the proximal celiac axis. Similar appearance of the distal celiac axis aneurysm at the bifurcation with associated mural thrombus. SMA: Dissection flap in the proximal superior mesenteric artery appears unchanged. The SMA is partially supplied by both the true and false lumens. RIGHT RENAL: Pulmonary origin of the right renal artery secondary to atherosclerotic disease. LEFT RENAL: Similar focal dilation of the abdominal aorta at the left renal artery origin. IMA: No significant abnormality. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: Right common iliac artery aneurysm measures 2.8 cm on image 35 series 3. Right internal iliac artery aneurysm measures up to 2.0 cm on image 398 series 3 LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: Left common iliac artery aneurysm measures 2.8 cm on image 35 series 3. Left internal iliac artery aneurysm measures up to 1.7 cm on image 399 series 3. ------------------------------------------------------------- LOWER CHEST: Please see separately dictated CT chest. ABDOMEN and PELVIS: LIVER: Scattered hepatic cysts. Additional subcentimeter foci of hypoattenuation throughout the liver are too small for accurate characterization but also likely represent cysts. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Left lower pole renal cyst. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostate gland is enlarged. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Scattered lumbar spine degenerative changes. No destructive osseous lesion.
3,082
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Gastric cancer restaging COMPARISON: 10/15/2021 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 189 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 2 ml per sec. Scan delay: 97 sec. Scan field of view: 410 mm. DLP: 1171.43 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately reported chest CT. ABDOMEN and PELVIS: LIVER: Noncirrhotic morphology. No steatosis. No concerning mass or lesion visualized. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis without surrounding inflammation. PANCREAS: Mild diffuse fatty atrophy. Stable pancreatic head calcification. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Mild bilateral lobulation without significant atrophy. Surrounding nonspecific stranding. No concerning mass identified. No hydroureteronephrosis. Right mid renal exophytic simple renal cyst is unchanged. LYMPH NODES: Revisualization of a centrally necrotic gastrohepatic lymph node measuring 2.6 x 2.3 cm (series 2 image 225), previously measuring 2.9 x 2.4 cm. Scattered intraperitoneal lymph nodes that are not pathologically enlarged. STOMACH / SMALL BOWEL: There is persistent nodularity involving the inferior border of the gastric body (series 601, image 111), relatively unchanged compared to prior exam. COLON / APPENDIX: Scattered colonic diverticula without surrounding inflammation. The appendix is normal. PERITONEUM / MESENTERY: There is nonspecific stranding within the mesentery surrounding the small bowel, best seen on series 2 image 328. The adjacent bowel is unremarkable. Focal infiltration involving the periumbilical omentum on series 2 image 344 is slightly smaller compared to prior exam. RETROPERITONEUM: There is a hypoattenuating retrocrural tubular structure that measures approximately 1.0 cm in maximum thickness, unchanged compared to prior and likely representing a dilated cisterna chyli. VESSELS: Mild atherosclerosis involving the abdominal aorta and branching vessels. Abdominal aorta is normal in caliber. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostatomegaly. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute or aggressive osseous abnormality. Scattered hyperattenuating foci within the pelvis, likely bone islands, unchanged. CONCLUSION: 1. Persistent but unchanged nodularity of the inferior border of the gastric body with stable centrally necrotic gastrohepatic lymph node. Stable periumbilical omental infiltrate. No new suspicious lymph node or lesion identified within the abdomen/pelvis. 2. 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.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately reported chest CT. ABDOMEN and PELVIS: LIVER: Noncirrhotic morphology. No steatosis. No concerning mass or lesion visualized. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis without surrounding inflammation. PANCREAS: Mild diffuse fatty atrophy. Stable pancreatic head calcification. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Mild bilateral lobulation without significant atrophy. Surrounding nonspecific stranding. No concerning mass identified. No hydroureteronephrosis. Right mid renal exophytic simple renal cyst is unchanged. LYMPH NODES: Revisualization of a centrally necrotic gastrohepatic lymph node measuring 2.6 x 2.3 cm (series 2 image 225), previously measuring 2.9 x 2.4 cm. Scattered intraperitoneal lymph nodes that are not pathologically enlarged. STOMACH / SMALL BOWEL: There is persistent nodularity involving the inferior border of the gastric body (series 601, image 111), relatively unchanged compared to prior exam. COLON / APPENDIX: Scattered colonic diverticula without surrounding inflammation. The appendix is normal. PERITONEUM / MESENTERY: There is nonspecific stranding within the mesentery surrounding the small bowel, best seen on series 2 image 328. The adjacent bowel is unremarkable. Focal infiltration involving the periumbilical omentum on series 2 image 344 is slightly smaller compared to prior exam. RETROPERITONEUM: There is a hypoattenuating retrocrural tubular structure that measures approximately 1.0 cm in maximum thickness, unchanged compared to prior and likely representing a dilated cisterna chyli. VESSELS: Mild atherosclerosis involving the abdominal aorta and branching vessels. Abdominal aorta is normal in caliber. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostatomegaly. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute or aggressive osseous abnormality. Scattered hyperattenuating foci within the pelvis, likely bone islands, unchanged.
FINDINGS: Surgical changes related to graft repair of the ascending thoracic aorta and aortic arch appear similar. Again seen overlapping stent graft within the descending thoracic aorta extending into the upper abdominal aorta. Peripherally calcified false lumen along the distal descending thoracic aorta appears similar to the prior examination with filling of the false lumen at the level of the celiac axis. No stent migration. Aortic measurements are provided below: Aortic measurements are as follows (using center line technique): Aortic root at the level of the sinuses: 47 x 38 x 42 mm as measured from sinus to commissure. Mid-ascending thoracic aorta: 36 x 33 mm. Aortic arch: 36 x 39 mm. Proximal descending thoracic aorta: 41 x 37 mm. Mid descending thoracic aorta: 39 x 37 mm. Distal descending thoracic aorta: 53 x 45 mm at the diaphragmatic hiatus, previously 54 x 43 mm. The great vessels are patent. The pulmonary arteries are normal caliber. The heart is not enlarged. No pericardial effusion. The thyroid gland is unremarkable. Central airways are patent. A prominent right lower paratracheal lymph node is unchanged in size. No new or enlarging thoracic lymph nodes. The esophagus is not dilated. Unchanged small right pleural effusion with mild bibasilar atelectasis. No new or enlarging lung nodules. Mild upper lobe predominant emphysema. The CT of the abdomen and pelvis will be dictated separately. No acute or aggressive osseous abnormality. Median sternotomy wires are present.
3,083
CLINICAL HISTORY: ICH Spec Inst: STEALTH PROTOCOL EXAM: CT Head wo contrast TECHNIQUE: 5 mm thick serial axial images were obtained throughout the head without intravenous contrast. Scan field of view: 252 mm. DLP: 1697 mGy cm. COMPARISON: 1/6/2022 FINDINGS: Bifrontal craniectomy changes are again noted. Left frontal lobe again herniates through the craniectomy defect. There is expected evolution of left frontal, right frontal hemorrhages, largest within the posterior left frontal lobe. There is mildly increased hypoattenuation of adjacent vasogenic edema. There is stable subarachnoid hemorrhage within the superior left frontal lobe. There are also areas of hypoattenuation within the anterior left temporal lobe representing nonhemorrhagic contusion and also small hemorrhagic contusion within the posterior left temporal lobe. There is also stable small amount of subdural hemorrhage along the cerebellar tentorium bilaterally. No new hemorrhage is identified. There is no midline shift. Ventricles are normal in size.. CONCLUSION: 01. Stable bifrontal decompressive craniectomy changes. 02. Expected evolution of multiple hemorrhagic contusions within both frontal lobes. Expected evolution of left temporal lobe nonhemorrhagic and hemorrhagic contusion. Stable significant associated vasogenic edema 03. Stable superior left frontal lobe subarachnoid hemorrhage and small cerebellar tentorium subdural hemorrhages
FINDINGS: Bifrontal craniectomy changes are again noted. Left frontal lobe again herniates through the craniectomy defect. There is expected evolution of left frontal, right frontal hemorrhages, largest within the posterior left frontal lobe. There is mildly increased hypoattenuation of adjacent vasogenic edema. There is stable subarachnoid hemorrhage within the superior left frontal lobe. There are also areas of hypoattenuation within the anterior left temporal lobe representing nonhemorrhagic contusion and also small hemorrhagic contusion within the posterior left temporal lobe. There is also stable small amount of subdural hemorrhage along the cerebellar tentorium bilaterally. No new hemorrhage is identified. There is no midline shift. Ventricles are normal in size..
FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Moderately suboptimal quality with incomplete evaluation of segmental and subsegmental pulmonary arteries. Exam limited due to motion artifact. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Diffuse centrilobular emphysema. No focal consolidation, pleural effusion, or pneumothorax. The central airways are patent. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. Unchanged calcified nodular densities in the anterior and posterior right chest wall. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No significant abnormality.
3,084
CT Neck Soft Tissue w contrast 1/7/2022 9:58 AM Clinical Information: Evaluate Lymphoma, C85.90 Non-Hodgkin lymphoma, unspecified, unspecified site Comparison: None available Technique: The neck was studied from the skull base to the thoracic inlet during contrast infusion, following an initial loading bolus of contrast. Patient weight: 184 lbs. IV contrast: Omnipaque 350, 140 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 180 sec. Scan field of view: 297 mm. DLP: 509.70 mGy cm. Findings: There is no cervical adenopathy by CT size criteria. Few small left supraclavicular and additional scattered lymph nodes are noted, which are not enlarged by size criteria There are small tiny bilateral thyroid lobe nodules, larger on the right measuring 6 mm. Bilateral submandibular glands appear partially atrophic, right greater than left. There are punctate calcifications within bilateral parotid glands. Mucosa of the aerodigestive tract appears unremarkable. No obvious enhancing neck mass is identified There are no aggressive osseous lesions. There are mild degenerative changes, most prominent at C5-6 and C6-7 with disc osteophyte contacts and uncovertebral DJD with moderate left foraminal narrowing at C5-6. Included portions of the brain and skull base appear normal. Chest findings are reported separately. Impression: 1. No evidence of cervical adenopathy by size criteria. Chest findings are reported separately. 2. Few tiny punctate parotid calcifications, could represent sialoliths. This finding could also be seen with Sjogren's syndrome.
Findings: There is no cervical adenopathy by CT size criteria. Few small left supraclavicular and additional scattered lymph nodes are noted, which are not enlarged by size criteria There are small tiny bilateral thyroid lobe nodules, larger on the right measuring 6 mm. Bilateral submandibular glands appear partially atrophic, right greater than left. There are punctate calcifications within bilateral parotid glands. Mucosa of the aerodigestive tract appears unremarkable. No obvious enhancing neck mass is identified There are no aggressive osseous lesions. There are mild degenerative changes, most prominent at C5-6 and C6-7 with disc osteophyte contacts and uncovertebral DJD with moderate left foraminal narrowing at C5-6. Included portions of the brain and skull base appear normal. Chest findings are reported separately.
FINDINGS: VASCULAR WITH ADVANCED 3-D OFF-LINE POSTPROCESSING: Aortic valve morphology is trileaflet, and free from calcifications. Aortic valve measuring during systole = 3.3 x 3.0 cm (30% cardiac cycle), during diastole = 3.1 x 3.0 cm (80% cardiac cycle). There is evidence of mild aortic coarctation with mild narrowing just after the takeoff of the left subclavian artery with minimal luminal diameter 1.3 x 1.3 cm, area 1.3 sq cm. The remainder of the thoracic aorta is normal in caliber. The thoracic aorta is normal in course, caliber, and contour. There is no acute aortic pathology, such as dissection, intramural hematoma, or contained rupture. The arch vessel branching pattern is normal and patent. Representative dimensions of the thoracic aorta are as follows (using central line and double oblique methods): 3.1 x 2.8 x 2.9 cm at the sinuses of Valsalva measured sinus to commisure (the sinotubular junction is preserved) 2.7 x 2.4 cm at the mid ascending aorta 2.0 x 1.8 cm at the transverse arch 2.8 x 2.6 cm at the proximal descending thoracic aorta (beyond the coarctation) 2.7 x 2.5 cm at the mid descending thoracic aorta 2.1 x 2.0 cm at the distal descending thoracic aorta The cardiac chambers demonstrate normal atrioventricular and ventriculoarterial concordance, and systemic and pulmonary venous return. There is evidence of persistent left SVC which drain directly to the coronary sinus to the right atrium. The left brachiocephalic vein is atretic. Cardiac chambers: The cardiac chamber sizes appear normal. No evidence of cardiac mass or thrombus. No pericardial effusion. Normal origin of coronary arteries. Dominant LCx circulation. No coronary artery calcification, although this study is not optimized for coronary assessment. The main pulmonary artery is normal in caliber; MPA = 2.2 cm; RPA = 1.6 cm; LPA = 1.3 cm. Cardiac function: LEFT VENTRICLE: Normal size, wall thickness and systolic function. LV volumetric parameters as follows: EF: 76 % EDV: 98 ml EDV index: 55 ml/m2 ESV: 24 ml ESV index: 13 ml/m2 SV: 74 ml SV index: 41 ml/m2 CI: 6.0 L/min/m2 RIGHT VENTRICLE: Normal size, wall thickness and mildly depressed systolic function. RV volumetric parameters as follows: EF: 44 % EDV: 131 ml EDV index: 73 ml/m2 ESV: 73 ml ESV index: 41ml/m2 SV: 58 ml SV index: 32ml/m2 CI: 2.6 L/min/m2 Lung: There are multiple bilateral hyperlucent and hyperinflated areas in both lungs involving all lung lobes with paucity of the pulmonary arterial vasculature at these areas. Paraseptal emphysema are also noted. No focal consolidation. The trachea and main bronchi are patent. No pleural effusion. Mediastinum: No mediastinal masses. No thoracic lymphadenopathy. Normal appearance of the esophagus. Bones and soft tissues: Severe right scoliotic deformity. No aggressive bone lesion. Chest wall soft tissues are unremarkable. The CT of the abdomen and pelvis will be reported separately.
3,085
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 53-year-old female with lymphoma; follow-up. COMPARISON: Multiple prior CTs of the abdomen pelvis, most recently 12/13/2021 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 184 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: 372 mm. DLP: 881 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis CT chest findings are reported separately. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Normal for technique. SPLEEN: Persistent splenomegaly, currently measuring approximately 20.9 cm in craniocaudal dimension on coronal series 203, image 74 (previously 20.4 cm). ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: Grossly stable size and appearance of multiple enlarged retroperitoneal and iliac chain/inguinal lymph nodes. Reference lymph node near the left renal vein currently measures 1.7 cm in short axis on axial series 202, image 231 (previously 1.6 cm in short axis). Additional reference left external iliac chain lymph node currently measures 1.8 cm in short axis on axial series 202, image 355 (previously 1.9 cm in short axis). STOMACH / SMALL BOWEL: Small hiatal hernia. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Enlargement of the splenic and main portal veins. Normal caliber abdominal aorta. Small esophageal varices are noted. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Persistent splenomegaly and lymphadenopathy as described above, not significantly changed from prior and compatible with known lymphoma. 2. Small esophageal varices with enlarged splenic and main portal veins, suggesting portal hypertension.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis CT chest findings are reported separately. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Normal for technique. SPLEEN: Persistent splenomegaly, currently measuring approximately 20.9 cm in craniocaudal dimension on coronal series 203, image 74 (previously 20.4 cm). ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: Grossly stable size and appearance of multiple enlarged retroperitoneal and iliac chain/inguinal lymph nodes. Reference lymph node near the left renal vein currently measures 1.7 cm in short axis on axial series 202, image 231 (previously 1.6 cm in short axis). Additional reference left external iliac chain lymph node currently measures 1.8 cm in short axis on axial series 202, image 355 (previously 1.9 cm in short axis). STOMACH / SMALL BOWEL: Small hiatal hernia. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Enlargement of the splenic and main portal veins. Normal caliber abdominal aorta. Small esophageal varices are noted. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
FINDINGS: STRUCTURED REPORT: CTA Abdomen VASCULATURE: ABDOMINAL AORTA: No significant abnormality. CELIAC AXIS and SMA: Common origin of the celiac axis and SMA without significant abnormality. RIGHT RENAL: No significant abnormality. LEFT RENAL: No significant abnormality. 2 left renal arteries. IMA: No significant abnormality. RIGHT COMMON ILIAC: No significant abnormality. LEFT COMMON ILIAC: No significant abnormality. ------------------------------------------------------------- The chest portion exam will be reported separately. ABDOMEN: LIVER: Normal in configuration. Area of increased enhancement along the periphery of the left hepatic lobe is likely perfusional. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: Incidental note of a circumaortic left renal vein. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
3,086
EXAM: CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: 49-year-old male with lower extremity pain and numbness. History of ECMO cannulation (1/1/2021). COMPARISON: CT chest 12/29/2021 TECHNIQUE: CT Abdomen and Pelvis wo IV contrast. Scan field of view: 385 mm. DLP: 497 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Unchanged left greater than right fibrotic changes with traction bronchiectasis and honeycombing. Air-trapping in left lower lobe. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Mild cardiac enlargement. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: Likely reactive left external iliac chain node measuring 1.4 cm in short axis (series 3, image 266). STOMACH / SMALL BOWEL: Proximal jejunal loops are seen in the lesser sac area within the stomach and pancreas without dilatation. Otherwise, stomach and small bowel are normal. COLON / APPENDIX: Contrast throughout the colon and rectum. Appendectomy changes. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Left common femoral vein ECMO cannula tip terminates in the intrahepatic IVC caudal to hepatic veins. Left common femoral artery ECMO cannula tip terminates in the proximal left external iliac artery. Small volume hemorrhage in the left inguinal region deep to the access site. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostatomegaly with central calcifications. BODY WALL: Small volume hemorrhage/fluid within the left inguinal region and along the left subcutaneous and intermuscular fat planes. Small fat-containing left inguinal hernia. MUSCULOSKELETAL: No aggressive osseous lesion. Advanced degenerative disc disease at L5-S1. CONCLUSION: 1. Left ECMO cannulation changes with small nonorganized fluid/edema in the left inguinal region and left thigh medially and muscle planes. No drainable collection. 2. Likely reactive left external iliac chain lymphadenopathy. 3. Unchanged sequela of bilateral interstitial lung disease. 4. Few proximal jejunal loops in the lesser sac region without dilatation, concerning for nonobstructing nonspecific internal hernia. 5. Additional incidental findings above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Unchanged left greater than right fibrotic changes with traction bronchiectasis and honeycombing. Air-trapping in left lower lobe. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Mild cardiac enlargement. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: Likely reactive left external iliac chain node measuring 1.4 cm in short axis (series 3, image 266). STOMACH / SMALL BOWEL: Proximal jejunal loops are seen in the lesser sac area within the stomach and pancreas without dilatation. Otherwise, stomach and small bowel are normal. COLON / APPENDIX: Contrast throughout the colon and rectum. Appendectomy changes. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Left common femoral vein ECMO cannula tip terminates in the intrahepatic IVC caudal to hepatic veins. Left common femoral artery ECMO cannula tip terminates in the proximal left external iliac artery. Small volume hemorrhage in the left inguinal region deep to the access site. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostatomegaly with central calcifications. BODY WALL: Small volume hemorrhage/fluid within the left inguinal region and along the left subcutaneous and intermuscular fat planes. Small fat-containing left inguinal hernia. MUSCULOSKELETAL: No aggressive osseous lesion. Advanced degenerative disc disease at L5-S1.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis Chest findings to be dictated separately. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: There is unchanged moderate left hydroureteronephrosis. New mild right hydroureteronephrosis is also noted. There is mild hypoenhancement of the left renal parenchyma compared to right. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerotic disease of the abdominal aorta which is normal in caliber. URINARY BLADDER: Significantly distended with fluid. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous lesions.
3,087
CT Chest with contrast Clinical Information: 53-year-old female Evaluate lymphoma, C85.90 Non-Hodgkin lymphoma, unspecified, unspecified site Comparison: No previous chest CT for comparison Technique: Following injection of non-ionic contrast 3 mm images were obtained through the chest. Abdominal findings will be reported separately. Patient weight: 184 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: 372 mm. Findings: Tiny right thyroid nodule is seen. Enlarged mediastinal and right hilar nodes are seen for example lower right paratracheal node is 11 x 20 mm on series 202 image 72 and right hilar node is 13 x 17 mm on image 110. Borderline enlarged bilateral axillary lymph nodes are seen measuring just under 10 mm in short axis. Additional bilateral borderline enlarged subpectoral lymph nodes are noted. Tiny right internal mammary node is seen. Small hiatal hernia is present. There are esophageal varices in the mid to distal esophagus. The heart size and mediastinum are otherwise normal. No pleural effusion. Bilateral pulmonary nodules are again seen with overall decrease in tiny nodules and interstitial prominence compared to the previous abdomen CT on 12/13/2021 . More focal discrete nodules are redemonstrated some of which have decreased in size such as in the medial RLL on image 159 other nodules or new such as in the RLL on image 125 and in the LLL on image 146.. No focal destructive osseous lesions identified. CT abdomen pelvis will be reported separately Impression: 1. Enlarged mediastinal and right hilar nodes are present with borderline enlarged bilateral axillary and subpectoral lymph nodes consistent with the history of lymphoma. 2. Bilateral pulmonary nodules are again seen some of which have decreased in size and a few of which are new. The underlying tiny interstitial nodularity has almost completely resolved. 3. Esophageal varices.
Findings: Tiny right thyroid nodule is seen. Enlarged mediastinal and right hilar nodes are seen for example lower right paratracheal node is 11 x 20 mm on series 202 image 72 and right hilar node is 13 x 17 mm on image 110. Borderline enlarged bilateral axillary lymph nodes are seen measuring just under 10 mm in short axis. Additional bilateral borderline enlarged subpectoral lymph nodes are noted. Tiny right internal mammary node is seen. Small hiatal hernia is present. There are esophageal varices in the mid to distal esophagus. The heart size and mediastinum are otherwise normal. No pleural effusion. Bilateral pulmonary nodules are again seen with overall decrease in tiny nodules and interstitial prominence compared to the previous abdomen CT on 12/13/2021 . More focal discrete nodules are redemonstrated some of which have decreased in size such as in the medial RLL on image 159 other nodules or new such as in the RLL on image 125 and in the LLL on image 146.. No focal destructive osseous lesions identified. CT abdomen pelvis will be reported separately
FINDINGS: The right hilar mass has decreased in size and bulk now measuring 18 x 14 mm. This is difficult to measure on prior examinations due to adjacent consolidation. The right upper lobe bronchus and bronchus intermedius are now patent. There is some residual soft tissue thickening along the proximal upper lobe bronchi and also along the bronchus intermedius and proximal right lower lobe and middle lobe bronchi. There is severe narrowing of the proximal middle lobe bronchus. The extensive postobstructive consolidation throughout the right lung has resolved. There is mild upper lobe predominant emphysema with chronic bronchial wall thickening bilaterally. No new or enlarging lung nodules. No pleural effusion or pleural thickening. The supraclavicular region is unremarkable. Central airways are patent. The thoracic aorta is nonaneurysmal. The heart is not enlarged. Moderate coronary calcifications. No pericardial effusion. No new or enlarging supraclavicular, mediastinal or hilar lymph nodes. There is some thickening of the midesophagus. Small hiatal hernia. The CT of the abdomen and pelvis will be dictated separately. No acute or aggressive osseous abnormality.
3,088
CT Head wo contrast 1/7/2022 10:12 AM Clinical Information: fu midline shift Comparison: CT head 1/5/2022. Technique: Unenhanced axial brain CT. Bone and soft tissue windows were reviewed. Sagittal and coronal images were generated from the axial data. Scan field of view: 216 mm. DLP: 1311.30 mGy cm. Findings: Redemonstration of large right MCA territory infarction with hemorrhagic transformation with stable appearance of multifocal hemorrhagic component. The index high attenuation hemorrhage component measures approximately 3.7 x 2.7 cm (image 28, series 201), stable from prior study. Interval increased perifocal edema in the right cerebral hemisphere with increased right to left subfalcine herniation and a current midline shift of 13 mm measured at the level of foramen of Munro (previously remeasured at the same level was 9 mm). There is increasing mass effect on the right lateral ventricle. There is asymmetric enlargement of the left lateral ventricle which may suggest early entrapment. The third ventricle is slitlike and is deviated to the left. Fourth ventricle appears patent. Left cerebral hemisphere and posterior fossa structures are unremarkable. Basal cisterns appear patent. Visualized bilateral orbits are unremarkable. Redemonstration of air-fluid level in the right sphenoid sinus. Oroesophageal tube in place. Bilateral mastoid effusions. Mild mucosal thickening in the right maxillary sinus. Otherwise visualized paranasal sinuses are unremarkable. No acute osseous abnormalities. Conclusion: 1. Interval increase in cerebral edema in relation to large right MCA territory infarct with hemorrhagic conversion. Interval increase in right-to-left midline shift of approximately 13 mm on the current study (previously measured 9 mm at the same level). 2. Mild asymmetric enlargement of left lateral ventricle, may suggest early entrapment. 3. Other stable findings as above.
Findings: Redemonstration of large right MCA territory infarction with hemorrhagic transformation with stable appearance of multifocal hemorrhagic component. The index high attenuation hemorrhage component measures approximately 3.7 x 2.7 cm (image 28, series 201), stable from prior study. Interval increased perifocal edema in the right cerebral hemisphere with increased right to left subfalcine herniation and a current midline shift of 13 mm measured at the level of foramen of Munro (previously remeasured at the same level was 9 mm). There is increasing mass effect on the right lateral ventricle. There is asymmetric enlargement of the left lateral ventricle which may suggest early entrapment. The third ventricle is slitlike and is deviated to the left. Fourth ventricle appears patent. Left cerebral hemisphere and posterior fossa structures are unremarkable. Basal cisterns appear patent. Visualized bilateral orbits are unremarkable. Redemonstration of air-fluid level in the right sphenoid sinus. Oroesophageal tube in place. Bilateral mastoid effusions. Mild mucosal thickening in the right maxillary sinus. Otherwise visualized paranasal sinuses are unremarkable. No acute osseous abnormalities.
Findings: Lines and Tubes: None. Body Wall and Abdomen: No destructive osseous lesions. A few vertebral body endplate fractures have a similar appearance. Included portions of the upper abdomen have an unremarkable appearance Lymph Nodes, Mediastinum and Neck: No axillary or mediastinal adenopathy. Lungs and Pleura: No pleural effusion. There is been a further decrease in density in the subpleural regions of consolidation. Subpleural groundglass opacity and subpleural curvilinear bands are now present. Cardiovascular: Relatively low density blood pool. No pericardial effusion, dense coronary artery atherosclerotic calcifications.
3,089
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 31-year-old female with concern for bile leak/abscess development COMPARISON: CT abdomen pelvis 1/3/2022 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 169 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Oral contrast Omnipaque: 16.9 oz. Saline flush: 62.90 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 78 sec Scan field of view: 376 mm. DLP: 677 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Bibasilar subsegmental atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Common bile duct stent in place. GALLBLADDER: Surgically absent. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Left renal cyst. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Redemonstration of marked circumferential colonic wall thickening extending from the cecum to the rectum. PERITONEUM / MESENTERY: Interval placement of a coiled pigtail drainage catheter in the right lower abdomen with interval decrease in volume of the free fluid seen on the prior study. Persistent small volume of free fluid tracks along the right colonic mesentery. Persistent organized fluid collection the lower pelvis with thin enhancing walls measures 8.3 x 3.7 cm on axial series 2, image 251. This collection is located just posterior to the uterus. Interval organization of a now peripherally enhancing collection near the gallbladder fossa which is multiloculated. Although difficult to measure, this region measures approximately 6.9 x 4.9 cm on axial series 2, image 87. Additional peritoneal drainage catheter remains in place near the hepatic dome. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Redemonstration of a small amount of air tracking along the right lateral abdominal wall superficial fascia. Peritoneal drainage catheter enters the right anterolateral abdominal wall. Additional drainage catheter seen in the right anterior lower abdominal wall. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Organized peripherally enhancing collection in the lower pelvis as described above, concerning for an abscess. 2. Interval organization of the fluid collection near the gallbladder fossa with enhancing walls. Given the location, this could reflect either an evolving biloma or abscess. Recommend clinical correlation. 3. Interval placement of a coiled pigtail drainage catheter in the right lower abdomen with interval decrease in amount of free fluid present in the abdomen. 4. Marked diffuse colonic wall thickening, suggestive of pancolitis. Although of uncertain etiology, recommend clinical correlation for infectious etiology such as pseudomembranous colitis.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Bibasilar subsegmental atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Common bile duct stent in place. GALLBLADDER: Surgically absent. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Left renal cyst. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Redemonstration of marked circumferential colonic wall thickening extending from the cecum to the rectum. PERITONEUM / MESENTERY: Interval placement of a coiled pigtail drainage catheter in the right lower abdomen with interval decrease in volume of the free fluid seen on the prior study. Persistent small volume of free fluid tracks along the right colonic mesentery. Persistent organized fluid collection the lower pelvis with thin enhancing walls measures 8.3 x 3.7 cm on axial series 2, image 251. This collection is located just posterior to the uterus. Interval organization of a now peripherally enhancing collection near the gallbladder fossa which is multiloculated. Although difficult to measure, this region measures approximately 6.9 x 4.9 cm on axial series 2, image 87. Additional peritoneal drainage catheter remains in place near the hepatic dome. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Redemonstration of a small amount of air tracking along the right lateral abdominal wall superficial fascia. Peritoneal drainage catheter enters the right anterolateral abdominal wall. Additional drainage catheter seen in the right anterior lower abdominal wall. MUSCULOSKELETAL: No significant abnormality.
Findings: Lines and Tubes: Right-sided port tip terminates at the cavoatrial junction, as on the previous. Body Wall and Abdomen: No destructive osseous lesions. Included portions of the upper abdomen have an unremarkable appearance post cholecystectomy. Lymph Nodes, Mediastinum and Neck: No axillary or mediastinal adenopathy. Lungs and Pleura: No pleural effusion. Tiny right upper lobe nodule image 28 series 2 is unchanged at least as far back as 4/7/2021. No suspicious appearing noncalcified or calcified pulmonary nodules. Cardiovascular: Mild coronary artery atherosclerotic calcifications. Heart size is normal. No pericardial effusion.
3,090
CT Orbit or Temporal Bones wo contrast 1/7/2022 9:25 AM Clinical Information: otitis media, mastoid tenderness, H66.92 Otitis media, unspecified, left ear, H92.09 Otalgia, unspecified ear Comparison: None. Technique: Axial helical CT images were obtained through the temporal bones. Coronal images were reconstructed from the axial data set. Scan field of view: 217 mm. DLP: 838 mGy cm. Findings: RIGHT EAR: The external auditory canal is clear. Tympanic membrane is not thickened. Middle ear cavity is clear. Ossicular chain and oval window are normal. Scutum and tegmen tympani are intact. The facial nerve canal is normal. The otic capsule, including the cochlea, vestibule, and semicircular canals, is normal. Round window is patent. Vestibular aqueduct is not enlarged. Internal auditory canal is normal. The mastoid air cells are clear. The superior semicircular canal is not dehiscent. LEFT EAR: The external auditory canal is clear. Tympanic membrane is not thickened. Mucoid density material surrounding the ureter ossicles and at the round window niche. Opacification of mastoid air cells, mastoid antrum and aditus ad antrum. No evidence for osseous erosion at the otomastoid. No adjacent abnormal fluid collection. Evaluation for intracranial abscess is limited secondary to lack of intravenous contrast. Otherwise ossicular chain and oval window are normal. Scutum and tegmen tympani are intact. The facial nerve canal is normal. The otic capsule, including the cochlea, vestibule, and semicircular canals, is normal. Round window is patent. Vestibular aqueduct is not enlarged. Internal auditory canal is normal. The superior semicircular canal is not dehiscent. Additional findings: Mucosal thickening in bilateral maxillary sinuses. Otherwise visualized paranasal sinuses are unremarkable. Visualized part of the brain and orbits are unremarkable. IMPRESSION: 1. Acute left otomastoiditis. No other additional significant findings.
Findings: RIGHT EAR: The external auditory canal is clear. Tympanic membrane is not thickened. Middle ear cavity is clear. Ossicular chain and oval window are normal. Scutum and tegmen tympani are intact. The facial nerve canal is normal. The otic capsule, including the cochlea, vestibule, and semicircular canals, is normal. Round window is patent. Vestibular aqueduct is not enlarged. Internal auditory canal is normal. The mastoid air cells are clear. The superior semicircular canal is not dehiscent. LEFT EAR: The external auditory canal is clear. Tympanic membrane is not thickened. Mucoid density material surrounding the ureter ossicles and at the round window niche. Opacification of mastoid air cells, mastoid antrum and aditus ad antrum. No evidence for osseous erosion at the otomastoid. No adjacent abnormal fluid collection. Evaluation for intracranial abscess is limited secondary to lack of intravenous contrast. Otherwise ossicular chain and oval window are normal. Scutum and tegmen tympani are intact. The facial nerve canal is normal. The otic capsule, including the cochlea, vestibule, and semicircular canals, is normal. Round window is patent. Vestibular aqueduct is not enlarged. Internal auditory canal is normal. The superior semicircular canal is not dehiscent. Additional findings: Mucosal thickening in bilateral maxillary sinuses. Otherwise visualized paranasal sinuses are unremarkable. Visualized part of the brain and orbits are unremarkable.
FINDINGS: STRUCTURED REPORT: CT Abdomen LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Stable small hypoattenuating focus in segment VII \T\ III lesions (series 9, image 60\T\ 89). BILIARY TRACT: Mild intrahepatic ductal dilatation. GALLBLADDER: Surgically absent. PANCREAS: Previously noted in pancreatic cys is not well visualized. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Right renal angiomyolipoma measures 3.4 x 2.8 cm (series 9, image 150) previously 3.5 x 2.7 cm. Right extrarenal pelvis with severe dilatation and mild prominent calyces, unchanged. Mild hydronephrosis on the left side is also unchanged. No stone identified. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerosis of the normal caliber infrarenal aorta and common iliac arteries. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Mild degenerative changes of the lumbar spine. No suspicious osseous lesion.
3,091
EXAM: CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: Bladder cancer. COMPARISON: 10/1/2021 TECHNIQUE: CT Abdomen and Pelvis wo IV contrast. Scan field of view: 420 mm. Oral contrast Omnipaque: 16 oz. DLP: 280.36 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: Gallstones. PANCREAS: Normal for technique. SPLEEN: Normal for technique. ADRENALS: Normal. KIDNEYS: Similar noncontrast appearance of the kidneys with asymmetric right renal atrophy. LYMPH NODES: Unchanged appearance of the borderline enlarged retroperitoneal lymph node. No new adenopathy is identified in the abdomen or pelvis. STOMACH / SMALL BOWEL: Postsurgical changes from ileal conduit formation. No high-grade obstruction. Herniation of a portion of the small bowel into the parastomal hernia with fecalization in this bowel loop. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerosis without aneurysm. URINARY BLADDER: Absent. No suspicious soft tissue in the cystectomy bed. REPRODUCTIVE ORGANS: Absent. No suspicious soft tissue in the prostatectomy bed BODY WALL: Increasing parastomal hernia as described above. Otherwise unremarkable. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Unchanged appearance of the retroperitoneal adenopathy. No new evidence of metastatic disease in the abdomen or pelvis within constraints of noncontrast technique. 2. Increasing parastomal hernia now contains a loop of small bowel. There is some degree of fecalization within this loop, suggesting some degree of partial obstruction. Correlate with patient's symptoms.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: Gallstones. PANCREAS: Normal for technique. SPLEEN: Normal for technique. ADRENALS: Normal. KIDNEYS: Similar noncontrast appearance of the kidneys with asymmetric right renal atrophy. LYMPH NODES: Unchanged appearance of the borderline enlarged retroperitoneal lymph node. No new adenopathy is identified in the abdomen or pelvis. STOMACH / SMALL BOWEL: Postsurgical changes from ileal conduit formation. No high-grade obstruction. Herniation of a portion of the small bowel into the parastomal hernia with fecalization in this bowel loop. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerosis without aneurysm. URINARY BLADDER: Absent. No suspicious soft tissue in the cystectomy bed. REPRODUCTIVE ORGANS: Absent. No suspicious soft tissue in the prostatectomy bed BODY WALL: Increasing parastomal hernia as described above. Otherwise unremarkable. MUSCULOSKELETAL: No significant abnormality.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Bilateral lower lobe subsegmental atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Right interpolar cyst. No hydronephrosis or nephrolithiasis. No ureteral calculi. Small vascular calcification at the left renal hilum. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Moderate amount of fecal material throughout the colon including formed stool extending to the proximal colon, suggesting delayed transit. Normal appendix. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Minimal atherosclerotic calcifications of the abdominal aorta and branch vessels. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostate gland is enlarged. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: Lower lumbar spine degenerative changes.
3,092
EXAM: CT Chest wo contrast CLINICAL INFORMATION: 63-year-old male follow-up bladder cancer COMPARISON: October 1, 2021 TECHNIQUE: CT Chest wo contrast. Scan field of view: 410 mm. DLP: 319.95 mGy cm. FINDINGS: Index lesions are measured in series 2. Ill-defined noncalcified right upper lobe nodule in image 41 is stable at 12 x 11 mm. Left upper lobe nodule in image 50 is approximately 5 x 5 mm, decreased from previous size of 11 x 11 mm. The elliptical right middle lobe density in image 107 is less prominent. Persistent bilateral apical parenchymal scarring without new nodule or mass or airspace consolidation. Subcentimeter size nodes in the mediastinum and both axilla are unchanged. There is atherosclerotic calcification of the coronary arteries. Right IJ Mediport catheter tip is in the cavoatrial junction. There is no pleural or pericardial effusion and visualized bones are unremarkable. CONCLUSION: The right upper lobe nodule is stable while the left upper lobe subpleural nodule is much smaller without new intrathoracic disease.
FINDINGS: Index lesions are measured in series 2. Ill-defined noncalcified right upper lobe nodule in image 41 is stable at 12 x 11 mm. Left upper lobe nodule in image 50 is approximately 5 x 5 mm, decreased from previous size of 11 x 11 mm. The elliptical right middle lobe density in image 107 is less prominent. Persistent bilateral apical parenchymal scarring without new nodule or mass or airspace consolidation. Subcentimeter size nodes in the mediastinum and both axilla are unchanged. There is atherosclerotic calcification of the coronary arteries. Right IJ Mediport catheter tip is in the cavoatrial junction. There is no pleural or pericardial effusion and visualized bones are unremarkable.
FINDINGS: Coronary arteries: Coronary anatomy: There is normal origin of the coronary arteries. Left Main Coronary Artery: The left main is normal sized vessel that bifurcates into the LAD and circumflex. There is tiny linear flap extending along the left main to the proximal LAD and proximal LCx. Left Anterior Descending Coronary Artery: There is severe narrowing of the proximal LAD with likely segment of dissection measures 11 mm the remainder of the LAD shows good contrast opacification to the distal LAD. It gives rise to 2 acute diagonal branches. Left Circumflex Coronary Artery: The LCX is a normal size vessel, which is non-dominant. There is suspected proximal LCx extension of dissection flap with approximately 4 mm segment with mild stenosis. The remainder of the LCx is normal size location. It gives rise to 1 large obtuse marginal branch. There is no significant atherosclerotic change or stenotic disease. Right Coronary Artery: The RCA is dominant. The proximal 10 mm of the RCA is patent, however after giving conus branch is there is nonopacification of contrast within the proximal, mid and distal RCA, suspecting dissection. At the distal RCA it bifurcates into the PDA and posterolateral branches which appears patent with contrast opacification. It gives rise to a AV nodal branch, and 2 acute marginal branches within the level of the dissection. No evidence of atherosclerotic calcification of the coronary arteries. Heart and great vessels: The cardiac chamber sizes appear normal. The aortic valve is trileaflet, and free from calcifications. The visualized thoracic aorta is normal in course, caliber, and contour. There is no acute aortic pathology, such as dissection, intramural hematoma, or contained rupture. The aortic arch is not included on this examination. The main pulmonary artery is normal in caliber. Lungs and extracardiac structures: The scanned Lung and pleura: Unremarkable. The scanned Mediastinum and lymph nodes: Unremarkable. The scanned Bones and chest wall: Unremarkable. The scanned Upper abdomen: Unremarkable.
3,093
CT Angio Head wo+w contrast 1/7/2022 10:07 AM Clinical Information: Cerebral aneurysm, follow-up, I67.1 Cerebral aneurysm, nonruptured Comparison: None. Technique: 5 mm axial images were obtained without contrast from the base of the skull to the vertex. During the IV infusion of contrast, 1 mm images were obtained from the base of skull through the vertex. Delayed contrast enhanced 5 mm axial images were then performed from the base of the skull to the vertex. 3-D CT angiographic images were generated from the axial data set. "Sliding MIP" images were also generated in the sagittal, axial, and coronal planes. Patient weight: 190 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: Bolus Tracked. Scan field of view: 200 mm. DLP: 2896 mGy cm. Findings: Head CT: Right pterional craniotomy, three aneurysm clips in the left MCA bifurcation, left supraclinoid ICA and A-comm regions, and ACA A2 segment aneurysm coiling are noted. The right supraclinoid region shows a hypointensity saccular lesion with calcified margin measuring 1.2 x 1.0 cm axially and 1.1 cm craniocaudally. Head CTA: Evaluation of the left MCA is limited due to aneurysm clip induced beam hardening artifacts. No obvious contrast filled outpouching is visualized around the treated aneurysms. The right supraclinoid saccular region shows no internal contrast filling. There are anatomical variations including severe hypoplasia of the right vertebral artery and proximal basilar artery, and ICA-basilar anastomosis through the persistent trigeminal artery. Impression: 1. Three aneurysm clips in the left MCA bifurcation, left supraclinoid ICA and A-comm regions, and ACA A2 segment aneurysm coiling. 2. Likely thrombosed aneurysm in the right supraclinoid region measuring 1.2 x 1.0 x 1.1 cm. 3. No evidence of recurrent aneurysm. 4. Severe vertebrobasilar hypoplasia with ICA-basilar anastomosis through persistent trigeminal artery.
Findings: Head CT: Right pterional craniotomy, three aneurysm clips in the left MCA bifurcation, left supraclinoid ICA and A-comm regions, and ACA A2 segment aneurysm coiling are noted. The right supraclinoid region shows a hypointensity saccular lesion with calcified margin measuring 1.2 x 1.0 cm axially and 1.1 cm craniocaudally. Head CTA: Evaluation of the left MCA is limited due to aneurysm clip induced beam hardening artifacts. No obvious contrast filled outpouching is visualized around the treated aneurysms. The right supraclinoid saccular region shows no internal contrast filling. There are anatomical variations including severe hypoplasia of the right vertebral artery and proximal basilar artery, and ICA-basilar anastomosis through the persistent trigeminal artery.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Stable asymmetric enlargement of the left lobe of the thyroid gland although evaluation is limited given lack of contrast and streak artifact from adjacent pacing device. CHEST: LUNGS / AIRWAYS / PLEURA: Small likely multiloculated right pleural effusion. Associated multifocal subsegmental atelectasis throughout the right lung. Groundglass opacities in the right lung base are similar to prior and likely related atelectasis. Multiple tiny pulmonary nodules within the left lung appear unchanged measuring up to a maximum of 5 mm. Left lung is otherwise clear. HEART / VESSELS: Grossly stable, moderate cardiomegaly. Aortic valve prosthesis unchanged. Stable ectasia of the ascending aorta to 4.1 cm. Main pulmonary artery is dilated at 3.7 cm. Pacing leads project in stable positions. Scattered mild coronary artery calcification. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. LYMPH NODES: Multiple enlarged mediastinal nodes the largest of which are in the prevascular space measuring 1.3 cm short axis and in the subcarinal space measuring 1.5 cm in short axis. CHEST WALL: Postsurgical changes within the right lateral chest wall with adjacent surgical clips and ill-defined fluid collection measuring 2.5 x 3.6 cm which overlies a chronic likely postsurgical defect of the right lateral fifth rib. Median sternotomy wires are unremarkable. UPPER ABDOMEN: Postsurgical changes from gastric bypass. Hypoattenuating splenic lesion measuring up to 4 cm which has appearance of cyst although incompletely evaluated on this unenhanced exam. Visualized upper abdomen is otherwise unremarkable. MUSCULOSKELETAL: Numerous chronic healed right rib fractures. No acute or destructive osseous lesion seen.
3,094
CT Maxillofacial wo contrast Clinical Information: Nasal fracture suspected, S02.2XXA Fracture of nasal bones, initial encounter for closed fracture Comparison: Maxillofacial head CT dated 7/5/2014. Technique: Axial helical CT images were obtained through the maxillofacial region. 2-D coronal reconstructions were generated from the axial data. Scan field of view: 210 mm. DLP: 867.95 mGy cm. Findings: There is nondisplaced linear fracture involving the left nasal bone and nasal process of maxilla. No nasal deformity, or septal fracture/hematoma is noted. Previous fracture/detachment of the nasal spine remains ununited. The orbits, maxillary sinus walls, mandible and dentition are intact. Incidentally noted is a torus palatinus. Impression: 1. Nondisplaced linear fracture involving the left nasal bone and nasal process of maxilla. 2. Chronic nasal spine fracture.
Findings: There is nondisplaced linear fracture involving the left nasal bone and nasal process of maxilla. No nasal deformity, or septal fracture/hematoma is noted. Previous fracture/detachment of the nasal spine remains ununited. The orbits, maxillary sinus walls, mandible and dentition are intact. Incidentally noted is a torus palatinus.
FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Focal cystic changes and pleural parenchymal scarring in the right upper lobe is stable. Stable small, less than 5 mm, right lower lobe pulmonary nodule on series 2 image 66. No focal consolidation, pleural effusion, or pneumothorax. HEART / VESSELS: Heart size is normal. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: No significant adenopathy. LYMPH NODES: There are multiple mildly enlarged right axillary lymph nodes measuring up to 1.4 cm in short axis diameter on series 2 image 41, increased from prior examination. Otherwise, no significantly enlarged lymph nodes are present in the chest. CHEST WALL: Right axillary adenopathy, as above. Similar appearance of diffuse skin thickening and dense septations calcifications involving the anterior chest wall. UPPER ABDOMEN: Please see same day CT abdomen for abdomen findings. MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality.
3,095
EXAM: CT Rsh Chest wo+w contrast METRIC CLINICAL INFORMATION: 65-year-old male with history of renal cancer COMPARISON: Contrast chest CT dated October 8, 2021 TECHNIQUE: CT Rsh Chest wo+w contrast METRIC. Patient weight: 165 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: 397 mm. DLP: 1079.69 mGy cm. FINDINGS: Subcentimeter size nodes in the mediastinum in the paratracheal, subcarinal and hilar region are unchanged. Tiny left lower lobe nodule persist in image 108, series 9, no new nodule or mass is seen.. Mild increased peribronchial thickening. There is no pleural or pericardial effusion and no focal lytic or sclerotic bone lesion is seen. CONCLUSION: Stable chest CT with persistent indeterminate left lower lobe nodule without new intrathoracic abnormality 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.
FINDINGS: Subcentimeter size nodes in the mediastinum in the paratracheal, subcarinal and hilar region are unchanged. Tiny left lower lobe nodule persist in image 108, series 9, no new nodule or mass is seen.. Mild increased peribronchial thickening. There is no pleural or pericardial effusion and no focal lytic or sclerotic bone lesion is seen.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis The chest portion of the exam will be reported separately. ABDOMEN and PELVIS: LIVER: Normal in configuration without focal lesion. Focal decreased attenuation adjacent to the fissure for the falciform ligament likely represents focal fat. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Stable rounded hypoattenuating splenic lesion. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: There are shotty periportal, inguinal, iliac chain lymph nodes, not significantly changed. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Extensive subcutaneous calcifications are noted throughout the abdomen and pelvis with associated skin thickening and subcutaneous stranding, not significantly changed. The previously described thickening along the base of the penis is excluded from view. MUSCULOSKELETAL: No significant abnormality.
3,096
EXAM: CT Rsh Body wo+w contrast METRIC CLINICAL INFORMATION: 65-year-old male with RCC, baseline study. COMPARISON: CT abdomen and pelvis 10/8/2021 TECHNIQUE: CT Rsh Body wo+w contrast METRIC. Patient weight: 165 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3 ml per sec. Scan delay: Bolus Tracked. Scan field of view: 397 mm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately dictated same-day CT chest. ABDOMEN and PELVIS: LIVER: New hyperenhancing lesion within the posterior right hepatic lobe measuring 1.4 x 1.2 cm (series 4 image 67), not seen on the portal venous phase. BILIARY TRACT: Normal. GALLBLADDER: Probable cholelithiasis. PANCREAS: Normal. SPLEEN: Splenomegaly. ADRENALS: The right adrenal is surgically absent. Unchanged thickening of the left adrenal gland. KIDNEYS: Postsurgical changes from a right nephrectomy. No evidence of nodularity within the surgical bed; however, evaluation is somewhat limited due to streak artifact from adjacent surgical clips. Similar appearance of the large left lower pole simple cyst measuring 6.2 x 6.3 cm (series 4 image 155). Subcentimeter hypodensity is statistically a cyst but formally indeterminate. LYMPH NODES: Similar appearance of the enlarged mesenteric nodes. STOMACH / SMALL BOWEL: Small hiatal hernia. COLON / APPENDIX: No abnormality. The appendix is normal. PERITONEUM / MESENTERY: There is mild haziness of the mesentery which appears similar to prior. There is a right midabdomen heterogeneously enhancing pericolonic lesion adjacent to the transverse colon measuring 3.9 x 3.2 cm (series 4 image 155), previously 1.5 x 1.3 cm (series 3 image 146). Invasion into the colonic wall is suspected. No new enhancing lesion is identified. No ascites RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic calcifications of the abdominal aorta which is normal in caliber. Circumaortic left renal vein. URINARY BLADDER: Small and thick-walled. REPRODUCTIVE ORGANS: Prostatomegaly. Bilateral hydroceles. BODY WALL: Bilateral fat-containing inguinal hernias. Small fat-containing umbilical hernia MUSCULOSKELETAL: Sclerotic lesion within the L3 vertebral body is likely a bone island. No aggressive osseous lesions. CONCLUSION: 1. Large right midabdomen heterogeneously enhancing pericolonic mesenteric lesion as described above is likely invading the colonic wall. 2. Interval development of a hyperenhancing lesion within the right hepatic lobe, concerning for metastasis. 3. Interval enlargement of the mesenteric lymph nodes with adjacent hazy mesentery. 4. Additional chronic and incidental findings as described above. 5. Please see separately dictated same-day CT chest. 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. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately dictated same-day CT chest. ABDOMEN and PELVIS: LIVER: New hyperenhancing lesion within the posterior right hepatic lobe measuring 1.4 x 1.2 cm (series 4 image 67), not seen on the portal venous phase. BILIARY TRACT: Normal. GALLBLADDER: Probable cholelithiasis. PANCREAS: Normal. SPLEEN: Splenomegaly. ADRENALS: The right adrenal is surgically absent. Unchanged thickening of the left adrenal gland. KIDNEYS: Postsurgical changes from a right nephrectomy. No evidence of nodularity within the surgical bed; however, evaluation is somewhat limited due to streak artifact from adjacent surgical clips. Similar appearance of the large left lower pole simple cyst measuring 6.2 x 6.3 cm (series 4 image 155). Subcentimeter hypodensity is statistically a cyst but formally indeterminate. LYMPH NODES: Similar appearance of the enlarged mesenteric nodes. STOMACH / SMALL BOWEL: Small hiatal hernia. COLON / APPENDIX: No abnormality. The appendix is normal. PERITONEUM / MESENTERY: There is mild haziness of the mesentery which appears similar to prior. There is a right midabdomen heterogeneously enhancing pericolonic lesion adjacent to the transverse colon measuring 3.9 x 3.2 cm (series 4 image 155), previously 1.5 x 1.3 cm (series 3 image 146). Invasion into the colonic wall is suspected. No new enhancing lesion is identified. No ascites RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic calcifications of the abdominal aorta which is normal in caliber. Circumaortic left renal vein. URINARY BLADDER: Small and thick-walled. REPRODUCTIVE ORGANS: Prostatomegaly. Bilateral hydroceles. BODY WALL: Bilateral fat-containing inguinal hernias. Small fat-containing umbilical hernia MUSCULOSKELETAL: Sclerotic lesion within the L3 vertebral body is likely a bone island. No aggressive osseous lesions.
FINDINGS: STRUCTURED REPORT: CTA Abdomen Pelvis VASCULATURE: DISTAL DESCENDING THORACIC AORTA: Mild to moderate atherosclerotic disease. ABDOMINAL AORTA: Infrarenal abdominal aortic aneurysm is noted status post aortobiiliac endograft stent placement, similar to prior examination. The native aneurysmal sac measures 5.7 x 4.7 cm (series 3, image 164), previously 5.4 x 4.5 cm when remeasured retrospectively. On venous phase imaging there is contrast in the excluded lumen (series 5, image 140, 151, and 164); exact origin is difficult to confirm. CELIAC AXIS: No significant abnormality. SMA: No significant abnormality. RIGHT RENAL: No significant abnormality. LEFT RENAL: No significant abnormality. IMA: Not well opacified proximally but appears patent distally. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: Common iliac stents appears normal. External and internal iliac arteries demonstrate mild atherosclerotic disease without significant stenosis. LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: Common iliac stents appears normal. External and internal iliac arteries demonstrate mild atherosclerotic disease without significant stenosis. ------------------------------------------------------------- LOWER CHEST: LUNG BASES / PLEURA: Mild left lower lobe atelectasis. DISTAL ESOPHAGUS: Tiny hiatal hernia. HEART / VESSELS: Retained metallic device is seen within the right ventricular apex. The heart is normal in size without pericardial effusion. ABDOMEN and PELVIS: LIVER: Scattered hepatic cysts. No suspicious lesions. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. No gallbladder wall thickening or pericholecystic fluid. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Right simple renal cysts. Otherwise, bilateral kidneys are normal without hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Tiny hiatal hernia. The small bowel is normal. COLON / APPENDIX: Diverticulosis without evidence of diverticulitis. Otherwise, the colon is normal. The appendix is not definitively visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is present. No adnexal masses. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
3,097
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Evaluate for occult malignancy. COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 255 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 77 sec Scan field of view: 457 mm. DLP: 1110 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Scattered multivessel coronary artery calcifications. Normal heart size. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: No evidence of malignancy in the abdomen or pelvis.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Scattered multivessel coronary artery calcifications. Normal heart size. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
FINDINGS: STRUCTURED REPORT: CTA Chest VASCULATURE: CORONARY ARTERIES: There are no atherosclerotic calcifications of the native coronary arteries. PULMONARY ARTERIES: No central pulmonary embolus. Normal size. ASCENDING THORACIC AORTA: No significant abnormality. AORTIC ARCH: No significant abnormality. ARCH VESSELS: No significant abnormality. DESCENDING THORACIC AORTA: No significant abnormality. UPPER ABDOMINAL AORTA: No significant abnormality. ------------------------------------------------------------- LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: No focal consolidation, pleural effusion, or pneumothorax. 5 mm nodule in the right middle lobe (image 53, series 2). 7 mm nodule along the right minor fissure likely represents a lymph node. The central airways are patent. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No significant abnormality.
3,098
EXAM: CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: Kidney transplant. Flank pain. COMPARISON: 4/25/2019 TECHNIQUE: CT Abdomen and Pelvis wo IV contrast. Scan field of view: 423.10 mm. DLP: 1059 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: There are focal patchy groundglass opacities seen in the bilateral lower lobes. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: There is significant coronary artery atherosclerotic constipation. Bilateral breast nodularity is again noted, nonspecific. ABDOMEN and PELVIS: LIVER: Unremarkable for technique BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Unremarkable for technique. SPLEEN: Unremarkable for technique ADRENALS: Normal. KIDNEYS: Atrophic native kidneys are noted without hydronephrosis or radiopaque urinary calculus. There is a right lower quadrant renal transplant which is grossly unchanged in appearance without hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is normal. The colon is unremarkable. PERITONEUM / MESENTERY: Trace pelvic free fluid, likely physiologic. RETROPERITONEUM: As above VESSELS: Mild aortoiliac atherosclerosis without aneurysmal dilatation. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Stranding within the right flank is unchanged.The fat-containing umbilical hernia appears to have been repaired without residual hernia. There are few closely adhesed small bowel in this region but no convincing evidence of obstruction MUSCULOSKELETAL: Mild degenerative changes are seen within the spine. Left femoral head osteonecrosis without subchondral collapse is again noted. CONCLUSION: 1. Patchy groundglass opacities in the lower lobes are concerning for pneumonia, specifically this could represent COVID pneumonia. 2. No acute abnormality is identified within the abdomen or pelvis given limitations of noncontrast CT. 3. Bilateral breast nodularity is again noted. Again, mammographic correlation is recommended, as clinically indicated. 4. Stable noncontrast appearance of right lower quadrant renal transplant. 5. Left femoral head osteonecrosis and additional findings above. *****IMPORTANT INCIDENTAL IMAGING FINDINGS REPORTED*****
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: There are focal patchy groundglass opacities seen in the bilateral lower lobes. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: There is significant coronary artery atherosclerotic constipation. Bilateral breast nodularity is again noted, nonspecific. ABDOMEN and PELVIS: LIVER: Unremarkable for technique BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Unremarkable for technique. SPLEEN: Unremarkable for technique ADRENALS: Normal. KIDNEYS: Atrophic native kidneys are noted without hydronephrosis or radiopaque urinary calculus. There is a right lower quadrant renal transplant which is grossly unchanged in appearance without hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is normal. The colon is unremarkable. PERITONEUM / MESENTERY: Trace pelvic free fluid, likely physiologic. RETROPERITONEUM: As above VESSELS: Mild aortoiliac atherosclerosis without aneurysmal dilatation. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Stranding within the right flank is unchanged.The fat-containing umbilical hernia appears to have been repaired without residual hernia. There are few closely adhesed small bowel in this region but no convincing evidence of obstruction MUSCULOSKELETAL: Mild degenerative changes are seen within the spine. Left femoral head osteonecrosis without subchondral collapse is again noted.
FINDINGS: SOFT TISSUES: The masticator, parapharyngeal, retropharyngeal, carotid, sublingual, and submandibular spaces are normal. The anterior superficial soft tissue fascial planes are unremarkable. LYMPH NODES: Scattered prominent but not pathologically enlarged by imaging size criteria. AERODIGESTIVE STRUCTURES: No asymmetric contrast enhancement or asymmetric soft tissue nodularity. Mild hypoattenuating prominence of the distal aspect of the uvula, likely related to adjacent mucosa, best seen on sagittal image, however, subtle submucosal edema would also be considered in the appropriate clinical context.. The remaining pharynx, epiglottis, aryepiglottic folds, and false cords are normal in size and without evidence of edema. PAROTID GLANDS/SUBMANDIBULAR GLANDS: Unremarkable. THYROID GLAND: Unremarkable. VASCULAR STRUCTURES: No evidence of dissection, occlusion, or aneurysm. There is partial retropharyngeal course of the right common carotid and proximal ICA. ORBITS: Unremarkable. PARANASAL SINUSES AND MASTOID AIR CELLS: Mild mucosal thickening in the inferior aspect of the right maxillary sinus. PARTIALLY VISUALIZED INTRACRANIAL STRUCTURES: Unremarkable. LUNG APICES: Please see separately dictated CT chest of the same day for intrathoracic findings. A small right lung nodule is partially visualized. 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 (
3,099
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Vaginal bleeding, recent vaginal delivery COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 159 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: 381 mm. DLP: 454.40 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: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Prior appendectomy. Otherwise normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. No evidence of ovarian vein thrombosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Post gravid uterus with multiple uterine fibroids including a large pedunculated, heterogenous subserosal fibroid extending from the right uterine body and measuring up to 6.1 cm on 169, series 2. Small unorganized fluid stranding within the anterior right lower abdomen/pelvis surrounding the pedunculated degenerating fibroid. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Large subserosal uterine fibroid extending from the right uterine body with surrounding inflammatory change raising suspicion for complicated fibroid degeneration and/or torsion of the pedunculated fibroid. 2. Postgravid uterus with numerous additional uterine fibroids.
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: Prior appendectomy. Otherwise normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. No evidence of ovarian vein thrombosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Post gravid uterus with multiple uterine fibroids including a large pedunculated, heterogenous subserosal fibroid extending from the right uterine body and measuring up to 6.1 cm on 169, series 2. Small unorganized fluid stranding within the anterior right lower abdomen/pelvis surrounding the pedunculated degenerating fibroid. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis Chest findings to be dictated separately. ABDOMEN and PELVIS: LIVER: Diffuse mild hepatic steatosis. No suspicious lesions. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. No wall thickening or pericholecystic fluid. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: New moderate left hydroureteronephrosis is noted with significant left perinephric stranding. There is hyperenhancement of the mid left ureter as well. The right kidney is normal without abnormal parenchymal enhancement or hydronephrosis. LYMPH NODES: Left external iliac node measures 1.5 x 1.3 cm (series 302, image 265), unchanged. Retroperitoneal aortocaval node measures 1.3 x 1.2 cm (series 302, image 172), similar to prior when allowing for differences in technique. Left para-aortic node measures 1.2 x 1.0 cm (series 302, image 147). STOMACH / SMALL BOWEL: Tiny hiatal hernia. The small bowel is normal. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Diffuse left retroperitoneal stranding likely reactive to left collecting system obstruction. VESSELS: There is collapse of the infrarenal IVC which is not well opacified. Evaluation of the distal IVC and bilateral iliac veins is limited by contrast mixing. URINARY BLADDER: There is persistent irregular bladder wall thickening and enhancement along the left posterolateral aspect, similar to prior examination. There is mild new urinary bladder wall thickening as well. REPRODUCTIVE ORGANS: The uterus is surgically absent. Asymmetric prominent soft tissue at the left superior vaginal apex is similar to prior examination. BODY WALL: Mild diffuse anasarca. Tiny fat-containing periumbilical hernia. MUSCULOSKELETAL: Multiple new sclerotic lesions are seen throughout the lumbosacral spine in the L1, L2, and S1 vertebral bodies.